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Adawiyah RA, Boettiger D, Applegate TL, Probandari A, Marthias T, Guy R, Wiseman V. Supply-side readiness to deliver HIV testing and treatment services in Indonesia: Going the last mile to eliminate mother-to-child transmission of HIV. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000845. [PMID: 36962570 PMCID: PMC10021386 DOI: 10.1371/journal.pgph.0000845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 07/06/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Despite national efforts to integrate Prevention of Mother-to-Child Transmission (PMTCT) of HIV services into antenatal care in Indonesia, the rate of mother-to-child transmission of HIV remains the highest in the world. A range of barriers to uptake and long-term engagement in care have been identified, but far less is known about health system preparedness to deliver PMTCT of HIV services. This study explored supply-side barriers to the delivery of PMTCT services in Indonesia and whether these factors are associated with the uptake of antenatal HIV testing. MATERIALS AND METHODS An ecological analysis was undertaken, linking data from the World Bank Quality Service and Delivery Survey (2016) with routine data from Indonesia's HIV and AIDS case surveillance system and district health profile reports (2016). Supply-side readiness scores-generated from a readiness index that measures overall structural capacity and is often used as proxy for quality of care-were adapted from the WHO Service Availability and Readiness Assessment and presented by sector and geographic area. Univariate and multivariate regression analysis was used to explore factors associated with the uptake of antenatal HIV testing in public facilities. RESULTS In general, public facilities scored more highly in most inputs compared to private facilities. Facilities located in urban areas also scored more highly in the majority of inputs compared to ones in rural areas. Readiness scores were lowest for PMTCT services compared to Antenatal Care and HIV Care and Support services, especially for the availability of medicines such as zidovudine and nevirapine. The national composite readiness score for PMTCT was only 0.13 (based on a maximum score of 1) with a composite score of 0.21 for public facilities and 0.06 for private facilities. The multivariate analysis shows that the proportion of pregnant women tested for HIV was more likely to be greater than or equal to 10% in facilities with a higher readiness score and a higher number of trained counsellors available, and less likely in facilities located outside of Java-Bali and in facilities supporting a higher number of village midwives. DISCUSSION Despite targeted efforts by the Indonesian government and multinational agencies, significant gaps exist in the delivery of PMTCT that compromise the standard of care delivered in Indonesia. Future strategies should focus on improving the availability of tests and treatment, especially in the private sector and in rural areas.
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Affiliation(s)
| | - David Boettiger
- The Kirby Institute, University New South Wales, Sydney, Australia
| | | | - Ari Probandari
- The Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Tiara Marthias
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
| | - Rebecca Guy
- The Kirby Institute, University New South Wales, Sydney, Australia
| | - Virginia Wiseman
- The Kirby Institute, University New South Wales, Sydney, Australia
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
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Hargreaves JR, Pliakas T, Hoddinott G, Mainga T, Mubekapi‐Musadaidzwa C, Donnell D, Wilson E, Piwowar‐Manning E, Agyei Y, Bell‐Mandla NF, Dunbar R, Schaap A, Macleod D, Floyd S, Bock P, Fidler S, Seeley J, Stangl A, Bond V, Ayles H, Hayes RJ. The association between HIV stigma and HIV incidence in the context of universal testing and treatment: analysis of data from the HPTN 071 (PopART) trial in Zambia and South Africa. J Int AIDS Soc 2022; 25 Suppl 1:e25931. [PMID: 35818869 PMCID: PMC9274206 DOI: 10.1002/jia2.25931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/03/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION To investigate the association between individual and community-level measures of HIV stigma and HIV incidence within the 21 communities participating in the HPTN (071) PopART trial in Zambia and South Africa. METHODS Secondary analysis of data from a population-based cohort followed-up over 36 months between 2013 and 2018. The outcome was rate of incident HIV infection among individuals who were HIV negative at cohort entry. Individual-level exposures, measured in a random sample of all participants, were: (1) perception of stigma in the community, (2) perception of stigma in health settings and (3) fear and judgement towards people living with HIV. Individual-level analyses were conducted with adjusted, individual-level Poisson regression. Community-level HIV stigma exposures drew on data reported by people living with HIV, health workers and community members. We used linear regression to explore the association between HIV stigma and community-level HIV incidence. RESULTS Among 8172 individuals who were HIV negative and answered individual-level stigma questions at enrolment to the cohort, there was no evidence of a statistically significant association between any domain of HIV stigma and risk of incident HIV infection. Among the full cohort of 26,110 individuals among whom HIV incidence was measured, there was no evidence that community-level HIV incidence was associated with any domain of HIV stigma. CONCLUSIONS HIV stigma is often cited as a barrier to the effectiveness of HIV prevention programming. However, in the setting for the HPTN 071 "PopART trial," measured stigma alone was not associated with the risk of HIV infection.
