51
|
Zakumumpa H, Bennett S, Ssengooba F. Leveraging the lessons learned from financing HIV programs to advance the universal health coverage (UHC) agenda in the East African Community. Glob Health Res Policy 2019; 4:27. [PMID: 31535036 PMCID: PMC6743123 DOI: 10.1186/s41256-019-0118-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/26/2019] [Indexed: 02/02/2023] Open
Abstract
Background Although there is broad consensus around the need to accelerate progress towards universal health coverage (UHC) in Sub-Saharan Africa, the financing strategies for achieving it are still unclear. We sought to leverage the lessons learned in financing HIV programs over the past two decades to inform efforts to advance the universal health coverage agenda in the East African Community. Methods We conducted a literature review of studies reporting financing mechanisms for HIV programs between 2004 and 2014. This review is further underpinned by evidence from a mixed-methods study entailing a survey of 195 health facilities across Uganda supplemented with 18 semi-structured interviews with HIV service managers. Results Our data shows that there are six broad HIV financing strategies with potential for application to the universal health coverage agenda in the East African Community (EAC); i) Bi-lateral and multi-lateral funding vehicles: The establishment of HIV-specific global financing vehicles such as PEPFAR and The Global Fund heralded an era of unprecedented levels of international funding of up to $ 500 billion over the past two decades ii) Eliciting private sector contribution to HIV funding: The private sector's financial contribution to HIV services was leveraged through innovative engagement and collaborative interventions iii) Private sector-led alternative HIV financing mechanisms: The introduction of 'VIP' HIV clinics, special 'HIV insurance' schemes and the rise of private philanthropic aid were important alternatives to the traditional sources of funding iv) Commodity social marketing: Commodity social marketing campaigns led to an increase in condom use among low-income earners v) The use of vouchers: Issuing of HIV-test vouchers to the poor was an important demand-side financing approach vi) Earmark HIV taxes: Several countries in Africa have introduced 'special HIV' taxes to boost domestic HIV funding. Conclusions The lessons learned from financing HIV programs suggest that a hybrid of funding strategies are advisable in the quest to achieve UHC in EAC partner states. The contribution of the private sector is indispensable and can be enhanced through targeted interventions towards UHC goals.
Collapse
Affiliation(s)
- Henry Zakumumpa
- 1Makerere University, School of Public Health, Kampala, Uganda
| | - Sara Bennett
- 2Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | | |
Collapse
|
52
|
Abstract
Delayed HIV diagnosis and enrollment in HIV care can lead to negative health outcomes for individuals and pose major barriers to achieving the UNAIDS 90-90-90 treatment targets. Household economic strengthening (HES) initiatives are increasingly used to alleviate the direct and indirect costs of HIV testing and linkage to care for those who are diagnosed. The evidence linking HES with a range of HIV outcomes is growing, and this evidence review aimed to comprehensively synthesize the research linking 15 types of HES interventions with a range of HIV prevention and treatment outcomes. The review was conducted between November 2015 and October 2016 and consisted of an academic database search, citation tracking of relevant articles, examination of secondary references, expert consultation, and a gray literature search. Given the volume of evidence, the results are presented and discussed in three papers. This is the second paper in the series and focuses on the 20 studies on HIV testing, diagnosis, and enrollment in care. The results indicate that financial incentives are consistently and independently linked with higher testing uptake and yield among adults. Limited evidence indicates they may also be beneficial for enrollment in care. Evidence for other HES interventions is too sparse to identify clear trends.
Collapse
|
53
|
Chen YN, Coker D, Kramer MR, Johnson BA, Wall KM, Ordóñez CE, McDaniel D, Edwards A, Hare AQ, Sunpath H, Marconi VC. The Impacts of Residential Location on the Risk of HIV Virologic Failure Among ART Users in Durban, South Africa. AIDS Behav 2019; 23:2558-2575. [PMID: 31049812 PMCID: PMC9356386 DOI: 10.1007/s10461-019-02523-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Using a case-control study of patients receiving antiretroviral treatment (ART) in 2010-2012 at McCord Hospital in Durban, South Africa, we sought to understand how residential locations impact patients' risk of virologic failure (VF). Using generalized estimating equations to fit logistic regression models, we estimated the associations of VF with socioeconomic status (SES) and geographic access to care. We then determined whether neighborhood-level poverty modifies the association between individual-level SES and VF. Automobile ownership for men and having non-spouse family members pay medical care for women remained independently associated with increased odds of VF for patients dwelling in moderately and severely poor neighborhoods. Closer geographic proximity to medical care was positively associated with VF among men, while higher neighborhood-level poverty was positively associated with VF among women. The programmatic implications of our findings include developing ART adherence interventions that address the role of gender in both the socioeconomic and geographical contexts.
Collapse
Affiliation(s)
- Yi-No Chen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Daniella Coker
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Kristin M Wall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Claudia E Ordóñez
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Darius McDaniel
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alex Edwards
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anna Q Hare
- Department of Dermatology, Oregon Health and Sciences University, Portland, OR, USA
| | - Henry Sunpath
- Infectious Diseases Unit, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Vincent C Marconi
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
54
|
Ghose T, Shubert V, Poitevien V, Choudhuri S, Gross R. Effectiveness of a Viral Load Suppression Intervention for Highly Vulnerable People Living with HIV. AIDS Behav 2019; 23:2443-2452. [PMID: 31098747 DOI: 10.1007/s10461-019-02509-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We examine the effect of the Undetectables Intervention (UI) on viral loads among socially vulnerable HIV-positive clients. The UI utilized a toolkit that included financial incentives, graphic novels, and community-based case management services. A pre-post repeated measures analysis (n = 502) through 4 years examined longitudinal effects of the intervention. Logistic models regressed social determinants on viral loads. Finally, in-depth qualitative interviews (n = 30) examined how UI shaped adherence. The proportion of virally suppressed time-points increased 15% (from 67 to 82% pre to post-enrollment, p < 0.0001). The proportion of the sample virally suppressed at all time-points increased by 23% (from 39 to 62% pre to post-enrollment, p < 0.0001). African Americans and the homeless were the most likely to be unsuppressed at baseline, but, along with substance users, benefitted the most from UI. The intervention shaped adherence through two pathways, by: (1) establishing worth around adherence, and (2) increasing motivation to become suppressed, and maintain adherence.
Collapse
Affiliation(s)
- Toorjo Ghose
- School of Social Policy and Practice, University of Pennsylvania, D17 Caster Building, 3401 Locust Walk, Philadelphia, PA, 19104, USA.
| | | | | | - Sambuddha Choudhuri
- School of Social Policy and Practice, University of Pennsylvania, D17 Caster Building, 3401 Locust Walk, Philadelphia, PA, 19104, USA
| | - Robert Gross
- School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
55
|
El-Sadr WM, Beauchamp G, Hall HI, Torian LV, Zingman BS, Lum G, Elion RA, Buchacz K, Burns D, Zerbe A, Gamble T, Donnell DJ. Brief Report: Durability of the Effect of Financial Incentives on HIV Viral Load Suppression and Continuity in Care: HPTN 065 Study. J Acquir Immune Defic Syndr 2019; 81:300-303. [PMID: 31194704 PMCID: PMC6587372 DOI: 10.1097/qai.0000000000001927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/13/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Results from the HPTN 065 study showed that financial incentives (FI) were associated with significantly higher viral load suppression and higher levels of engagement in care among patients at HIV care sites randomized to FI versus sites randomized to standard of care (SOC). We assessed HIV viral suppression and continuity in care after intervention withdrawal to determine the durability of FI on these outcomes. SETTING A total of 37 HIV test and 39 HIV care sites in the Bronx, New York, and Washington, DC, participated in the study. METHODS Laboratory data reported to the US National HIV Surveillance System were used to determine site-level viral suppression and continuity in care outcomes. Postintervention effects were assessed for the 3 quarters after discontinuation of FI. Generalized estimation equations were used to compare FI and SOC site-level outcomes after intervention withdrawal. RESULTS After FI withdrawal, a trend remained for an increase in viral suppression by 2.7% (-0.3%, 5.6%, P = 0.076) at FI versus SOC sites, decreasing from the 3.8% increase noted during implementation of the intervention. The significant increase in continuity in care during the FI intervention was sustained after intervention with 7.5% (P = 0.007) higher continuity in care at FI versus SOC sites. CONCLUSIONS After the withdrawal of FI, findings at the 9-months postintervention withdrawal from this large study showed evidence of durable effects of FI on continuity in care, with trend for continued higher viral suppression. These findings are promising for adoption of such interventions to enhance key HIV-related care outcomes.
Collapse
Affiliation(s)
| | - Geetha Beauchamp
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - H Irene Hall
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Lucia V Torian
- New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Barry S Zingman
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Garret Lum
- District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD and TB Administration, Washington, DC
| | - Richard A Elion
- George Washington University, School of Medicine, Washington, DC
| | - Kate Buchacz
- Centers for Disease Control and Prevention, Atlanta, GA
| | - David Burns
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | | | - Theresa Gamble
- HPTN Leadership and Operations Center, FHI 360, Durham, NC
| | - Deborah J Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| |
Collapse
|
56
|
Norton BL, Bachhuber MA, Singh R, Agyemang L, Arnsten JH, Cunningham CO, Litwin AH. Evaluation of contingency management as a strategy to improve HCV linkage to care and treatment in persons attending needle and syringe programs: A pilot study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 69:1-7. [PMID: 31003171 PMCID: PMC6704472 DOI: 10.1016/j.drugpo.2019.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND A greater proportion of HCV-infected people who inject drugs (PWID) need to be linked to care for HCV antiviral treatment. This study sets out to evaluate the efficacy of contingency management (CM) for improving HCV linkage to care, treatment initiation, adherence, and cure for PWID recruited from a needle and syringe program. METHODS Between March 2015 and April 2016, 20 participants were enrolled into the CM arm, and then subsequently enrolled 20 participants in the enhanced standard of care (eSOC) arm. Participants in the eSOC arm received an expedited appointment and a round-trip transit card. Participants enrolled in the CM arm received eSOC plus $25 for up to ten HCV clinical visits and $10 for each returned weekly medication blister pack. Adherence was measured via electronic blister packs. RESULTS Overall the median age was 47 years; most were men (67%) and Hispanic (69%). There were no significant differences in demographic characteristics between participants in the study arms. In the CM arm 74% were linked to HCV care, compared to 30% in the eSOC arm (p = 0.01). In the CM arm, 75% (9/12) of treatment eligible participants initiated treatment, compared to 100%(4/4) in the eSOC arm (p = 0.53). All patients (9/9) achieved cure in the CM arm, as compared to 75% (3/4) of patients in the eSOC arm. There were no differences in adherence between study arms. CONCLUSIONS In this pilot study, contingency management led to higher rates of HCV linkage to care for PWID, as compared to standard of care. CM should be considered as a possible intervention to improve the HCV treatment cascade for PWID.