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Affiliation(s)
- James R. Hargreaves
- Department of Public Health, Environments and Society, Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Triantafyllos Pliakas
- Department of Public Health, Environments and Society, Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Tila Mainga
- Zambart, School of Public HealthUniversity of ZambiaLusakaZambia
| | - Constance Mubekapi‐Musadaidzwa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | | | - Ethan Wilson
- Fred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | | | - Yaw Agyei
- Johns Hopkins UniversitySchool of MedicineBaltimoreMarylandUSA
| | - Nomtha F. Bell‐Mandla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Rory Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Ab Schaap
- Zambart, School of Public HealthUniversity of ZambiaLusakaZambia
| | - David Macleod
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Sarah Fidler
- Department of Medicine, Imperial College NIHR BRCImperial College LondonLondonUK
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Anne Stangl
- International Center for Research on WomenWashingtonDCUSA
- Hera SolutionsBaltimoreMarylandUSA
| | - Virginia Bond
- Zambart, School of Public HealthUniversity of ZambiaLusakaZambia
- Department of Global Health and Development, Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Helen Ayles
- Zambart, School of Public HealthUniversity of ZambiaLusakaZambia
- Department of Clinical Research, Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
| | - Richard J. Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
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Yang LH, Eschliman EL, Mehta H, Misra S, Poku OB, Entaile P, Becker TD, Melese T, Brooks MJ, Eisenberg M, Stockton MA, Choe K, Tal D, Li T, Go VF, Link BG, Rampa S, Jackson VW, Manyeagae GD, Arscott-Mills T, Goodman M, Opondo PR, Ho-Foster AR, Blank MB. A pilot pragmatic trial of a "what matters most"-based intervention targeting intersectional stigma related to being pregnant and living with HIV in Botswana. AIDS Res Ther 2022; 19:26. [PMID: 35739534 PMCID: PMC9219368 DOI: 10.1186/s12981-022-00454-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/08/2022] [Indexed: 01/21/2023] Open
Abstract
We conducted a pilot trial of an intervention targeting intersectional stigma related to being pregnant and living with HIV while promoting capabilities for achieving 'respected motherhood' ('what matters most') in Botswana. A pragmatic design allocated participants to the intervention (N = 44) group and the treatment-as-usual (N = 15) group. An intent-to-treat, difference-in-difference analysis found the intervention group had significant decreases in HIV stigma (d = - 1.20; 95% CI - 1.99, - 0.39) and depressive symptoms (d = - 1.96; 95% CI - 2.89, - 1.02) from baseline to 4-months postpartum. Some, albeit less pronounced, changes in intersectional stigma were observed, suggesting the importance of structural-level intervention components to reduce intersectional stigma.
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Affiliation(s)
- Lawrence H Yang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Evan L Eschliman
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Haitisha Mehta
- Department of Clinical and Counseling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Supriya Misra
- Department of Public Health, San Francisco State University, San Francisco, CA, USA
| | - Ohemaa B Poku
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | | | - Timothy D Becker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tadele Melese
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Merrian J Brooks
- Botswana-UPenn Partnership, Gaborone, Botswana
- Department of Pediatrics, Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Marlene Eisenberg
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Melissa A Stockton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons & New York State Psychiatric Institute, New York, USA
| | - Karen Choe
- Department of Clinical and Counseling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Danielle Tal
- Department of Clinical and Counseling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Tingyu Li
- Department of Clinical and Counseling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Vivian F Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Bruce G Link
- School of Public Policy, University of California Riverside, Riverside, CA, USA
- Department of Sociology, University of California Riverside, Riverside, CA, USA
| | - Shathani Rampa
- Department of Psychology, University of Botswana, Gaborone, Botswana
| | - Valerie W Jackson
- Department of Anesthesia, University of California San Francisco, San Francisco, CA, USA
| | - Gorata D Manyeagae
- Department of Statistics, Faculty of Social Sciences, University of Botswana, Gaborone, Botswana
| | - Tonya Arscott-Mills
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Melody Goodman
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, USA
| | - Philip R Opondo
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Ari R Ho-Foster
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Office of Research and Graduate Studies, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Michael B Blank
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Dey NEY, Owusu Ansah K, Norman QA, Manukure JM, Brew ABK, Dey EA, Agbadi P. HIV Testing among sexually active Ghanaians: an examination of the rural-urban correlates. AIDS Behav 2022; 26:4063-4081. [PMID: 35704123 DOI: 10.1007/s10461-022-03731-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/28/2022]
Abstract
HIV testing is critical in reducing the risk of HIV transmission. We investigated the rural-urban correlates of HIV testing amongst sexually active Ghanaians using data from the 2017/2018 Ghana Multiple Indicator Cluster Survey Six (GMICS 6). Robust Poisson models (reporting Adjusted Prevalence Ratios (APR) and 95% Confidence Intervals (CIs)) were used to achieve this aim. About 46% of the participants had ever tested for HIV. According to the results, approximately 52% and 39% of urban and rural dwellers, respectively, have undergone HIV testing. HIV knowledge, HIV stigma, gender, age, education, marital status, childbirth history, sexual history, health insurance coverage, media exposure, household wealth, and region of residence were significantly related to HIV testing with observed variations across rural-urban areas. The findings call for the expansion of advocacy efforts towards encouraging HIV testing, targeting sexually active Ghanaians particularly in rural areas.
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Affiliation(s)
| | | | | | | | | | - Enam Amen Dey
- Department of Family and Community Health, University of Health and Allied Sciences, PMB 31, Ho, Ghana
| | - Pascal Agbadi
- Department of Sociology and Social Policy, Lingnan University, 8 Castle Peak Road, Tuen Mun, SAR, Hong Kong
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Mason S, Ezechi OC, Obiezu-Umeh C, Nwaozuru U, BeLue R, Airhihenbuwa C, Gbaja-Biamila T, Oladele D, Musa AZ, Modi K, Parker J, Uzoaru F, Engelhart A, Tucker J, Iwelunmor J. Understanding factors that promote uptake of HIV self-testing among young people in Nigeria: Framing youth narratives using the PEN-3 cultural model. PLoS One 2022; 17:e0268945. [PMID: 35657809 PMCID: PMC9165856 DOI: 10.1371/journal.pone.0268945] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 05/12/2022] [Indexed: 12/02/2022] Open
Abstract
It is important to understand how to frame the formats for promoting HIV self-testing to increase uptake among young people. In this study, we used a culture-centered model to understand the narratives of HIV self-testing preferences among young people in Nigeria. We conducted a crowdsourcing contest to solicit ideas surrounding HIV self-testing promotion among young people (10–24 years) in Nigeria from October to November 2018 as part of the 2018 World AIDS Day event. We received 903 submissions and employed thematic content analysis to evaluate 769 eligible youth narratives. Thematic content analysis of the statements from the youth narratives was guided by the PEN-3 cultural model to examine the positive, existential, and negative perceptions (beliefs and values), enablers (resources), and nurturers (roles of friends and family) of HIV self-testing promotion among young people in Nigeria. Several themes emerged as factors that influence the uptake of HIV self-testing among young people in Nigeria. Specifically, seven themes emerged as perceptions: HIV testing accessibility, stigma reduction, and autonomy (positive); HIV self-testing kit packaging and advertisements (existential); lack of knowledge and increased stigma (negative). Seven themes emerged as enablers: social media, school, and government promotion (positive); gamification and animation (existential); high cost and access to linkage to care services (negative); And seven themes emerged as nurturers: peer, families, and faith-based communities (positive); parents and family-centered approach (existential); and partners and family (negative). Our data suggests that increased awareness around HIV self-testing on current youth-friendly platforms, de-stigmatization of HIV and HIV self-testing, decreased prices for HIV self-testing kits, reliability of testing kits, increased linkage to care services, and promotion of self-testing among family members and the community will be beneficial for HIV self-testing scale-up measures among young people in Nigeria.