Collapse
Affiliation(s)
- B L Norton
- Division of General Internal Medicine, Montefiore Medical Center, United States.
| | - M A Bachhuber
- Division of General Internal Medicine, Montefiore Medical Center, United States
| | - R Singh
- New York University, United States
| | - L Agyemang
- Division of General Internal Medicine, Montefiore Medical Center, United States
| | - J H Arnsten
- Division of General Internal Medicine, Montefiore Medical Center, United States
| | - C O Cunningham
- Division of General Internal Medicine, Montefiore Medical Center, United States
| | - A H Litwin
- Division of General Internal Medicine, Montefiore Medical Center, United States.
| |
Collapse
|
57
|
Ortblad KF, Musoke DK, Ngabirano T, Salomon JA, Haberer JE, McConnell M, Oldenburg CE, Bärnighausen T. Is knowledge of HIV status associated with sexual behaviours? A fixed effects analysis of a female sex worker cohort in urban Uganda. J Int AIDS Soc 2019; 22:e25336. [PMID: 31287625 PMCID: PMC6615530 DOI: 10.1002/jia2.25336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 06/05/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Female sex workers (FSWs) have strong economic incentives for sexual risk-taking behaviour. We test whether knowledge of HIV status affects such behaviours among FSWs. METHODS We used longitudinal data from a FSW cohort in urban Uganda, which was formed as part of an HIV self-testing trial with four months of follow-up. Participants reported perceived knowledge of HIV status, number of clients per average working night, and consistent condom use with clients at baseline, one month, and four months. We measured the association between knowledge of HIV status and FSWs' sexual behaviours using linear panel regressions with individual fixed effects, controlling for study round and calendar time. RESULTS Most of the 960 participants tested for HIV during the observation period (95%) and experienced a change in knowledge of HIV status (71%). Knowledge of HIV status did not affect participants' number of clients but did affect their consistent condom use. After controlling for individual fixed effects, study round and calendar month, knowledge of HIV-negative status was associated with a significant increase in consistent condom use by 9.5 percentage points (95% CI 5.2 to 13.5, p < 0.001), while knowledge of HIV-positive status was not associated with a significant change in consistent condom use (2.5 percentage points, 95% CI -8.0 to 3.1, p = 0.38). CONCLUSIONS In urban Uganda, FSWs engaged in safer sex with clients when they perceived that they themselves were not living with HIV. Even in communities with very high HIV prevalence, the majority of the population will test HIV-negative. Our results thus imply that expansion of HIV testing programmes may serve as a behavioural HIV prevention measure among FSWs.
Collapse
Affiliation(s)
| | | | | | - Joshua A Salomon
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
- Department of MedicineStanford UniversityStanfordCAUSA
| | - Jessica E Haberer
- Department of General Internal MedicineMassachusetts General Hospital Global HealthBostonMAUSA
| | - Margaret McConnell
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Catherine E Oldenburg
- Francis I. Proctor FoundationUniversity of California San FranciscoSan FranciscoCAUSA
- Department of OphthalmologyUniversity of CaliforniaSan FranciscoSan FranciscoCAUSA
- Department of Epidemiology & BiostatisticsUniversity of CaliforniaSan FranciscoCAUSA
| | - Till Bärnighausen
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Heidelberg Institute of Public HealthUniversity of HeidelbergHeidelbergGermany
| |
Collapse
|
58
|
Heard E, Oost E, McDaid L, Mutch A, Dean J, Fitzgerald L. How can HIV/STI testing services be more accessible and acceptable for gender and sexually diverse young people? A brief report exploring young people's perspectives in Queensland. Health Promot J Austr 2019; 31:150-155. [PMID: 31175695 DOI: 10.1002/hpja.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/31/2019] [Indexed: 11/07/2022] Open
Abstract
ISSUE ADDRESSED Gender and sexually diverse young people (GSDYP) are an important target group for HIV/sexually transmitted infection (STI) prevention and there is an immediate need to explore ways to make testing interventions accessible and appropriate for this group. METHODS We used a modified World Café workshop with 14 GSDYP in Brisbane Australia, to inform the development of a pilot community-based testing intervention. RESULTS The workshop identified the key features of an ideal service, which would include multiple, accessible sites that offer holistic, affordable services and confidential care by respectful and knowledgeable providers. The service would allow young people to engage in decision-making processes, have a culturally inclusive, comfortable and friendly atmosphere, and provide free sexual and reproductive health technologies. CONCLUSION When designing HIV/STI testing interventions for key groups, health promotion practitioners need to be cognisant of localised and nuanced expectations and ensure that services are tailored to the needs and experiences of the local population. SO WHAT?: This study provides insights into the needs and expectations of HIV/STI testing interventions for GSDYP in Australia, a key at-risk group whose perspectives are not adequately voiced in sexual health research and intervention design. SUMMARY This study explores facilitators and current barriers to HIV/STI testing with a group of gender and sexually diverse young people in Brisbane, Australia. Outcomes provide insights into the needs and expectations of HIV/STI testing services for this group.
Collapse
Affiliation(s)
- Emma Heard
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Ellen Oost
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Lisa McDaid
- School of Social Sciences and Health, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Allyson Mutch
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Judith Dean
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Lisa Fitzgerald
- School of Public Health, University of Queensland, Brisbane, Australia
| |
Collapse
|
59
|
Carbone NB, Njala J, Jackson DJ, Eliya MT, Chilangwa C, Tseka J, Zulu T, Chinkonde JR, Sherman J, Zimba C, Mofolo IA, Herce ME. "I would love if there was a young woman to encourage us, to ease our anxiety which we would have if we were alone": Adapting the Mothers2Mothers Mentor Mother Model for adolescent mothers living with HIV in Malawi. PLoS One 2019; 14:e0217693. [PMID: 31173601 PMCID: PMC6555548 DOI: 10.1371/journal.pone.0217693] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 05/12/2019] [Indexed: 12/03/2022] Open
Abstract
Background Pregnant and post-partum adolescent girls and young women (AGYW) living with HIV in sub-Saharan Africa experience inferior outcomes along the prevention of mother-to-child transmission of HIV (PMTCT) cascade compared to their adult counterparts. Yet, despite this inequality in outcomes, scarce data from the region describe AGYW perspectives to inform adolescent-sensitive PMTCT programming. In this paper, we report findings from formative implementation research examining barriers to, and facilitators of, PMTCT care for HIV-infected AGYW in Malawi, and explore strategies for adapting the mothers2mothers (m2m) Mentor Mother Model to better meet AGYW service delivery-related needs and preferences. Methods Qualitative researchers conducted 16 focus group discussions (FGDs) in 4 Malawi districts with HIV-infected adolescent mothers ages 15–19 years categorized into two groups: 1) those who had experience with m2m programming (8 FGDs, n = 38); and 2) those who did not (8 FGDs, n = 34). FGD data were analyzed using thematic analysis to assess major and minor themes and to compare findings between groups. Results Median participant age was 17 years (interquartile range: 2 years). Poverty, stigma, food insecurity, lack of transport, and absence of psychosocial support were crosscutting barriers to PMTCT engagement. While most participants highlighted resilience and self-efficacy as motivating factors to remain in care to protect their own health and that of their children, they also indicated a desire for tailored, age-appropriate services. FGD participants indicated preference for support services delivered by adolescent HIV-infected mentor mothers who have successfully navigated the PMTCT cascade themselves. Conclusions HIV-infected adolescent mothers expressed a preference for peer-led, non-judgmental PMTCT support services that bridge communities and facilities to pragmatically address barriers of stigma, poverty, health system complexity, and food insecurity. Future research should evaluate implementation and health outcomes for adolescent mentor mother services featuring these and other client-centered attributes, such as provision of livelihood assistance and peer-led psychosocial support.
Collapse
Affiliation(s)
| | - Joseph Njala
- University of North Carolina Project/Malawi, Lilongwe, Malawi
| | - Debra J. Jackson
- UNICEF/New York, New York, New York, United States of America
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Michael T. Eliya
- Department of HIV and AIDS, Ministry of Health, Government of the Republic of Malawi, Lilongwe, Malawi
| | | | - Jennifer Tseka
- University of North Carolina Project/Malawi, Lilongwe, Malawi
| | - Tasila Zulu
- University of North Carolina Project/Malawi, Lilongwe, Malawi
| | | | | | - Chifundo Zimba
- University of North Carolina Project/Malawi, Lilongwe, Malawi
| | | | - Michael E. Herce
- University of North Carolina Project/Malawi, Lilongwe, Malawi
- Institute for Global Health & Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- * E-mail:
| |
Collapse
|
60
|
Brantley AD, Burgess S, Bickham J, Wendell D, Gruber D. Using Financial Incentives to Improve Rates of Viral Suppression and Engagement in Care of Patients Receiving HIV Care at 3 Health Clinics in Louisiana: The Health Models Program, 2013-2016. Public Health Rep 2019; 133:75S-86S. [PMID: 30457949 DOI: 10.1177/0033354918793096] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The Care and Prevention in the United States Demonstration Project aimed to reduce HIV/AIDS-related morbidity and mortality among racial/ethnic minority groups in 8 states. We evaluated Health Models, a pay-for-performance program piloted by the Louisiana Department of Health that used financial incentives to improve rates of engagement in HIV medical care and viral suppression among people with HIV. METHODS We enrolled 2076 patients of 3 urban HIV specialty clinics in Louisiana in the Health Models pay-for-performance program on a rolling basis from September 2013 through September 2016 and gave patients cash incentives to attend HIV medical appointments, achieve or maintain viral suppression, and link to supportive services. We used laboratory data collected from Louisiana's HIV surveillance database to calculate rates of engagement in care and viral suppression during the first 24 months of enrollment. RESULTS Of the 2076 patients who enrolled, 1400 (67.4%) were non-Hispanic black, 1480 (71.3%) were male, 1175 (56.6%) were men who have sex with men, and 1371 (66.0%) reported an annual income of <$15 000. At enrollment, 1456 (70.1%) patients were engaged in HIV care, and 1197 (57.7%) patients were virally suppressed. After 12 months of enrollment, 1474 of 1783 (82.7%) patients were virally suppressed. Of enrolled patients with at least 12 or 24 months of follow-up data, 1299 of 1317 (98.6%) patients were engaged in care during their first 12 months of enrollment, and 995 of 1033 (96.3%) patients were engaged in care between 12 and 24 months of enrollment. CONCLUSIONS During the implementation of Health Models, enrolled patients had increases in rates of viral suppression and achieved rates of engagement in care and viral suppression that were higher than national levels; however, additional supportive services may be needed to further reduce socioeconomic disparities in the rates of viral suppression.
Collapse
Affiliation(s)
- Antoine D Brantley
- 1 Louisiana Department of Health, STD/HIV Program, Office of Public Health, New Orleans, LA, USA
| | - Samuel Burgess
- 1 Louisiana Department of Health, STD/HIV Program, Office of Public Health, New Orleans, LA, USA
| | - Jacquelyn Bickham
- 1 Louisiana Department of Health, STD/HIV Program, Office of Public Health, New Orleans, LA, USA
| | - Deborah Wendell
- 1 Louisiana Department of Health, STD/HIV Program, Office of Public Health, New Orleans, LA, USA
| | - DeAnn Gruber
- 1 Louisiana Department of Health, STD/HIV Program, Office of Public Health, New Orleans, LA, USA
| |
Collapse
|
61
|
Tanser F, Bärnighausen T, Dobra A, Sartorius B. Identifying 'corridors of HIV transmission' in a severely affected rural South African population: a case for a shift toward targeted prevention strategies. Int J Epidemiol 2019; 47:537-549. [PMID: 29300904 PMCID: PMC5913614 DOI: 10.1093/ije/dyx257] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 11/24/2022] Open
Abstract
Background In the context of a severe generalized African HIV epidemic, the value of geographically targeted prevention interventions has only recently been given serious consideration. However, to date no study has performed a population-based analysis of the micro-geographical clustering of HIV incident infections, limiting the evidential support for such a strategy. Methods We followed 17 984 HIV-uninfected individuals aged 15–54 in a population-based cohort in rural KwaZulu-Natal, South Africa, and observed individual HIV sero-conversions between 2004 and 2014. We geo-located all individuals to an exact homestead of residence (accuracy <2 m). We then employed a two-dimensional Gaussian kernel of radius 3 km to produce robust estimates of HIV incidence which vary across continuous geographical space. We also applied Tango's flexibly shaped spatial scan statistic to identify irregularly shaped clusters of high HIV incidence. Results Between 2004 and 2014, we observed a total of 2 311 HIV sero-conversions over 70 534 person-years of observation, at an overall incidence of 3.3 [95% confidence interval (CI), 3.1-3.4] per 100 person-years. Three large irregularly-shaped clusters of new HIV infections (relative risk = 1.6, 1.7 and 2.3) were identified in two adjacent peri-urban communities near the National Road (P = 0.001, 0.015) as well as in a rural node bordering a recent coal mine development (P = 0.020), respectively. Together the clusters had a significantly higher age-sex standardized incidence of 5.1 (95% CI, 4.7-5.6) per 100 person-years compared with a standardized incidence of 3.0 per 100 person-years (95% CI, 2.9-3.2) in the remainder of the study area. Though these clusters comprise just 6.8% of the study area, they account for one out of every four sero-conversions observed over the study period. Conclusions Our study has revealed clear ‘corridors of transmission’ in this typical rural, hyper-endemic population. Even in a severely affected rural African population, an approach that seeks to provide preventive interventions to the most vulnerable geographies could be more effective and cost-effective in reducing the overall rate of new HIV infections. There is an urgent need to develop and test such interventions as part of an overall combination prevention approach.
Collapse
Affiliation(s)
- Frank Tanser
- Africa Health Research Institute, Durban, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, South Africa.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.,Institute of Epidemiology and Health Care, University College London, London, UK
| | - Till Bärnighausen
- Africa Health Research Institute, Durban, South Africa.,Institute of Epidemiology and Health Care, University College London, London, UK.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Institute for Public Health, University of Heidelberg, Heidelberg, Germany
| | - Adrian Dobra
- Department of Statistics, Department of Biobehavioral Nursing and Health Informatics, Center for Statistics and the Social Sciences and Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA
| | - Benn Sartorius
- School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
| |
Collapse
|
62
|
Katuramu R, Wallenta J, Semitala FC, Amanyire G, Kampiire L, Namusobya J, Kamya MR, Havlir D, Glidden DV, Geng E. Closing the gap: A novel metric of change in performance. EAST AFRICAN JOURNAL OF APPLIED HEALTH MONITORING AND EVALUATION 2019; 2019:http://eajahme.com/wp-content/uploads/2019/02/Katuramu_FINAL.pdf. [PMID: 32817932 PMCID: PMC7428843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Interventions to improve performance of global programs in the HIV cascade of care are widespread and increasing the focus of implementation science. At present, however, there is no clear consensus on how to conceptualize their improvement at the program level. The commonly used measures of association, based on ratios of probabilities (or odds), have well-known defects in public health applications. They yield large effect sizes even when the absolute effects, and therefore the public health impact, are small. On the other hand, risk differences create problems because settings with higher baseline values are penalized. We aim to examine ways of quantifying improvement in each health center of a cluster-randomized trial in Uganda to accelerate antiretroviral therapy initiation among HIV-infected adults. METHODS We formalize the concept of the 'improvement index,' defined as the fraction of gaps closed as a metric of improvement, and suggest that it has unique features and strengths when compared to risk ratios and risk differences. RESULTS Overall agreement between the different indices was not high, especially among health centers that were among the top 5 or 10. However, all ranking showed broad similarities at the far ends of the spectrum. On scatter plots, there was a positive linear relationship between the metrics, and the Bland Altman (B-A) plots were in agreement. CONCLUSION The improvement index can be used as an alternative measure of association in implementation science interventions. It can be useful for public health purposes as it demonstrates how much can be covered from the baseline.
Collapse
Affiliation(s)
| | - Jeanna Wallenta
- Department of Medicine, Division of HIV, ID and Global Medicine, University of California, San Francisco, USA
| | - Fred C Semitala
- Makerere University, Kampala, Uganda
- Makerere University Joint AIDS Program, Kampala, Uganda
| | | | | | | | - Moses R. Kamya
- Makerere University, Kampala, Uganda
- Makerere University Joint AIDS Program, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Diane Havlir
- Department of Medicine, Division of HIV, ID and Global Medicine, University of California, San Francisco, USA
| | - David V. Glidden
- Department of Medicine, Division of HIV, ID and Global Medicine, University of California, San Francisco, USA
| | - Elvin Geng
- Department of Medicine, Division of HIV, ID and Global Medicine, University of California, San Francisco, USA
| |
Collapse
|
63
|
Abadie R, Brown B, Fisher CB. "Money Helps": People who inject drugs and their perceptions of financial compensation and its ethical implications. ETHICS & BEHAVIOR 2018; 29:607-620. [PMID: 31579222 PMCID: PMC6774386 DOI: 10.1080/10508422.2018.1535976] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study documents how people who inject drugs (PWID) in rural Puerto Rico perceive payments for participating in HIV epidemiological studies. In-depth interviews were conducted among a subset (n = 40) of active PWID older than 18 years of age who had been previously enrolled in a much larger study (N = 360). Findings suggest that financial compensation was the main motivation for initially enrolling in the parent study. Then, as trust in the researchers developed, participants came to perceive compensation as part of a reciprocal exchange in which they assisted researchers by providing a trustful account of their experiences and researchers reciprocated with financial support.
Collapse
Affiliation(s)
- Roberto Abadie
- Department of Sociology, University of Nebraska-Lincoln Brandon Brown
| | - Brandon Brown
- Center for Healthy Communities, University of California Riverside
| | | |
Collapse
|
64
|
Stevens ER, Li L, Nucifora KA, Zhou Q, McNairy ML, Gachuhi A, Lamb MR, Nuwagaba-Biribonwoha H, Sahabo R, Okello V, El-Sadr WM, Braithwaite RS. Cost-effectiveness of a combination strategy to enhance the HIV care continuum in Swaziland: Link4Health. PLoS One 2018; 13:e0204245. [PMID: 30222768 PMCID: PMC6141095 DOI: 10.1371/journal.pone.0204245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/04/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Link4Health, a cluster-RCT, demonstrated the effectiveness of a combination strategy targeting barriers at various HIV continuum steps on linkage to and retention in care; showing effectiveness in achieving linkage to HIV care within 1 month plus retention in care at 12 months after HIV testing for people living with HIV (RR 1.48, 95% CI 1.19-1.96, p = 0.002). In addition to standard of care, Link4Health included: 1) Point-of-care CD4+ count testing; 2) Accelerated ART initiation; 3) Mobile phone appointment reminders; 4) Care and prevention package including commodities and informational materials; and 5) Non-cash financial incentive. Our objective was to evaluate the cost-effectiveness of a scale-up of the Link4Health strategy in Swaziland. METHODS AND FINDINGS We incorporated the effects and costs of the Link4Health strategy into a computer simulation of the HIV epidemic in Swaziland, comparing a scenario where the strategy was scaled up to a scenario with no implementation. The simulation combined a deterministic compartmental model of HIV transmission with a stochastic microsimulation of HIV progression calibrated to Swaziland epidemiological data. It incorporated downstream health costs potentially saved and infections potentially prevented by improved linkage and treatment adherence. We assessed the incremental cost-effectiveness ratio of Link4Health compared to standard care from a health sector perspective reported in US$2015, a time horizon of 20 years, and a discount rate of 3% in accordance with WHO guidelines.[1] Our results suggest that scale-up of the Link4Health strategy would reduce new HIV infections over 20 years by 11,059 infections, a 7% reduction from the projected 169,019 cases and prevent 5,313 deaths, an 11% reduction from the projected 49,582 deaths. Link4Health resulted in an incremental cost per infection prevented of $13,310 and an incremental cost per QALY gained of $3,560/QALY from the health sector perspective. CONCLUSIONS Using a threshold of <3 x per capita GDP, the Link4Health strategy is likely to be a cost-effective strategy for responding to the HIV epidemic in Swaziland.
Collapse
Affiliation(s)
- Elizabeth R. Stevens
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
| | - Lingfeng Li
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
| | - Kimberly A. Nucifora
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
| | - Qinlian Zhou
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
| | | | - Averie Gachuhi
- ICAP at Columbia University, New York, NY, United States of America
| | - Matthew R. Lamb
- ICAP at Columbia University, New York, NY, United States of America
| | - Harriet Nuwagaba-Biribonwoha
- ICAP at Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | | | | | - Wafaa M. El-Sadr
- ICAP at Columbia University, New York, NY, United States of America
| | - R. Scott Braithwaite
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
| |
Collapse
|
65
|
Matoga MM, Hosseinipour MC, Jere E, Ndalama B, Kamtambe B, Chasela C. Improving STI and HIV Passive Partner Notification using the Model for Improvement: A Quality Improvement Study in Lilongwe Malawi. ACTA ACUST UNITED AC 2018; 3. [PMID: 30417175 PMCID: PMC6223304 DOI: 10.4172/2576-1420.1000128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: In Malawi, passive partner notification is the mainstay method of partner notification (PN). Despite its wide use, the proportion of sexual partners referred for care through this method is very low. We aimed to increase the proportion of sexual partner referral through passive PN. Methods: We implemented a quality improvement (QI) project at Bwaila STI unit in Lilongwe, Malawi between January and June 2017 using a pre- and post- intervention quasi-experimental study design. Pre-intervention, we conducted key-informant interviews and clinic observations and used the findings to design a QI project using expert opinion. The intervention included three change ideas: early start time of the clinic, shortening of the group health talk and expedited clinic flow for sexual partners. Each change idea was tested twice through 1-week long Plan-Do-Study-Act cycles using the model for improvement (MFI) and then combined and tested twice. Process data were collected and monitored using run charts. Post-intervention, we evaluated the proportion of sexual partners who presented to the clinic, to detect a 10% increase at 95% power and α=0.05, between pre- and post-intervention periods. Results: The average duration of the group health talk dropped from 56 minutes to 38 minutes and the duration of clinic stay for sexual partners reduced by 45 minutes (from 1hour 36 minutes to 51 minutes). The average clinic start time improved from 09:02 hours to 08:17 hours. The proportion of sexual partner referral increased by 37% (P=0.04) - from 15.6% to 21.4%. We observed an upward trend in the proportion of sexual partners referred in the post-intervention period. Conclusion: The yield of sexual partners through passive PN was improved using a simple QI intervention implemented using the MFI. However, the proportion of sexual partner referral remains suboptimal. More effort is required to increase the proportion of sexual partner referral in Malawi.