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Affiliation(s)
- Stacey Mason
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
- * E-mail:
| | - Oliver C. Ezechi
- Clinical Sciences Division, Nigerian Institute of Medical Research, Medical Compound, Lagos, Nigeria
| | - Chisom Obiezu-Umeh
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Ucheoma Nwaozuru
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Rhonda BeLue
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Collins Airhihenbuwa
- Global Research Against Noncommunicable Diseases (GRAND), Georgia State University, School of Public Health, Atlanta, Georgia, United States of America
| | - Titilola Gbaja-Biamila
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - David Oladele
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Adesola Z. Musa
- Clinical Sciences Division, Nigerian Institute of Medical Research, Medical Compound, Lagos, Nigeria
| | - Karan Modi
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Jessica Parker
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Florida Uzoaru
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Alexis Engelhart
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Joseph Tucker
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
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Hubbard JA, Mphande M, Phiri K, Balakasi K, Hoffman RM, Daniels J, Choko A, Coates TJ, Dovel K. Improving ART initiation among men who use HIV self-testing in Malawi: a qualitative study. J Int AIDS Soc 2022; 25:e25950. [PMID: 35700027 PMCID: PMC9196890 DOI: 10.1002/jia2.25950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/24/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION HIV self-testing (HIVST) increases HIV testing uptake among men; however, the linkage to antiretroviral therapy (ART) among HIVST users is low. Innovative strategies for ART initiation are needed, yet little is known about the unique barriers to care experienced by male HIVST users, and what ART-related interventions men desire. METHODS We conducted semi-structured in-depth interviews with cisgender men (≥15 years) in Malawi who tested HIV positive using HIVST between 2018 and 2020, as well as interviews with their female partners (≥15 years) who distributed the HIVST kits. Medical records from seven facilities were used to identify respondents. We included men who received HIVST from a health facility (primary distribution) and from sexual partners (secondary distribution). Interview guides focused on unique barriers to ART initiation following HIVST and desired interventions to improve linkage and initiation. Interviews were audio recorded, translated and transcribed to English, and analysed using constant comparison methods in Atlas.ti v.8.4. Themes were compared by HIVST distribution strategy. Data were collected between 2019 and 2020. RESULTS Twenty-seven respondents were interviewed: eight male/female dyads (16 respondents), eight men without a female partner and three women who represented men who did not participate in the study. Among the 19 men represented (16 men interviewed in person, three represented by secondary report from female partners), seven received HIVST through primary distribution, 12 through secondary distribution. Six men never initiated ART (all secondary HIVST distribution). Barriers to ART initiation centred on the absence of healthcare workers at the time of diagnosis and included lack of external motivation for linkage to care (men had to motivate themselves) and lack of counselling before and after testing (leaving ART-related fears and misconceptions unaddressed)--the latter was especially true for secondary HIVST distribution. Desired interventions were similar across distribution strategies and included ongoing peer mentorship for normalizing treatment adherence, counselling messages tailored to men, outside-facility services for convenience and privacy, and facility navigation to help men understand how to navigate ART clinics. CONCLUSIONS Male HIVST users face unique challenges to ART initiation, especially those receiving HIVST through secondary distribution. Male-tailored interventions are desired by men and may help overcome barriers to care.
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Affiliation(s)
- Julie A. Hubbard
- Division of Infectious DiseasesDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
- Partners in Hope Medical CenterLilongweMalawi
| | | | | | | | - Risa M. Hoffman
- Division of Infectious DiseasesDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Joseph Daniels
- Edson College of Nursing and Health InnovationArizona State UniversityPhoenixArizonaUSA
| | - Augustine Choko
- Malawi‐Liverpool‐Wellcome Trust Clinical Research ProgrammeTB/HIVBlantyreMalawi
| | - Thomas J. Coates
- Division of Infectious DiseasesDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
- University of California Global Health InstituteSan FranciscoCaliforniaUSA
| | - Kathryn Dovel
- Division of Infectious DiseasesDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
- Partners in Hope Medical CenterLilongweMalawi
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Jordão T, Magno L, Pereira M, Rossi TRA, de Almeida Silva P, Figueiredo MAA, de Brito Lima Prado NM, Dos Santos AM, Cangussu MC, Dourado I. Willingness of health care providers to offer HIV self-testing from specialized HIV care services in the northeast of Brazil. BMC Health Serv Res 2022; 22:713. [PMID: 35637470 PMCID: PMC9149328 DOI: 10.1186/s12913-022-08091-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background The insufficient knowledge regarding the serological status of people affected with human immunodeficiency virus (HIV) is a concern in Brazil. HIV self-testing (HIVST) has been proved to have great potential for increasing testing, especially among vulnerable populations. The large-scale distribution of HIVST by the Brazilian public health system has increased in recent years. We aimed to investigate the awareness of HIVST among health care providers (HCP) from specialized HIV/AIDS care services in the state of Bahia, Northeast Brazil. Further we investigated HCP acceptability and willingness to offer its use. Methods A cross-sectional study on HCP from 29 specialized care services (SCS) located in 21 cities in the state of Bahia. HCP working in the service for at least 6 months were included. Sociodemographic, occupational, and behavioral data were collected using a questionnaire. Descriptive statistics were carried out. Bivariate, and multivariate analyses estimating adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) using logistic regression were conducted. Results The awareness and acceptability of HIVST and the willingness to provide it were 79.8, 55.2, and 47.1%, respectively. Few HCP reported that the SCS where they worked dispensed HIVST (3.6%), and 13.5% received some information or training on HIVST. Factors associated with willingness to offer HIVST were: HIVST acceptability (aOR = 9.45; 95% CI: 4.53–19.71), willingness to use HIVST on themselves (aOR = 4.45; 95% CI: 1.62–12.24), confidence in offering HIVST to clients (aOR = 5.73; 95% CI: 2.26–12.72), and considering everyone eligible for HIVST (aOR = 2.88; 95% CI: 1.25–6.59). Conclusions Although most HCP were aware of HIVST, acceptability and willingness to provide it to the clients was moderate. The scale up of HIVST as a mean for the HIV prevention and control policy in Brazil, requires further training of HCP and better implementation of this program. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08091-2.
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Affiliation(s)
- Tiago Jordão
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil.,Diretoria de Vigilância Epidemiológica da Bahia, Secretaria de Saúde do Estado da Bahia, Salvador, Brazil
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil. .,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil.
| | - Marcos Pereira
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil.,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Thais Regis Aranha Rossi
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil
| | - Pedro de Almeida Silva
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil
| | | | | | - Adriano Maia Dos Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brazil
| | | | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Global Health Facility-Based Interventions to Achieve UNAIDS 90-90-90: A Systematic Review and Narrative Analysis. AIDS Behav 2022; 26:1489-1503. [PMID: 34694526 DOI: 10.1007/s10461-021-03503-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
To evaluate whether health facility-based HIV interventions align with UNAIDS 90-90-90 targets, we performed a systematic review through the lens of UNAIDS targets. We searched 11 databases, retrieving 5201 citations with 26 eligible studies classified by country income and UNAIDS target. We analyzed whether reporting of study outcome metrics was in line with UNAIDS targets using a standardized extraction form and results were summarized in a narrative synthesis given data heterogeneity. We also assessed the quality of randomized trials with the Cochrane Risk of Bias Tool and observational studies with the Newcastle-Ottawa Scale. Stratification of interventions by country income level revealed themes in successful interventions that provide insight for scale-up in similar resource contexts. Few studies reported outcomes using metrics according to UNAIDS targets. Standardization of reporting according to the UNAIDS framework could facilitate comparability of interventions and inform country-level progress on an international scale.
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Watson-Grant S, Reynolds Z, Lee D, Mufeti J, Mungunda H, Mswia R. Where are the men in HIV testing and prevention in Namibia? J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01365-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ekholuenetale M, Nzoputam CI, Okonji OC. Association between socio-economic factors and HIV self-testing knowledge amongst South African women. South Afr J HIV Med 2022; 23:1347. [PMID: 35399747 PMCID: PMC8991179 DOI: 10.4102/sajhivmed.v23i1.1347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background Self-testing for HIV is an effective and alternative method of increasing HIV testing rates and a strategy for reaching populations that are underserved by HIV testing services. Nonetheless, many resource-constrained settings are yet to adopt HIV self-testing (HIVST) into their national HIV programmes. Objectives This study aimed to examine the association between socio-economic factors and HIVST knowledge amongst South African women. Method We used nationally representative data from the 2016 South African Demographic and Health Survey. A sample of 8182 women of reproductive age was analysed. The outcome variable was HIVST knowledge. This was measured dichotomously; know versus do not know about HIVST. The multivariable logistic model was used to examine the measures of association, with the level of significance set at P < 0.05. Results The prevalence rate of HIVST knowledge was found to be approximately 24.5% (95% confidence interval [CI]: 22.9–26.1) amongst South African women. Women with tertiary education were 3.93 times more likely to have HIVST knowledge, when compared with those with no formal education (odds ratio [OR]: 3.93; 95% CI: 1.37–11.26). Rural residents had a 33% reduction in HIVST knowledge when compared with those residing in urban areas (OR: 0.67; 95% CI: 0.51–0.89). The odds of interaction between the richer and richest women who have good knowledge of HIV infection were 1.88 and 2.24 times more likely to have HIVST knowledge, respectively, when compared with those from the poorest wealth household who have good knowledge of HIV infection. Conclusion Based on the low level of HIVST knowledge, the findings emphasise the importance of developing effective HIVST educational campaigns. Moreover, programmes should be designed to address the unique needs of the socio-economically disadvantaged women.
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Affiliation(s)
- Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Chimezie I. Nzoputam
- Department of Public Health, Center of Excellence in Reproductive Health Innovation (CERHI), College of Medical Sciences, University of Benin, Benin City, Nigeria
- Department of Medical Biochemistry, School of Basic Medical Sciences, University of Benin, Benin City, Nigeria
| | - Osaretin C. Okonji
- School of Pharmacy, Faculty of Natural Science, University of the Western Cape, Cape Town, South Africa
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Lazarus L, Prakash R, Kombo BK, Thomann M, Olango K, Ongaro MK, Kuria S, Melon M, Musyoki H, Shaw S, Bhattacharjee P, Lorway R. Understanding socio-sexual networks: critical consideration for HIVST intervention planning among men who have sex with men in Kenya. BMC Public Health 2022; 22:559. [PMID: 35313838 PMCID: PMC8939075 DOI: 10.1186/s12889-022-12901-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV self-testing (HIVST) has emerged as a way of reaching individuals who may be less likely to access testing, including men who have sex with men (MSM). Understanding the social networks of MSM is key to tailoring interventions, such as HIVST, for particular locations. METHODS We undertook a socio-sexual network study to characterize and identify patterns of connection among MSM and inform an HIVST intervention in three sites in Kenya. Community researchers in each site selected eight seeds to complete a demographic form and network surveys for 15 each of their sexual and social network members. Seeds recruited three respondents, including two regular service users and one MSM who was "unreached" by the program, who then each identified three respondents, resulting with data on 290 individuals. RESULTS Findings illustrate the interconnectedness of community-based organization (CBO) members and non-members. In networks where a majority of members had a CBO membership, members had better contacts with programs and were more likely to have accessed health services. Larger networks had more HIV testing and seeds with frequent testing had a positive influence on their network members also being tested frequently. HIVST was tried in very few networks. Almost all network members were willing to use HIVST. CONCLUSION Willingness to use HIVST was nearly universal and points to the importance of networks for reaching individuals not enrolled in programs. Network analysis can help in understanding which type of networks had higher testing and how network-based approaches can be useful to promote HIVST in certain contexts.