Collapse
Affiliation(s)
- M M Matoga
- The University of the Witwatersrand University, School of public health, Department of Epidemiology & Biostatistics, Johannesburg, South Africa.,University of North Carolina Project, Lilongwe, Malawi
| | - M C Hosseinipour
- University of North Carolina Project, Lilongwe, Malawi.,University of North Carolina at Chapel Hill. School of Medicine Division of Infectious Diseases, Chapel Hill, NC, USA
| | - E Jere
- University of North Carolina Project, Lilongwe, Malawi
| | - B Ndalama
- University of North Carolina Project, Lilongwe, Malawi
| | - B Kamtambe
- Bwaila District Hospital, Lilongwe District Health Office, Lilongwe, Malawi
| | - C Chasela
- The University of the Witwatersrand University, School of public health, Department of Epidemiology & Biostatistics, Johannesburg, South Africa.,Right to Care, Outspan house, Centurion, South Africa
| |
Collapse
|
66
|
Achieving the 90-90-90 target: incentives for HIV testing. THE LANCET. INFECTIOUS DISEASES 2018; 16:1215-1216. [PMID: 27788971 DOI: 10.1016/s1473-3099(16)30383-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/09/2016] [Accepted: 09/19/2016] [Indexed: 11/20/2022]
|
67
|
Mitchell SG, Monico LB, Stitzer M, Matheson T, Sorensen JL, Feaster DJ, Schwartz RP, Metsch L. How patient navigators view the use of financial incentives to influence study involvement, substance use, and HIV treatment. J Subst Abuse Treat 2018; 94:18-23. [PMID: 30243412 DOI: 10.1016/j.jsat.2018.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS While patient navigation has been shown to be an effective approach for linking persons to HIV care, and contingency management is effective at improving substance use-related outcomes, Project HOPE combined these two interventions in a novel way to engage HIV-positive patients with HIV and substance use treatment. The aims of this paper are to examine patient navigator views regarding how contingency management interacted with and affected their navigation process. DESIGN Semi-structured qualitative interviews. PARTICIPANTS 22 patient navigators from the original 10 Project HOPE study sites. MEASUREMENTS Individual, semi-structured interviews lasting approximately 60 min addressed the patient navigator's professional background, descriptions of the participant population, substance use disorder versus HIV treatment entry and engagement issues, and the use of contingency management within the navigation service delivery protocol. FINDINGS Patient navigators believed that financial incentives helped motivate participant attendance at navigation sessions, particularly early in study involvement, which helped them to establish rapport and develop relationships with participants. Patient navigators often noted that financial incentives positively influenced targeted HIV health-related behaviors, such as attending medical appointments, which provided a rapid pay-off with an escalating sum. Contingency management was more complex when used by the patient navigators for substance use-related behaviors, particularly when incentives revolved around negative urine screening. Patient navigators noted that not all participants responded the same way to the contingency management and that the incentives were particularly helpful when participants were financially strained with limited resources or when internal motivation was lacking. CONCLUSIONS Overall patient navigators found the inclusion of contingency management to be helpful and affective at influencing participant behaviors, particularly concerning navigation session attendance and HIV healthcare-related participation. However, issues and concerns surrounding the inclusion of contingency management for drug-related behaviors as delivered in Project HOPE were noted. CLINICAL TRIALS REGISTRATION NCT01612169.
Collapse
Affiliation(s)
| | - Laura B Monico
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - Maxine Stitzer
- Behavioral Pharmacology Research Unit, Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Baltimore, MD 21223, USA
| | - Timothy Matheson
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA
| | - James L Sorensen
- Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, SFGH Building 20, Rm. 2117, San Francisco, CA 94110, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, USA
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - Lisa Metsch
- Department of Sociomedical Sciences, Mailman School of public Health, Columbia University, 722 West 168th St. 9th floor, New York, NY 10032, USA
| |
Collapse
|
68
|
|
69
|
Stitzer ML, Hammond AS, Matheson T, Sorensen JL, Feaster DJ, Duan R, Gooden L, del Rio C, Metsch LR. Enhancing Patient Navigation with Contingent Incentives to Improve Healthcare Behaviors and Viral Load Suppression of Persons with HIV and Substance Use. AIDS Patient Care STDS 2018; 32:288-296. [PMID: 29883190 DOI: 10.1089/apc.2018.0014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This secondary analysis compares health behavior outcomes for two groups of HIV+ substance users randomized in a 3-arm trial [1] to receive Patient Navigation with (PN+CM) or without (PN) contingent financial incentives (CM). Mean age of participants was 45 years; the majority was male (67%), African American (78%), unemployed (35%), or disabled (50%). Behaviors incentivized for PN+CM were (1) attendance at HIV care visits and (2) verification of an active HIV medication prescription. Incentives were associated with shorter time to treatment initiation and higher rates of behaviors during the 6-month intervention with exception of month 6 HIV care visits. Median HIV care visits were 3 (IQR 2-4) for PN+CM versus 1.5 (IQR 0-3) for PN (Wilcoxon p < 0.001); median validated medication checks were 4 (IQR 2-6) for PN+CM versus 1 (IQR 0-3) for PN (Wilcoxon p < 0.001). Viral suppression rates at end of treatment were not significantly different for the two groups but were directly related to the number of behaviors completed for both care visits (χ2(1) = 7.69, p = 0.006) and validated medication (χ2(1) = 8.49, p = 0.004). Results support use of incentives to increase performance of key healthcare behaviors. Adjustments to the incentive program may be needed to achieve greater rates of sustained health behavior change that result in improved viral load outcomes.
Collapse
Affiliation(s)
- Maxine L. Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Alexis S. Hammond
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Tim Matheson
- San Francisco Department of Public Health, San Francisco, California
| | - James L. Sorensen
- UCSF Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Rui Duan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Lauren Gooden
- Department of Sociomedical Sciences Mailman School of Public Health, Columbia University, New York, New York
| | - Carlos del Rio
- Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, Georgia
| | - Lisa R. Metsch
- Department of Sociomedical Sciences Mailman School of Public Health, Columbia University, New York, New York
| |
Collapse
|
70
|
McGill B, O'Hara BJ, Bauman A, Grunseit AC, Phongsavan P. Are Financial Incentives for Lifestyle Behavior Change Informed or Inspired by Behavioral Economics? A Mapping Review. Am J Health Promot 2018; 33:131-141. [PMID: 29699412 DOI: 10.1177/0890117118770837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To identify the behavioral economics (BE) conceptual underpinnings of lifestyle financial incentive (FI) interventions. DATA SOURCE A mapping review of peer-reviewed literature was conducted by searching electronic databases. STUDY INCLUSION AND EXCLUSION CRITERIA Inclusion criteria were real-world FI interventions explicitly mentioning BE, targeting individuals, or populations with lifestyle-related behavioral outcomes. Exclusion criteria were hypothetical studies, health professional focus, clinically oriented interventions. DATA EXTRACTION Study characteristics were tabulated according to purpose, categorization of BE concepts and FI types, design, outcome measures, study quality, and findings. DATA SYNTHESIS AND ANALYSIS Financial incentives were categorized according to type and payment structure. Behavioral economics concepts explicitly used in the intervention design were grouped based on common patterns of thinking. The interplay between FI types, BE concepts, and outcome was assessed. RESULTS Seventeen studies were identified from 1452 unique records. Analysis showed 76.5% (n = 13) of studies explicitly incorporated BE concepts. Six studies provided clear theoretical justification for the inclusion of BE. No pattern in the type of FI and BE concepts used was apparent. CONCLUSIONS Not all FI interventions claiming BE inclusion did so. For interventions that explicitly included BE, the degree to which this was portrayed and woven into the design varied. This review identified BE concepts common to FI interventions, a first step in providing emergent and pragmatic information to public health and health promotion program planners.
Collapse
Affiliation(s)
- Bronwyn McGill
- 1 Prevention Research Collaboration, Sydney School of Public Health, Camperdown, New South Wales, Australia.,2 Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia.,3 The Australian Prevention Partnership Centre, Ultimo, New South Wales, Australia
| | - Blythe J O'Hara
- 1 Prevention Research Collaboration, Sydney School of Public Health, Camperdown, New South Wales, Australia.,2 Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Adrian Bauman
- 1 Prevention Research Collaboration, Sydney School of Public Health, Camperdown, New South Wales, Australia.,2 Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia.,3 The Australian Prevention Partnership Centre, Ultimo, New South Wales, Australia
| | - Anne C Grunseit
- 1 Prevention Research Collaboration, Sydney School of Public Health, Camperdown, New South Wales, Australia.,2 Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia.,3 The Australian Prevention Partnership Centre, Ultimo, New South Wales, Australia
| | - Philayrath Phongsavan
- 1 Prevention Research Collaboration, Sydney School of Public Health, Camperdown, New South Wales, Australia.,2 Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
71
|
Matoga M, Mmodzi P, Massa C, Bula A, Hosseinipour M, Chasela C. Health System Factors Influencing Partner Notification for STIs and HIV in Lilongwe Malawi. A Pre-intervention Phase Assessment for a Quality Improvement Project. ACTA ACUST UNITED AC 2018; 3. [PMID: 29707699 PMCID: PMC5918274 DOI: 10.4172/2576-1420.1000125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Despite its wide use, passive partner notification (PN) has a low yield of sexual partners influenced by patient-related and health system (HS) factors. Methods We conducted a qualitative study and clinic observations during a pre-intervention phase of a quality improvement (QI) project to identify HS factors that influenced passive PN at Bwaila STI unit (BSU) in Lilongwe Malawi from January to February 2016. We conducted 15 in-depth interviews with health workers and clinic observations for six clinic flow and PN processes at the clinic. Results The majority of health workers felt that the lack of incentives for sexual partners or couples who presented to the clinic was the most important negative HS factor that influenced passive PN. We observed an average clinic start time of 09:02 hours. The average duration of the group health talk was 56 minutes and there was no difference in the time spent at the clinic between index cases and partners (1 hour 41 minutes versus 1 hour 36 minutes respectively). Discussion Lack of incentives for sexual partners or couples was the most important HS factors that impacted the yield of sexual partners. Interventions focusing on designing simple non-monetary incentives and QI of passive PN should be encouraged.
Collapse
Affiliation(s)
- Mitch Matoga
- University of North Carolina Project, Lilongwe, Malawi.,University of the Witwatersrand, Johannesburg, South Africa
| | | | - Cecelia Massa
- University of North Carolina Project, Lilongwe, Malawi
| | - Agatha Bula
- University of North Carolina Project, Lilongwe, Malawi
| | - Mina Hosseinipour
- University of North Carolina Project, Lilongwe, Malawi.,University of North Carolina, Chapel Hill, North Carolina, USA
| | - Charles Chasela
- University of the Witwatersrand, Johannesburg, South Africa.,Right to Care, EQUIP, Centurion, South Africa
| |
Collapse
|
72
|
Schechter MC, Bizune D, Kagei M, Holland DP, Del Rio C, Yamin A, Mohamed O, Oladele A, Wang YF, Rebolledo PA, Ray SM, Kempker RR. Challenges Across the HIV Care Continuum for Patients With HIV/TB Co-infection in Atlanta, GA [corrected]. Open Forum Infect Dis 2018; 5:ofy063. [PMID: 29657955 PMCID: PMC5890473 DOI: 10.1093/ofid/ofy063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/17/2018] [Indexed: 11/13/2022] Open
Abstract
Background Antiretroviral therapy (ART) for persons with HIV infection prevents tuberculosis (TB) disease. Additionally, sequential ART after initiation of TB treatment improves outcomes. We examined ART use, retention in care, and viral suppression (VS) before, during, and 3 years following TB treatment for an inner-city cohort in the United States. Methods Retrospective cohort study among persons treated for culture-confirmed TB between 2008 and 2015 at an inner-city hospital. Results Among 274 persons with culture-confirmed TB, 96 (35%) had HIV co-infection, including 23 (24%) new HIV diagnoses and 73 (76%) previous diagnoses. Among those with known HIV prior to TB, the median time of known HIV was 6 years, and only 10 (14%) were on ART at the time of TB diagnosis. The median CD4 at TB diagnosis was 87 cells/uL. Seventy-four (81%) patients received ART during treatment for TB, and 47 (52%) has VS at the end of TB treatment. Only 32% of patients had continuous VS 3 years after completing TB treatment. There were 3 TB recurrences and 3 deaths post–TB treatment; none of these patients had retention or VS after TB treatment. Conclusions Among persons with active TB co-infected with HIV, we found that the majority had known HIV and were not on ART prior to TB diagnosis, and retention in care and VS post–TB treatment were very low. Strengthening the HIV care continuum is needed to improve HIV outcomes and further reduce rates of active TB/HIV co-infection in our and similar settings.
Collapse
Affiliation(s)
- Marcos C Schechter
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Destani Bizune
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - David P Holland
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia.,Communicable Disease Prevention Branch, Fulton County Health Board of Health, Atlanta, Georgia
| | - Carlos Del Rio
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Aliya Yamin
- Communicable Disease Prevention Branch, Fulton County Health Board of Health, Atlanta, Georgia
| | - Omar Mohamed
- Communicable Disease Prevention Branch, Fulton County Health Board of Health, Atlanta, Georgia
| | | | - Yun F Wang
- Department of Pathology and Laboratory Medicine, School of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Pathology, Grady Memorial Hospital, Atlanta, Georgia
| | - Paulina A Rebolledo
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia.,Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Susan M Ray
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Russell R Kempker
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
73
|
Ford N, Mills EJ. Commentary: Increasing uptake of HIV testing: gifts are good but more is needed. Int J Epidemiol 2018; 45:2109-2111. [PMID: 27864411 DOI: 10.1093/ije/dyw137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nathan Ford
- Department of HIV, World Health Organization, Geneva, Switzerland
| | | |
Collapse
|
74
|
Sibanda EL, Tumushime M, Mufuka J, Mavedzenge SN, Gudukeya S, Bautista-Arredondo S, Hatzold K, Thirumurthy H, McCoy SI, Padian N, Copas A, Cowan FM. Effect of non-monetary incentives on uptake of couples' counselling and testing among clients attending mobile HIV services in rural Zimbabwe: a cluster-randomised trial. LANCET GLOBAL HEALTH 2018; 5:e907-e915. [PMID: 28807189 DOI: 10.1016/s2214-109x(17)30296-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/23/2017] [Accepted: 07/05/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Couples' HIV testing and counselling (CHTC) is associated with greater engagement with HIV prevention and care than individual testing and is cost-effective, but uptake remains suboptimal. Initiating discussion of CHTC might result in distrust between partners. Offering incentives for CHTC could change the focus of the pre-test discussion. We aimed to determine the impact of incentives for CHTC on uptake of couples testing and HIV case diagnosis in rural Zimbabwe. METHODS In this cluster-randomised trial, 68 rural communities (the clusters) in four districts receiving mobile HIV testing services were randomly assigned (1:1) to incentives for CHTC or not. Allocation was not masked to participants and researchers. Randomisation was stratified by district and proximity to a health facility. Within each stratum random permutation was done to allocate clusters to the study groups. In intervention communities, residents were informed that couples who tested together could select one of three grocery items worth US$1·50. Standard mobilisation for testing was done in comparison communities. The primary outcome was the proportion of individuals testing with a partner. Analysis was by intention to treat. 3 months after CHTC, couple-testers from four communities per group individually completed a telephone survey to evaluate any social harms resulting from incentives or CHTC. The effect of incentives on CHTC was estimated using logistic regression with random effects adjusting for clustering. The trial was registered with the Pan African Clinical Trial Registry, number PACTR201606001630356. FINDINGS From May 26, 2015, to Jan 29, 2016, of 24 679 participants counselled with data recorded, 14 099 (57·1%) were in the intervention group and 10 580 (42·9%) in the comparison group. 7852 (55·7%) testers in the intervention group versus 1062 (10·0%) in the comparison group tested with a partner (adjusted odds ratio 13·5 [95% CI 10·5-17·4]). Among 427 (83·7%) of 510 eligible participants who completed the telephone survey, 11 (2·6%) reported that they were pressured or themselves pressured their partner to test together; none regretted couples' testing. Relationship unrest was reported by eight individuals (1·9%), although none attributed this to incentives. INTERPRETATION Small non-monetary incentives, which are potentially scalable, were associated with significantly increased CHTC and HIV case diagnosis. Incentives did not increase social harms beyond the few typically encountered with CHTC without incentives. The intervention could help achieve UNAIDS 90-90-90 targets. FUNDING The study was funded by the UK Department for International Development, Irish AID, and Swedish SIDA, through Population Services International Zimbabwe under the Integrated Support Program.
Collapse
Affiliation(s)
- Euphemia L Sibanda
- CeSHHAR Zimbabwe, Avondale, Harare, Zimbabwe; Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.
| | | | | | | | | | | | - Karin Hatzold
- Population Services International, Washington, DC, USA
| | - Harsha Thirumurthy
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sandra I McCoy
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | | | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Frances M Cowan
- CeSHHAR Zimbabwe, Avondale, Harare, Zimbabwe; Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| |
Collapse
|
75
|
Bor J, Chiu C, Ahmed S, Katz I, Fox MP, Rosen S, Yapa M, Tanser F, Pillay D, Bärnighausen T. Failure to initiate HIV treatment in patients with high CD4 counts: evidence from demographic surveillance in rural South Africa. Trop Med Int Health 2018; 23:206-220. [PMID: 29160949 PMCID: PMC5829292 DOI: 10.1111/tmi.13013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To assess the relationship between CD4 count at presentation and ART uptake and assess predictors of timely treatment initiation in rural KwaZulu-Natal, South Africa. METHODS We used Kaplan-Meier and Cox proportional hazards models to assess the association between first CD4 count and time from first CD4 to ART initiation among all adults presenting to the Hlabisa HIV Treatment and Care Programme between August 2011 and December 2012 with treatment-eligible CD4 counts (≤ 350 cells/mm3 ). For a subset of healthier patients (200 < CD4 ≤ 350 cells) residing within the population surveillance of the Africa Health Research Institute, we assessed sociodemographic, economic and geographic predictors hypothesised to influence ART uptake. RESULTS A total of 4739 patients presented for care with eligible CD4 counts. The proportion initiating ART within six months of diagnosis was 67% (95% CI 63, 71) in patients with CD4 ≤ 50, 59% (0.55, 0.63) in patients with CD4 151-200 and 48% (95% CI 44, 51) in patients with CD4 301-350. The hazard of starting ART fell by 17% (95% CI 14, 20) for every 100-cell increase in baseline CD4 count. Among healthier patients under demographic surveillance (n = 193), observable sociodemographic, economic and geographic predictors did not add discriminatory power beyond CD4 count, age and sex to identify patients at high risk of non-initiation. CONCLUSIONS Individuals presenting for HIV care at higher CD4 counts were less likely to initiate ART than patients presenting at low CD4 counts. Overall, ART uptake was low. Under new guidelines that establish ART eligibility regardless of CD4 count, patients with high CD4 counts may require additional interventions to encourage treatment initiation.
Collapse
Affiliation(s)
- Jacob Bor
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Calvin Chiu
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shahira Ahmed
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Ingrid Katz
- Division of Women's Health, Brigham and Women's Hospital, Boston, MA, USA
- Center for Global Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Matthew P Fox
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Sydney Rosen
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Manisha Yapa
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Frank Tanser
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | - Deenan Pillay
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Virology, University College London, London, United Kingdom
| | - Till Bärnighausen
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Research Department of Infection & Population Health, University College London, London, United Kingdom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
76
|
Kranzer K, Simms V, Bandason T, Dauya E, McHugh G, Munyati S, Chonzi P, Dakshina S, Mujuru H, Weiss HA, Ferrand RA. Economic incentives for HIV testing by adolescents in Zimbabwe: a randomised controlled trial. Lancet HIV 2018; 5:e79-e86. [PMID: 29170030 PMCID: PMC5809636 DOI: 10.1016/s2352-3018(17)30176-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/20/2017] [Accepted: 09/14/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND HIV testing is the important entry point for HIV care and prevention service, but uptake of HIV testing and thus coverage of antiretroviral therapy are much lower in older children and adolescents than in adults. We investigated the effect of economic incentives provided to caregivers of children aged 8-17 years on uptake of HIV testing and counselling in Harare, Zimbabwe. METHODS This randomised controlled trial was nested within a household HIV prevalence survey of children aged 8-17 years in Harare. Households with one or more survey participants whose HIV status was unknown were eligible to participate in the trial. Eligible households were randomly assigned (1:1:1) to either receive no incentive, receive a fixed US$2 incentive, or participate in a lottery for $5 or $10 if the participant presented for HIV testing and counselling at a local primary health-care centre. The survey fieldworkers who enrolled participants were not blinded to trial arm allocation, but the statistician was blinded for analysis of outcome. The primary outcome was the proportion of households in which at least one child had an HIV test within 4 weeks of enrolment. HIV test uptake in the incentivised groups was compared with uptake in the non-incentivised group using logistic regression, adjusting for community and number of children as fixed effects and research assistant as a random effect. All analyses were by intention to treat. The trial is registered with the Pan African Clinical Trials Registry, number PACTR201605001615280. FINDINGS Between Aug 4, and Dec 18, 2015, 2050 eligible households were enrolled in the prevalence survey. 649 (32%) households were assigned no incentive, 740 (34%) households were assigned a $2 incentive, and 661 (32%) households were assigned to lottery participation. Children were unavailable in 148 households in the no-incentive group, 63 households in the $2 incentive group, and 81 households in the lottery group. 1688 households had at least one child with unknown HIV status and were enrolled into the trial. 22 households had no undiagnosed child, and one household refused consent. The primary outcome of HIV testing was assessed in 472 (28%) households in the no-incentive group, 654 (39%) households in the $2 incentive group, and 562 (33%) households in the lottery group. At least one child was HIV tested in 93 (20%) households in the no-incentive group, in 316 (48%) households in the $2 incentive group (adjusted odds ratio 3·67, 95% CI 2·77-4·85; p<0·0001), and in 223 (40%) of 562 households in the lottery group (2·66, 2·00-3·55; p<0·0001). No adverse events were reported. INTERPRETATION Fixed incentives and lottery-based incentives increased the uptake of HIV testing by older children and adolescents, a key hard-to-reach population. This strategy would be sustainable in the context of vertical HIV infection as repeated testing would not be necessary until sexual debut. FUNDING Wellcome Trust.