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Affiliation(s)
- Lisa Lazarus
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Ave, Winnipeg, Manitoba, R3E 0T6, Canada.
| | - Ravi Prakash
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Ave, Winnipeg, Manitoba, R3E 0T6, Canada.,India Health Action Trust, Bangalore, India
| | - Bernadette K Kombo
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Ave, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Matthew Thomann
- Department of Anthropology, University of Maryland, College Park, MD, USA
| | | | | | | | - Memory Melon
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Helgar Musyoki
- Ministry of Health, National AIDS and STI Control Programme, Nairobi, Kenya
| | - Souradet Shaw
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Ave, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Parinita Bhattacharjee
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Ave, Winnipeg, Manitoba, R3E 0T6, Canada.,Partners for Health and Development in Africa, Nairobi, Kenya
| | - Robert Lorway
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Ave, Winnipeg, Manitoba, R3E 0T6, Canada
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Ukaegbu E, Alibekova R, Ali S, Crape B, Issanov A. Trends of HIV/AIDS knowledge and attitudes among Nigerian women between 2007 and 2017 using Multiple Indicator Cluster Survey data. BMC Public Health 2022; 22:440. [PMID: 35246087 PMCID: PMC8897895 DOI: 10.1186/s12889-022-12865-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 02/23/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Globally, Nigeria ranks third among the countries with the highest number of People Living with HIV (PLHIV). Given that HIV/AIDS knowledge is a key factor that determines the risk of transmission and certain attitudes towards PLHIV, there is a need to understand the trend of HIV knowledge within the population for the purpose of assessing the progress and outcome of HIV prevention strategies. The aim of the study was to understand the trends of HIV/AIDS knowledge and attitude towards PLHIV between 2007 to 2017 among Nigerian women, and to investigate change in the factors associated with HIV/AIDS knowledge and attitude towards PLHIV over years. METHODS Data were derived from three Nigerian Multiple Indicator Cluster Surveys (2007, 2011 and 2016-2017) among women aged 15-49 years old from each geo-political zone (South South, South East, South West, North East, North West, North Central) in Nigeria. Participants who did not answer questions related to HIV/AIDS knowledge and attitude were excluded from the study. The final sample sizes were 17,733 for 2007, 26,532 for 2011 and 23,530 for 2017. In descriptive statistics, frequencies represented the study sample, while percentages represented weighted estimates for the population parameters. Rao-Scott chi-square test for complex survey design studies was used to assess bivariable associations. Factors associated with outcome variables were examined using the survey-weighted multivariable logistic regression models for the complex survey design while controlling for potential confounding variables. RESULTS There was a relatively high level of HIV/AIDS knowledge level in 2007 and 2016-2017 surveys (64.6 and 64.1%, respectively), however a decrease in HIV/AIDS knowledge trend was observed in 2011 (45.6%). The positive attitude towards PLHIV progressively increased across the years (from 40.5 to 47.0% to 53.5%). Multivariable analysis revealed that women who had a higher educational level, higher wealth index, and lived in urban areas had higher odds for HIV/AIDS knowledge and positive attitude towards PLHIV across the years. In addition, the Northern zones had predominantly higher knowledge and attitude levels. CONCLUSIONS Our study found increasing tendency for high HIV/AIDS knowledge and positive attitude towards PLHIV over the years. Women's age, wealth index, education level and residence were consistently associated with knowledge and attitude over the years. There is a need for more pragmatic HIV/AIDS-related knowledge action plan to target to cover all age groups, all geo-political zones while paying close attention to the rural areas and the less educated women. In addition, more replicative studies of HIV/AIDS knowledge and attitude trends is crucial in monitoring of the progress of HIV interventions in the country in the coming years.
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Affiliation(s)
- Enyinnaya Ukaegbu
- Department of Medicine, School of Medicine, Nazarbayev University, Kerey and Zhanibek Khans St 5/1, Nur-Sultan, Kazakhstan 010000
| | - Raushan Alibekova
- Department of Medicine, School of Medicine, Nazarbayev University, Kerey and Zhanibek Khans St 5/1, Nur-Sultan, Kazakhstan 010000
| | - Syed Ali
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Kerey and Zhanibek Khans St 5/1, Nur-Sultan, Kazakhstan 010000
| | - Byron Crape
- Department of Medicine, School of Medicine, Nazarbayev University, Kerey and Zhanibek Khans St 5/1, Nur-Sultan, Kazakhstan 010000
| | - Alpamys Issanov
- Department of Medicine, School of Medicine, Nazarbayev University, Kerey and Zhanibek Khans St 5/1, Nur-Sultan, Kazakhstan 010000
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Johnson MJ, Darbes LA, Hosegood V, Johnson MO, Fritz K, Ngubane T, van Rooyen H, McGrath N. Social Influence and Uptake of Couples HIV Testing and Counselling in KwaZulu-Natal, South Africa. AIDS Behav 2022; 26:764-774. [PMID: 34417920 PMCID: PMC8840905 DOI: 10.1007/s10461-021-03435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 11/17/2022]
Abstract
Social influences may create a barrier to couples HIV testing and counselling (CHTC) uptake in sub-Saharan Africa. This secondary analysis of data collected in the 'Uthando Lwethu' randomised controlled trial used discrete-time survival models to evaluate the association between within-couple average 'peer support' score and uptake of CHTC by the end of nine months' follow-up. Peer support was conceptualised by self-rated strength of agreement with two statements describing friendships outside of the primary partnership. Eighty-eight couples (26.9%) took up CHTC. Results tended towards a dichotomous trend in models adjusted only for trial arm, with uptake significantly less likely amongst couples in the higher of four peer support score categories (OR 0.34, 95% CI 0.18, 0.68 [7-10 points]; OR 0.53, 95% CI 0.28, 0.99 [≥ 11 points]). A similar trend remained in the final multivariable model, but was no longer significant (AOR 0.59, 95% CI 0.25, 1.42 [7-10 points]; AOR 0.88, 95% CI 0.36, 2.10 [≥ 11 points]). Accounting for social influences in the design of couples-focused interventions may increase their success.
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Affiliation(s)
- Matthew J. Johnson
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Mailpoint 95, Tremona Road, Southampton, SO16 6YD UK
- NIHR ARC Wessex Data Science Hub, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, UK
| | - Lynae A. Darbes
- Center for AIDS Prevention Studies, Division of Prevention Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA USA
- Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, USA
| | - Victoria Hosegood
- Department of Social Statistics and Demography, Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Mallory O. Johnson
- Center for AIDS Prevention Studies, Division of Prevention Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Katherine Fritz
- International Center for Research on Women, Washington, DC USA
| | | | - Heidi van Rooyen
- Human Sciences Research Council, Durban, South Africa
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nuala McGrath
- Department of Social Statistics and Demography, Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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Chimoyi L, Chikovore J, Musenge E, Mabuto T, Chetty-Makkan CM, Munyai R, Nchachi T, Charalambous S, Setswe G. Understanding factors influencing utilization of HIV prevention and treatment services among patients and providers in a heterogeneous setting: A qualitative study from South Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000132. [PMID: 36962320 PMCID: PMC10021737 DOI: 10.1371/journal.pgph.0000132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/29/2021] [Indexed: 12/16/2022]
Abstract
Despite advances made in HIV prevention and treatment interventions in South Africa, barriers to their utilization continue to exist. Understanding perspectives from patients and providers of healthcare can shed light on the necessary strategies to enhance uptake of HIV services. A cross-sectional qualitative study was conducted in July 2020 in Ekurhuleni District. Based on HIV prevalence estimates from a national survey, male condom use coverage and antiretroviral treatment (ART) initiation rates from routinely collected clinical data for 2012, we selected facilities from geographical areas with varying HIV prevalence and uptake of HIV services. In-depth interviews were conducted with adult (≥18 years) patients and healthcare workers in selected primary healthcare facilities. Thematic analysis was performed following a framework built around the social cognitive theory to describe behavioural, personal, and social/environmental factors influencing utilization of HIV services. Behavioural factors facilitating uptake of HIV services included awareness of the protective value of condoms, and the benefits of ART in suppressing viral load and preventing mother-to-child HIV transmission which was evident across geographical areas. Barriers in high prevalence areas included suboptimal condom use, fears of a positive HIV result, and anticipated HIV-related stigma while seeking healthcare services. Across the geographical areas, personal factors included ability to correctly use available services enhanced by knowledge acquired during counselling sessions and community-based health promotion activities. Further, social support from family reinforced engagement in care. Compared to low uptake areas, clinics in high uptake areas used care-facilitators, outreach teams and decanting programs to address the environmental barriers including staff shortages and long queues. Barriers at multiple levels prevent optimal utilization of HIV services, calling for strategies that target and address the different levels and tailored to needs of specific settings. Overall, improved delivery of HIV prevention or treatment interventions can be achieved through strengthening training of healthcare providers in facilities and communities and addressing negative sequelae from utilising services in low uptake areas.
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Affiliation(s)
- Lucy Chimoyi
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeremiah Chikovore
- Human and Social Capabilities Research Division, Human Sciences Research Council, Durban, South Africa
| | - Eustasius Musenge
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Tonderai Mabuto
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Candice. M. Chetty-Makkan
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Faculty of Health Sciences, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Reuben Munyai
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Tshegang Nchachi
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Salome Charalambous
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Geoffrey Setswe
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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Do Community-based Livelihood Interventions Affect Sexual and Reproductive Health and Rights of Young People in Slum Areas of Uganda: a Difference-in-difference with Kernel Propensity Score Matching Analysis. J Urban Health 2022; 99:164-189. [PMID: 35034278 PMCID: PMC8866584 DOI: 10.1007/s11524-021-00596-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 02/03/2023]
Abstract
Slum dwellers across Africa have been targeted in interventions whose impacts remain unclear. We evaluated the impact of a livelihood intervention on the sexual and reproductive health and rights (SRHR) of young people in the slum areas of Kampala, Uganda. We carried out a repeated cross-sectional survey in 2014 and 2017 to examine the impact of community-based livelihood interventions on the SRHR of young people in the slum areas of Kampala, Uganda. Impacts were observed such as reduced sexual activity, reduction in aspects of gender-based violence attitudes and beliefs, increased access to and decision-making about contraceptive and family-planning services, increased availability and affordability of SRHR services, reduced need to seek further knowledge on SRHR, reduced barriers to HIV testing, and increased knowledge of health responsibilities. Unexpected results included: increased proportion of young people who had ever had sex, decreased mean age of sexual debut, unaffordability of contraceptives, and increased culturally shaped attitudes and social norms related to gender-based violence. We observed no impact on condom use, consensual sex and sexual assault, the number of sexual partners, knowledge about HIV/AIDS, stigma and discrimination against people living with HIV/AIDS, affordability of male and female condoms, and uptake of HIV testing services. Rights-based interventions are crucial to how we understand the SRHR of young people in complex sociocultural environments. While the livelihood interventions made significant impacts on the SRHR of young people, there are questions about how such interventions address deeply rooted sociocultural practices to maximise outcomes.