Collapse
Affiliation(s)
- Katharina Kranzer
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; National and Supranational Tuberculosis Reference Laboratory, Leibniz Research Centre Borstel, Borstel, Germany.
| | - Victoria Simms
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Grace McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Suba Dakshina
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Hilda Mujuru
- Department of Paediatrics, University of Zimbabwe, Harare, Zimbabwe
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rashida A Ferrand
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe
| |
Collapse
|
77
|
Maughan-Brown B, Smith P, Kuo C, Harrison A, Lurie MN, Bekker LG, Galárraga O. A Conditional Economic Incentive Fails to Improve Linkage to Care and Antiretroviral Therapy Initiation Among HIV-Positive Adults in Cape Town, South Africa. AIDS Patient Care STDS 2018; 32:70-78. [PMID: 29432045 PMCID: PMC5808383 DOI: 10.1089/apc.2017.0238] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Interventions to improve antiretroviral therapy (ART) access are urgently needed to maximize the multiple benefits from ART. This pilot study examined the effect of a conditional economic incentive on linkage to care and uptake of treatment following ART referral by a mobile health clinic. Between April 2015 and May 2016, 86 individuals (≥18 years old) referred for ART in a resource-limited setting were randomized (1:1) to a control group or to an incentive: R300 cash (∼$23, or 3.5 days minimum wage in the domestic worker sector), conditional upon starting ART within 3 months. Outcome data were obtained from clinic records. The incentive effects on linkage to care (first clinic visit within 3 months) and ART initiation (treatment uptake within 3 months) were assessed using logistic regression. Overall, 67% linked to care and 42% initiated ART within 3 months after referral. No significant differences were found between the incentive and non-incentive group in terms of linkage to care [adjusted odds ratio (aOR): 0.70, 95% confidence interval (CI): 0.26-1.91] and initiation of ART (aOR: 0.67, 95% CI: 0.26-1.78). Ordinary least-squares regression analysis showed that incentivized individuals linked to care in fewer days (-7.9, 95% CI: -18.09 to 2.26) and started treatment in fewer days (-7.3, 95% CI: -27.01 to 12.38), but neither result was statistically significant. Our findings demonstrate poor treatment uptake by both the intervention and control participants and further highlight the challenge in achieving universal early treatment access. Further research is required to understand how economic incentives, which have been shown to have many benefits, can be applied to improve linkage to HIV care and treatment.
Collapse
Affiliation(s)
- Brendan Maughan-Brown
- Southern Africa Labour and Development Research Unit (SALDRU), University of Cape Town, Cape Town, South Africa
| | - Philip Smith
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Caroline Kuo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Mark N. Lurie
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Omar Galárraga
- Department of Health Services, Policy and Practice (HSPP), Brown University School of Public Health, Providence, Rhode Island
| |
Collapse
|
78
|
Thapa S, Hannes K, Buve A, Bhattarai S, Mathei C. Theorizing the complexity of HIV disclosure in vulnerable populations: a grounded theory study. BMC Public Health 2018; 18:162. [PMID: 29351785 PMCID: PMC5775526 DOI: 10.1186/s12889-018-5073-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 01/11/2018] [Indexed: 12/04/2022] Open
Abstract
Background HIV disclosure is an important step in delivering the right care to people. However, many people with an HIV positive status choose not to disclose. This considerably complicates the delivery of adequate health care. Methods We conducted a grounded theory study to develop a theoretical model explaining how local contexts impact on HIV disclosure and what the mechanisms are that determine whether people choose to disclose or not. We conducted in-depth interviews among 23 people living with HIV, 8 health workers and 5 family and community members, and 1 community development worker in Achham, Nepal. Data were analysed using constant-comparative method, performing three levels of open, axial, and selective coding. Results Our theoretical model illustrates how two dominant systems to control HIV, namely a community self-coping and a public health system, independently or jointly, shape contexts, mechanisms and outcomes for HIV disclosure. Conclusion This theoretical model can be used in understanding processes of HIV disclosure in a community where HIV is concentrated in vulnerable populations and is highly stigmatized, and in determining how public health approaches would lead to reduced stigma levels and increased HIV disclosure rates.
Collapse
Affiliation(s)
- Subash Thapa
- Department of Public Health and Primary care, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium. .,Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Karin Hannes
- Centre for Sociological Research, Faculty of Social Sciences, KU Leuven, Parkstraat 45, 3000, Leuven, Belgium
| | - Anne Buve
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Shivani Bhattarai
- Department of Public Health, Nobel College Pokhara University, Kathmandu, 44601, Nepal
| | - Catharina Mathei
- Department of Public Health and Primary care, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
| |
Collapse
|
79
|
Ortblad K, Kibuuka Musoke D, Ngabirano T, Nakitende A, Magoola J, Kayiira P, Taasi G, Barresi LG, Haberer JE, McConnell MA, Oldenburg CE, Bärnighausen T. Direct provision versus facility collection of HIV self-tests among female sex workers in Uganda: A cluster-randomized controlled health systems trial. PLoS Med 2017; 14:e1002458. [PMID: 29182634 PMCID: PMC5705079 DOI: 10.1371/journal.pmed.1002458] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/23/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND HIV self-testing allows HIV testing at any place and time and without health workers. HIV self-testing may thus be particularly useful for female sex workers (FSWs), who should test frequently but face stigma and financial and time barriers when accessing healthcare facilities. METHODS AND FINDINGS We conducted a cluster-randomized controlled health systems trial among FSWs in Kampala, Uganda, to measure the effect of 2 HIV self-testing delivery models on HIV testing and linkage to care outcomes. FSW peer educator groups (1 peer educator and 8 participants) were randomized to either (1) direct provision of HIV self-tests, (2) provision of coupons for free collection of HIV self-tests in a healthcare facility, or (3) standard of care HIV testing. We randomized 960 participants in 120 peer educator groups from October 18, 2016, to November 16, 2016. Participants' median age was 28 years (IQR 24-32). Our prespecified primary outcomes were self-report of any HIV testing at 1 month and at 4 months; our prespecified secondary outcomes were self-report of HIV self-test use, seeking HIV-related medical care and ART initiation. In addition, we analyzed 2 secondary outcomes that were not prespecified: self-report of repeat HIV testing-to understand the intervention effects on frequent testing-and self-reported facility-based testing-to quantify substitution effects. Participants in the direct provision arm were significantly more likely to have tested for HIV than those in the standard of care arm, both at 1 month (risk ratio [RR] 1.33, 95% CI 1.17-1.51, p < 0.001) and at 4 months (RR 1.14, 95% CI 1.07-1.22, p < 0.001). Participants in the direct provision arm were also significantly more likely to have tested for HIV than those in the facility collection arm, both at 1 month (RR 1.18, 95% CI 1.07-1.31, p = 0.001) and at 4 months (RR 1.03, 95% CI 1.01-1.05, p = 0.02). At 1 month, fewer participants in the intervention arms had sought medical care for HIV than in the standard of care arm, but these differences were not significant and were reduced in magnitude at 4 months. There were no statistically significant differences in ART initiation across study arms. At 4 months, participants in the direct provision arm were significantly more likely to have tested twice for HIV than those in the standard of care arm (RR 1.51, 95% CI 1.29-1.77, p < 0.001) and those in the facility collection arm (RR 1.22, 95% CI 1.08-1.37, p = 0.001). Participants in the HIV self-testing arms almost completely replaced facility-based testing with self-testing. Two adverse events related to HIV self-testing were reported: interpersonal violence and mental distress. Study limitations included self-reported outcomes and limited generalizability beyond FSWs in similar settings. CONCLUSIONS In this study, HIV self-testing appeared to be safe and increased recent and repeat HIV testing among FSWs. We found that direct provision of HIV self-tests was significantly more effective in increasing HIV testing among FSWs than passively offering HIV self-tests for collection in healthcare facilities. HIV self-testing could play an important role in supporting HIV interventions that require frequent HIV testing, such as HIV treatment as prevention, behavior change for transmission reduction, and pre-exposure prophylaxis. TRIAL REGISTRATION ClinicalTrials.gov NCT02846402.
Collapse
Affiliation(s)
- Katrina Ortblad
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | | | | | | | | | | | - Leah G. Barresi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jessica E. Haberer
- Department of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Margaret A. McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Catherine E. Oldenburg
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Heidelberg Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
80
|
Impact of Facility-Based Mother Support Groups on Retention in Care and PMTCT Outcomes in Rural Zimbabwe: The EPAZ Cluster-Randomized Controlled Trial. J Acquir Immune Defic Syndr 2017; 75 Suppl 2:S207-S215. [PMID: 28498191 DOI: 10.1097/qai.0000000000001360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Prevention of mother-to-child transmission elimination goals are hampered by low rates of retention in care. The Eliminating Paediatric AIDS in Zimbabwe project assessed whether mother support groups (MSGs) improve rates of retention in care of HIV-exposed infants and their HIV-positive mothers, and maternal and infant outcomes. METHODS The study involved 27 rural clinics in eastern Zimbabwe. MSGs were established in 14 randomly selected clinics and met every 2 weeks coordinated by volunteer HIV-positive mothers. MSG coordinators provided health education and reminded mothers of MSG meetings by cell phone. Infant retention in care was defined as "12 months postpartum point attendance" at health care visits of HIV-exposed infants at 12 months of age. We also measured regularity of attendance and other program indicators of HIV-positive mothers and their HIV-exposed infants. RESULTS Among 507 HIV-positive pregnant women assessed as eligible, 348 were enrolled and analyzed (69%) with mothers who had disclosed their HIV status being overrepresented. In the intervention arm, 69% of infants were retained in care at 12 months versus 61% in the control arm, with no statistically significant difference. Retention and other program outcomes were systematically higher in the intervention versus control arm, suggesting trends toward positive health outcomes with exposure to MSGs. DISCUSSION We were unable to show that facility-based MSGs improved retention in care at 12 months among HIV-exposed infants. Selective enrollment of mothers more likely to be retained-in-care may have contributed to lack of effect. Methods to increase the impact of MSGs on retention including targeting of high-risk mothers are discussed.