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Phiri MM, Schaap A, Simwinga M, Hensen B, Floyd S, Mulubwa C, Simuyaba M, Chiti B, Bond V, Shanaube K, Fidler S, Hayes R, Ayles H. Closing the gap: did delivery approaches complementary to home-based testing reach men with HIV testing services during and after the HPTN 071 (PopART) trial in Zambia? J Int AIDS Soc 2022; 25:e25855. [PMID: 35001530 PMCID: PMC8743361 DOI: 10.1002/jia2.25855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 11/26/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The HPTN 071 (PopART) trial demonstrated that universal HIV testing-and-treatment reduced community-level HIV incidence. Door-to-door delivery of HIV testing services (HTS) was one of the main components of the intervention. From an early stage, men were less likely to know their HIV status than women, primarily because they were not home during service delivery. To reach more men, different strategies were implemented during the trial. We present the relative contribution of these strategies to coverage of HTS and the impact of community hubs implemented after completion of the trial among men. METHODS Between 2013 and 2017, three intervention rounds (IRs) of door-to-door HTS delivery were conducted in eight PopART communities in Zambia. Additional strategies implemented in parallel, included: community-wide "Man-up" campaigns (IR1), smaller HTS campaigns at work/social places (IR2) and revisits to households with the option of HIV self-testing (HIVST) (IR3). In 2018, community "hubs" offering HTS were implemented for 7 months in all eight communities. Population enumeration data for each round of HTS provided the denominator, allowing for calculation of the proportion of men tested as a result of each strategy during different time periods. RESULTS By the end of the three IRs, 65-75% of men were reached with HTS, primarily through door-to-door service delivery. In IR1 and IR2, "Man-up" and work/social place campaigns accounted for ∼1 percentage point each and in IR3, revisits with the option of self-testing for ∼15 percentage points of this total coverage per IR. The yield of newly diagnosed HIV-positive men ranged from 2.2% for HIVST revisits to 9.9% in work/social places. At community hubs, the majority of visitors accepting services were men (62.8%). In total, we estimated that ∼36% (2.2% tested HIV positive) of men resident but not found at their household during IR3 of PopART accessed HTS provided at the hubs after trial completion. CONCLUSIONS Achieving high coverage of HTS among men requires universal, home-based service delivery combined with an option of HIVST and delivery of HTS through community-based hubs. When men are reached, they are willing to test for HIV. Reaching men thus requires implementers to adapt their HTS delivery strategies to meet men's needs. CLINICAL TRIAL NUMBER NCT01900977.
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Affiliation(s)
| | - Ab Schaap
- ZambartLusakaZambia
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | | | - Bernadette Hensen
- Clinical Research DepartmentLondon School of Hygiene and Tropical MedicineLondonUK
| | - Sian Floyd
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | | | | | | | - Virginia Bond
- ZambartLusakaZambia
- Department of Global HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | | | - Sarah Fidler
- Imperial College and Imperial College NIHR BRCLondonUK
| | - Richard Hayes
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Helen Ayles
- ZambartLusakaZambia
- Clinical Research DepartmentLondon School of Hygiene and Tropical MedicineLondonUK
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Hensen B, Phiri M, Schaap A, Sigande L, Simwinga M, Floyd S, Belemu S, Simuyaba M, Shanaube K, Fidler S, Hayes R, Ayles HM. Uptake of HIV Testing Services Through Novel Community-Based Sexual and Reproductive Health Services: An Analysis of the Pilot Implementation Phase of the Yathu Yathu Intervention for Adolescents and Young People Aged 15-24 in Lusaka, Zambia. AIDS Behav 2022; 26:172-182. [PMID: 34302282 DOI: 10.1007/s10461-021-03368-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/24/2022]
Abstract
Adolescents and young people aged 15-24 are underserved by available HIV-testing services (HTS). Delivering HTS through community-based, peer-led, hubs may prove acceptable and accessible to adolescents and young people, thus increasing HIV-testing coverage. We used data from the pilot phase of a cluster-randomised trial of community-based sexual and reproductive health services for adolescents and young people in Lusaka, Zambia, between September 2019 and January 2020, to explore factors associated with uptake of HTS through community-based hubs. 5,757 adolescents and young people attended the hubs (63% female), among whom 75% tested for HIV (76% of females, 75% of males). Community-based hubs provided HTS to 80% of adolescents and young people with no history of HIV-testing. Among females, uptake of HTS was lower among married/cohabiting females; among males, uptake was lower among unmarried males and among individuals at risk of hazardous alcohol use. The high number of adolescents and young people accessing hubs for HIV testing suggests they are acceptable. Enhanced targeting of HTS to groups who may not perceive their HIV risk needs to be implemented.
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Affiliation(s)
- B Hensen
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
| | | | - A Schaap
- Zambart, Lusaka, Zambia
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - S Floyd
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - S Fidler
- Imperial College London, Imperial College National Institute of Heath Research BRC, London, UK
| | - R Hayes
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - H M Ayles
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Zambart, Lusaka, Zambia
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Kway A, Sabi I, Olomi W, Mcharo RD, Sanga E, William W, Chimbe O, Ntinginya NE, Maganga L. HIV testing and linkage to care-A case of a mobile diagnostic and counseling service in Mbeya, Tanzania; A quantitative study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000448. [PMID: 36962533 PMCID: PMC10021411 DOI: 10.1371/journal.pgph.0000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/13/2022] [Indexed: 11/19/2022]
Abstract
HIV-care programmes are faced with significant challenges in getting newly diagnosed People Living with Human Immunodeficiency Virus (PLHIV) linked to care despite massive investment in HIV prevention, treatment and care. This study assessed the performance of mobile HIV Testing and Counseling service (mHTC) in provision of HIV-testing and linkage to care of newly diagnosed PLHIV from Key and Vulnerable Populations (KVPs). A retrospective review of the records of 25,248 clients was extracted from the mHTC database from October-2016 to September-2018. Of 25,248 clients, 51.71% were in 25-45 years age group, 55.4% were males, 60.5% were married and 62.1% had primary level of education. The median age of clients was 31 (IQR: 23-42) years. Out of the clients tested, 800 (3.17%) were diagnosed HIV-positive. Positivity was high among females 450 (4%), age group 25-45 years 538 (4.12%), divorced 202 (7.41%) and clients with primary level of education 504 (3.21%). An association between HIV status and sex, age group, relationship status and level of education was observed (P<0001). Out of the 800 HIV-positive clients, 418 (52.30%) were successfully linked to care. Among the positive clients, 5/6 (83.33%) children below 15 years old, 238/450 (52.89%) females and 39/64 (60.94%) widows were successfully linked to care. In the multivariable log binomial regression model age of the clients was associated with successful linkage to care. The mHTC was able to reach KVP clients; overall linkage for both sexes was 52.30% below the recommended UNAIDS 90-90-90 target. Raising the need to address the challenges associated with linkage and specific care for KVPs as a subset of the general population. The mHTC has shown that it is feasible to improve the reach of KVP clients; however, further research is required to examine the quality of this service at the community level.