Collapse
|
81
|
Feasibility and Acceptability of Health Communication Interventions Within a Combination Intervention Strategy for Improving Linkage and Retention in HIV Care in Mozambique. J Acquir Immune Defic Syndr 2017; 74 Suppl 1:S29-S36. [PMID: 27930609 PMCID: PMC5147034 DOI: 10.1097/qai.0000000000001208] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Challenges to ensuring timely linkage to and retention in HIV care are well documented. Combination intervention strategies can be effective in improving the HIV care continuum. Data on feasibility and acceptability of intervention types within intervention packages are limited. METHODS The Engage4Health study assessed the effectiveness of a combination intervention strategy to increase linkage and retention among adults newly diagnosed with HIV in Mozambique. The study included 2 health communication interventions-modified delivery of pre-antiretroviral therapy (pre-ART) counseling sessions and SMS reminders-and 3 structural interventions-point-of-care CD4 testing after diagnosis, accelerated ART initiation, and noncash financial incentives. We used a process evaluation framework to assess dose delivered-extent each intervention was delivered as planned-and dose received-participant acceptability-of health communication versus structural interventions in the effectiveness study to understand associated benefits and challenges. Data sources included study records, participant interviews, and clinical data. RESULTS For dose delivered of health communication interventions, 98% of eligible clients received pre-ART counseling and 90% of participants received at least one SMS reminder. For structural interventions, 74% of clients received CD4 testing and 53% of eligible participants initiated ART within 1 month. Challenges for structural interventions included facility-level barriers, staffing limitations, and machine malfunctions. For dose received, participants reported pre-ART counseling and CD4 testing as the most useful interventions for linkage and financial incentives as the least useful for linkage and retention. DISCUSSION Findings demonstrate that health communication interventions can be feasibly and acceptably integrated with structural interventions to create combination intervention strategies.
Collapse
|
82
|
Stitzer M, Matheson T, Cunningham C, Sorensen JL, Feaster DJ, Gooden L, Hammond AS, Fitzsimons H, Metsch LR. Enhancing patient navigation to improve intervention session attendance and viral load suppression of persons with HIV and substance use: a secondary post hoc analysis of the Project HOPE study. Addict Sci Clin Pract 2017. [PMID: 28651612 PMCID: PMC5485550 DOI: 10.1186/s13722-017-0081-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Interventions are needed to improve viral suppression rates among persons with HIV
and substance use. A 3-arm randomized multi-site study (Metsch et al. in JAMA 316:156–70, 2016) was conducted to evaluate the effect on HIV outcomes of usual care referral to HIV and substance use services (N = 253) versus patient navigation delivered alone (PN: N = 266) or together with contingency management (PN + CM; N = 271) that provided financial incentives targeting potential behavioral mediators of viral load suppression. Aims This secondary analysis evaluates the effects of financial incentives on attendance at PN sessions and the relationship between session attendance and viral load suppression at end of the intervention. Methods Frequency of sessions attended was analyzed over time and by distribution of individual session attendance frequency (PN vs PN + CM). Percent virally suppressed (≤200 copies/mL) at 6 months was compared for low, medium and high rate attenders. In PN + CM a total of $220 could be earned for attendance at 11 PN sessions over the 6-month intervention with payments ranging from $10 to $30 under an escalating schedule. Results The majority (74%) of PN-only participants attended 6 or more sessions but only 28% attended 10 or more and 16% attended all eleven sessions. In contrast, 90% of PN + CM attended 6 or more visits, 69% attended 10 or more and 57% attended all eleven sessions (attendance distribution χ2[11] = 105.81; p < .0001). Overall (PN and PN + CM participants combined) percent with viral load suppression at 6-months was 15, 38 and 54% among those who attended 0–5, 6–9 and 10–11 visits, respectively (χ2(2) = 39.07, p < .001). Conclusion In this secondary post hoc analysis, contact with patient navigators was increased by attendance incentives. Higher rates of attendance at patient navigation sessions was associated with viral suppression at the 6-month follow-up assessment. Study results support use of attendance incentives to improve rates of contact between service providers and patients, particularly patients who are difficult to engage in care. Trial Registration clinicaltrials.govIdentifier: NCT01612169.
Collapse
Affiliation(s)
- Maxine Stitzer
- Department of Psychiatry and Behavioral Sciences, Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA.
| | - Tim Matheson
- San Francisco Department of Public Health, 25 Van Ness Avenue Suite 500, San Francisco, CA, 94102, USA
| | - Colin Cunningham
- Department of Psychiatry and Behavioral Sciences, Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - James L Sorensen
- UCSF Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue SFGH Building 20, Rm. 2117, San Francisco, CA, 94110, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, CRB 1059, Miami, FL, 33136, USA
| | - Lauren Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 918, New York, NY, 10032, USA
| | - Alexis S Hammond
- Department of Psychiatry and Behavioral Sciences, Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - Heather Fitzsimons
- Department of Psychiatry and Behavioral Sciences, Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 918, New York, NY, 10032, USA
| |
Collapse
|
83
|
Sharma M, Barnabas RV, Celum C. Community-based strategies to strengthen men's engagement in the HIV care cascade in sub-Saharan Africa. PLoS Med 2017; 14:e1002262. [PMID: 28399122 PMCID: PMC5388461 DOI: 10.1371/journal.pmed.1002262] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Monica Sharma and colleagues discuss evidence-based approaches to improving HIV services for men in sub-Saharan Africa.
Collapse
Affiliation(s)
- Monisha Sharma
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Ruanne V. Barnabas
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- School of Medicine, University of Washington, Seattle, Washington, United States of America
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Connie Celum
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- School of Medicine, University of Washington, Seattle, Washington, United States of America
| |
Collapse
|
84
|
Healy J, Hope R, Bhabha J, Eyal N. Paying for antiretroviral adherence: is it unethical when the patient is an adolescent? JOURNAL OF MEDICAL ETHICS 2017; 43:145-149. [PMID: 27645199 DOI: 10.1136/medethics-2015-103359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 07/13/2016] [Accepted: 08/11/2016] [Indexed: 06/06/2023]
Abstract
With the expansion of antiretroviral treatment programmes, many children and adolescents with HIV in sub-Saharan Africa could expect to live healthy lives. Yet adolescents have the highest levels of poor antiretroviral adherence and of loss to follow-up compared with other age groups. This can lead to increased morbidity and mortality, to the development of drug-resistant strains, and to high societal costs. While financial incentives have been extensively used to promote medication adherence among adults, their use among adolescents remains rare. And while there is a large body of ethical literature exploring financial incentives among adults, little philosophical thought has gone into their use among adolescents. This paper explores three oft-mentioned ethical worries about financial incentives for health behaviours and it asks whether these concerns are more serious in the context of incentives for improving adolescent adherence. The three worries are that such incentives would unduly coerce adolescents' decision-making, would compromise distributive justice and would crowd out intrinsic motivations and non-monetary values. Our tentative conclusion is that more empirical investigation of these concerns is necessary, and that at this point they are not compelling enough to rule out trials in which adolescents are incentivised for antiretroviral adherence.
Collapse
Affiliation(s)
| | | | - Jacqueline Bhabha
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Nir Eyal
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
85
|
Stitzer M, Calsyn D, Matheson T, Sorensen J, Gooden L, Metsch L. Development of a Multi-Target Contingency Management Intervention for HIV Positive Substance Users. J Subst Abuse Treat 2017; 72:66-71. [PMID: 27624618 PMCID: PMC5154853 DOI: 10.1016/j.jsat.2016.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 08/24/2016] [Indexed: 12/23/2022]
Abstract
Contingency management (CM) interventions generally target a single behavior such as attendance or drug use. However, disease outcomes are mediated by complex chains of both healthy and interfering behaviors enacted over extended periods of time. This paper describes a novel multi-target contingency management (CM) program developed for use with HIV positive substance users enrolled in a CTN multi-site study (0049 Project HOPE). Participants were randomly assigned to usual care (referral to health care and SUD treatment) or 6-months strength-based patient navigation interventions with (PN+CM) or without (PN only) the CM program. Primary outcome of the trial was viral load suppression at 12-months post-randomization. Up to $1160 could be earned over 6 months under escalating schedules of reinforcement. Earnings were divided among eight CM targets; two PN-related (PN visits; paperwork completion; 26% of possible earnings), four health-related (HIV care visits, lab blood draw visits, medication check, viral load suppression; 47% of possible earnings) and two drug-use abatement (treatment entry; submission of drug negative UAs; 27% of earnings). The paper describes rationale for selection of targets, pay amounts and pay schedules. The CM program was compatible with and fully integrated into the PN intervention. The study design will allow comparison of behavioral and health outcomes for participants receiving PN with and without CM; results will inform future multi-target CM development.
Collapse
Affiliation(s)
- Maxine Stitzer
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Baltimore, MD, 21224.
| | - Donald Calsyn
- Department of Psychiatry and Behavioral Science, University of Washington
| | - Timothy Matheson
- San Francisco Department of Public Health, 25 Van Ness Avenue Suite 500, San Francisco, CA, 94102.
| | - James Sorensen
- UCSF Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue SFGH Building 20, Rm. 2117, San Francisco, CA, 94110.
| | - Lauren Gooden
- Department of Sociomedical Sciences Mailman School of Public Health, Columbia University Columbia University, 722 West 168th Street, Room 918, New York, NY, 10032.
| | - Lisa Metsch
- Department of Sociomedical Sciences Mailman School of Public Health, Columbia University Columbia University, 722 West 168th Street, Room 918, New York, NY, 10032.
| |
Collapse
|
86
|
Sears C, Andersson Z, Cann M. Referral Systems to Integrate Health and Economic Strengthening Services for People with HIV: A Qualitative Assessment in Malawi. GLOBAL HEALTH: SCIENCE AND PRACTICE 2016; 4:610-625. [PMID: 28031300 PMCID: PMC5199178 DOI: 10.9745/ghsp-d-16-00195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/01/2016] [Indexed: 01/01/2023]
Abstract
Two types of referral systems were implemented in this low-resource context: (1) a simple paper-based system connecting clinical HIV and nutrition support to village savings and loans services, and (2) a complex mHealth-based system with more than 20 types of health, economic strengthening, livelihoods, and food security services. Clients reported the referrals improved their health and nutrition and ability to save money in both models but more with the simple model. Providers had difficulty using the mobile app under the mHealth system, even after repeated trainings, considerable ongoing technical assistance, and multiple rounds of revisions to the interface. Background: Supporting the diverse needs of people living with HIV (PLHIV) can help reduce the individual and structural barriers they face in adhering to antiretroviral treatment (ART). The Livelihoods and Food Security Technical Assistance II (LIFT) project sought to improve adherence in Malawi by establishing 2 referral systems linking community-based economic strengthening and livelihoods services to clinical health facilities. One referral system in Balaka district, started in October 2013, connected clients to more than 20 types of services while the other simplified approach in Kasungu and Lilongwe districts, started in July 2014, connected PLHIV attending HIV and nutrition support facilities directly to community savings groups. Methods: From June to July 2015, LIFT visited referral sites in Balaka, Kasungu, and Lilongwe districts to collect qualitative data on referral utility, the perceived association of referrals with client and household health and vulnerability, and the added value of the referral system as perceived by network member providers. We interviewed a random sample of 152 adult clients (60 from Balaka, 57 from Kasungu, and 35 from Lilongwe) who had completed their referral. We also conducted 2 focus group discussions per district with network providers. Findings: Clients in all 3 districts indicated their ability to save money had improved after receiving a referral, although the percentage was higher among clients in the simplified Kasungu and Lilongwe model than the more complex Balaka model (85.6% vs. 56.0%, respectively). Nearly 70% of all clients interviewed had HIV infection; 72.7% of PLHIV in Balaka and 95.7% of PLHIV in Kasungu and Lilongwe credited referrals for helping them stay on their ART. After the referral, 76.0% of clients in Balaka and 92.3% of clients in Kasungu and Lilongwe indicated they would be willing to spend their savings on health costs. The more diverse referral network and use of an mHealth app to manage data in Balaka hindered provider uptake of the system, while the simpler system in Kasungu and Lilongwe, which included only 2 referral options and use of a paper-based referral tool, seemed simpler for the providers to manage. Conclusions: Participation in the referral systems was perceived positively by clients and providers in both models, but more so in Kasungu and Lilongwe where the referral process was simpler. Future referral networks should consider limiting the number of service options included in the network and simplify referral tools to the extent possible to facilitate uptake among network providers.
Collapse
|
87
|
Priebe S, Bremner SA, Pavlickova H. Discontinuing financial incentives for adherence to antipsychotic depot medication: long-term outcomes of a cluster randomised controlled trial. BMJ Open 2016; 6:e011673. [PMID: 27655261 PMCID: PMC5051432 DOI: 10.1136/bmjopen-2016-011673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES In a cluster randomised controlled trial, offering financial incentives improved adherence to antipsychotic depot medication over a 1-year period. Yet, it is unknown whether this positive effect is sustained once the incentives stop. METHODS AND ANALYSES Patients in the intervention and control group were followed up for 2 years after the intervention. Primary and secondary outcomes were assessed at 6 months and 24 months post intervention. Assessments were conducted between September 2011 and November 2014. RESULTS After the intervention period, intervention and control groups did not show any statistically significant differences in adherence, neither in the first 6 months (71% and 77%, respectively) nor in the following 18 months (68%, 74%). There were no statistically significant differences in secondary outcomes, that is, adherence ≥95% and untoward incidents either. CONCLUSIONS It may be concluded that incentives to improve adherence to antipsychotic maintenance medication are effective only for as long as they are provided. Once they are stopped, adherence returns to approximately baseline level with no sustained benefit. TRIAL REGISTRATION NUMBER ISRCTN77769281; Results.
Collapse
Affiliation(s)
- Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University London, London, UK
| | - Stephen A Bremner
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Hana Pavlickova
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University London, London, UK
| |
Collapse
|
88
|
Metsch LR, Feaster DJ, Gooden L, Matheson T, Stitzer M, Das M, Jain MK, Rodriguez AE, Armstrong WS, Lucas GM, Nijhawan AE, Drainoni ML, Herrera P, Vergara-Rodriguez P, Jacobson JM, Mugavero MJ, Sullivan M, Daar ES, McMahon DK, Ferris DC, Lindblad R, VanVeldhuisen P, Oden N, Castellón PC, Tross S, Haynes LF, Douaihy A, Sorensen JL, Metzger DS, Mandler RN, Colfax GN, del Rio C. Effect of Patient Navigation With or Without Financial Incentives on Viral Suppression Among Hospitalized Patients With HIV Infection and Substance Use: A Randomized Clinical Trial. JAMA 2016; 316:156-70. [PMID: 27404184 PMCID: PMC5339876 DOI: 10.1001/jama.2016.8914] [Citation(s) in RCA: 153] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Substance use is a major driver of the HIV epidemic and is associated with poor HIV care outcomes. Patient navigation (care coordination with case management) and the use of financial incentives for achieving predetermined outcomes are interventions increasingly promoted to engage patients in substance use disorders treatment and HIV care, but there is little evidence for their efficacy in improving HIV-1 viral suppression rates. OBJECTIVE To assess the effect of a structured patient navigation intervention with or without financial incentives to improve HIV-1 viral suppression rates among patients with elevated HIV-1 viral loads and substance use recruited as hospital inpatients. DESIGN, SETTING, AND PARTICIPANTS From July 2012 through January 2014, 801 patients with HIV infection and substance use from 11 hospitals across the United States were randomly assigned to receive patient navigation alone (n = 266), patient navigation plus financial incentives (n = 271), or treatment as usual (n = 264). HIV-1 plasma viral load was measured at baseline and at 6 and 12 months. INTERVENTIONS Patient navigation included up to 11 sessions of care coordination with case management and motivational interviewing techniques over 6 months. Financial incentives (up to $1160) were provided for achieving targeted behaviors aimed at reducing substance use, increasing engagement in HIV care, and improving HIV outcomes. Treatment as usual was the standard practice at each hospital for linking hospitalized patients to outpatient HIV care and substance use disorders treatment. MAIN OUTCOMES AND MEASURES The primary outcome was HIV viral suppression (≤200 copies/mL) relative to viral nonsuppression or death at the 12-month follow-up. RESULTS Of 801 patients randomized, 261 (32.6%) were women (mean [SD] age, 44.6 years [10.0 years]). There were no differences in rates of HIV viral suppression versus nonsuppression or death among the 3 groups at 12 months. Eighty-five of 249 patients (34.1%) in the usual-treatment group experienced treatment success compared with 89 of 249 patients (35.7%) in the navigation-only group for a treatment difference of 1.6% (95% CI, -6.8% to 10.0%; P = .80) and compared with 98 of 254 patients (38.6%) in the navigation-plus-incentives group for a treatment difference of 4.5% (95% CI -4.0% to 12.8%; P = .68). The treatment difference between the navigation-only and the navigation-plus-incentives group was -2.8% (95% CI, -11.3% to 5.6%; P = .68). CONCLUSIONS AND RELEVANCE Among hospitalized patients with HIV infection and substance use, patient navigation with or without financial incentives did not have a beneficial effect on HIV viral suppression relative to nonsuppression or death at 12 months vs treatment as usual. These findings do not support these interventions in this setting. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01612169.
Collapse
Affiliation(s)
- Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Daniel J Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Lauren Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Tim Matheson
- San Francisco Department of Public Health, San Francisco, California
| | - Maxine Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Moupali Das
- San Francisco Department of Public Health, San Francisco, California5San Francisco General Hospital, San Francisco, California6University of California, San Francisco
| | - Mamta K Jain
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas8Parkland Health and Hospital System, Dallas, Texas
| | - Allan E Rodriguez
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida
| | - Wendy S Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Gregory M Lucas
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ank E Nijhawan
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts13Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Patricia Herrera
- Ruth M. Rothstein CORE Center, John H. Stroger, Jr, Hospital of Cook County, Chicago, Illinois
| | | | - Jeffrey M Jacobson
- Division of Infectious Diseases, Drexel University College of Medicine, Philadelphia, Pennsylvania16Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania17Department of Neuroscience, Lewis Katz School of Medi
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham
| | - Meg Sullivan
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Eric S Daar
- Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance
| | | | - David C Ferris
- Mount Sinai St Luke's and Mount Sinai West Hospitals, New York, New York23Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Neal Oden
- The Emmes Corporation, Rockville, Maryland
| | - Pedro C Castellón
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Susan Tross
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, Department of Psychiatry, Columbia University Medical Center, New York, New York26Greater New York Node, National Drug Abuse Treatment Clinical Trials Network, Subst
| | - Louise F Haynes
- Division of Addiction Sciences, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Antoine Douaihy
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - James L Sorensen
- Western States Node, National Drug Abuse Treatment Clinical Trials Network, Department of Psychiatry, University of California, San Francisco
| | - David S Metzger
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia31Treatment Research Institute, Philadelphia, Pennsylvania
| | - Raul N Mandler
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Grant N Colfax
- San Francisco Department of Public Health, San Francisco, California
| | - Carlos del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia33Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| |
Collapse
|
89
|
Meintjes G, Kerkhoff AD, Burton R, Schutz C, Boulle A, Van Wyk G, Blumenthal L, Nicol MP, Lawn SD. HIV-Related Medical Admissions to a South African District Hospital Remain Frequent Despite Effective Antiretroviral Therapy Scale-Up. Medicine (Baltimore) 2015; 94:e2269. [PMID: 26683950 PMCID: PMC5058922 DOI: 10.1097/md.0000000000002269] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/23/2015] [Accepted: 11/16/2015] [Indexed: 11/25/2022] Open
Abstract
The public sector scale-up of antiretroviral therapy (ART) in South Africa commenced in 2004. We aimed to describe the hospital-level disease burden and factors contributing to morbidity and mortality among hospitalized HIV-positive patients in the era of widespread ART availability. Between June 2012 and October 2013, unselected patients admitted to medical wards at a public sector district hospital in Cape Town were enrolled in this cross-sectional study with prospective follow-up. HIV testing was systematically offered and HIV-infected patients were systematically screened for TB. The spectrum of admission diagnoses among HIV-positive patients was documented, vital status at 90 and 180 days ascertained and factors independently associated with death determined. Among 1018 medical admissions, HIV status was ascertained in 99.5%: 60.1% (n = 609) were HIV-positive and 96.1% (n = 585) were enrolled. Of these, 84.4% were aware of their HIV-positive status before admission. ART status was naive in 35.7%, current in 45.0%, and interrupted in 19.3%. The most frequent primary clinical diagnoses were newly diagnosed TB (n = 196, 33.5%), other bacterial infection (n = 100, 17.1%), and acquired immunodeficiency syndrome (AIDS)-defining illnesses other than TB (n = 64, 10.9%). By 90 days follow-up, 175 (29.9%) required readmission and 78 (13.3%) died. Commonest causes of death were TB (37.2%) and other AIDS-defining illnesses (24.4%). Independent predictors of mortality were AIDS-defining illnesses other than TB, low hemoglobin, and impaired renal function. HIV still accounts for nearly two-thirds of medical admissions in this South African hospital and is associated with high mortality. Strategies to improve linkage to care, ART adherence/retention and TB prevention are key to reducing HIV-related hospitalizations in this setting.
Collapse
Affiliation(s)
- Graeme Meintjes
- From the Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine (GM, CS, LB); Department of Medicine, Faculty of Health Sciences, University of Cape Town (GM, RB, CS, SDL); Department of Medicine, Khayelitsha District Hospital, South Africa (GM, RB); Department of Medicine, Imperial College London, London, UK (GM); The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, South Africa (ADK, SDL); Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA (ADK); Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands (ADK); School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town (AB); Health Impact Assessment Directorate, Western Cape Department of Health (AB); Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town (AB); Department of Medicine, Mitchells Plain Hospital (GVW); Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town (MPN); National Health Laboratory Service, South Africa (MPN); and Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK (SDL)
| | | | | | | | | | | | | | | | | |
Collapse
|