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Affiliation(s)
- Amani Kway
- National Institute for Medical Research - Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Issa Sabi
- National Institute for Medical Research - Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Willyhelmina Olomi
- National Institute for Medical Research - Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Ruby Doryn Mcharo
- National Institute for Medical Research - Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Erica Sanga
- National Institute for Medical Research - Mwanza Centre, Mwanza, Tanzania
| | - Wiston William
- National Institute for Medical Research - Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Ombeni Chimbe
- National Institute for Medical Research - Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Nyanda Elias Ntinginya
- National Institute for Medical Research - Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Lucas Maganga
- National Institute for Medical Research - Mbeya Medical Research Centre, Mbeya, Tanzania
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Iguna S, Getahun M, Lewis-Kulzer J, Odhiambo G, Adhiambo F, Montoya L, Petersen ML, Bukusi E, Odeny T, Geng E, Camlin CS. Attitudes towards and experiences with economic incentives for engagement in HIV care and treatment: Qualitative insights from a randomized trial in Kenya. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000204. [PMID: 36962322 PMCID: PMC10021832 DOI: 10.1371/journal.pgph.0000204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022]
Abstract
Growing literature has shown heterogenous effects of conditional cash incentives (CCIs) on HIV care retention. The field lacks insights into reasons why incentives impact various patients in different ways-differences that may be due to variations in psychological and social mechanisms of effect. A deeper understanding of patients' perceptions and experiences of CCIs for retention may help to clarify these mechanisms. We conducted a qualitative study embedded in the ADAPT-R trial (NCT#02338739), a sequential multiple assignment randomized trial (SMART) that evaluated economic incentives to support retention in HIV care among persons living with HIV (PLHIV) initiating antiretroviral therapy in Kenya. Participants who attended their scheduled clinic visits received an incentive of approximately $4 each visit. Interviews were conducted between July 2016 and June 2017 with 39 participants to explore attitudes and experiences with economic incentives conditional on care engagement. Analyses revealed that incentives helped PLHIV prioritize care-seeking by alleviating transport barriers and food insecurity: "I decided to forgo [work] and attend clinic […] the voucher relieved me". Patients who borrowed money for care-seeking reported feeling relieved from the burden of indebtedness to others: "I borrow with confidence that I will pay after my appointment." Incentives fostered their autonomy, and enabled them to support others: "I used the money to buy some clothes and Pampers for the children." Participants who were intrinsically motivated to engage in care ("my life depends on the drugs, not the incentive"), and those who mistrusted researchers, reported being less prompted by the incentive itself. For patients not already prioritizing care-seeking, incentives facilitated care engagement through alleviating transport costs, indebtedness and food insecurity, and also supported social role fulfillment. Conditional cash incentives may be an important cue to action to improve progression through the HIV treatment cascade, and contribute to better care retention.
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Affiliation(s)
- Sarah Iguna
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Jayne Lewis-Kulzer
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Gladys Odhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Fridah Adhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Lina Montoya
- Division of Biostatistics, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Maya L Petersen
- Divisions of Biostatistics and Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Elizabeth Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Thomas Odeny
- Department of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Elvin Geng
- Division of Infectious Diseases, Department of Internal Medicine, Washington University, St. Louis, Missouri, United States of America
| | - Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, California, United States of America
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Hempel S, Ferguson L, Bolshakova M, Yagyu S, Fu N, Motala A, Gruskin S. Frameworks, measures, and interventions for HIV-related internalised stigma and stigma in healthcare and laws and policies: systematic review protocol. BMJ Open 2021; 11:e053608. [PMID: 34887280 PMCID: PMC8663079 DOI: 10.1136/bmjopen-2021-053608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is strong global commitment to eliminate HIV-related stigma. Wide variation exists in frameworks and measures, and many strategies to prevent, reduce or mitigate stigma have been proposed but critical factors determining success or failure remain elusive. METHODS AND ANALYSIS Building on existing knowledge syntheses, we designed a systematic review to identify frameworks, measures and intervention evaluations aiming to address internalised stigma, stigma and discrimination in healthcare, and stigma and discrimination at the legal or policy level. The review addresses four key questions (KQ): KQ1: Which conceptual frameworks have been proposed to assess internal stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? KQ2: Which measures of stigma have been proposed and what are their descriptive properties? KQ3: Which interventions have been evaluated that aimed to reduce these types of stigma and discrimination or mitigate their adverse effects and what are the effectiveness and unintended consequences? KQ4: What common 'critical factors for success or failure' can be identified across interventions that have been evaluated? We will search PubMed, PsycINFO, Web of Science, Universal Human Rights Index, HeinOnline, PAIS, HIV Legal Network, CDSR, Campbell Collaboration, PROSPERO and Open Science Framework. Critical appraisal will assess the source, processes and consensus finding for frameworks; COnsensus-based Standards for the selection of health Measurement Instruments criteria for measures; and risk of bias for interventions. Quality of evidence grading will apply . A gap analysis will provide targeted recommendations for future research. We will establish a compendium of frameworks, a comprehensive catalogue of available measures, and a synthesis of intervention characteristics to advance the science of HIV-related stigma. PROSPERO REGISTRATION NUMBER CRD42021249348.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sachi Yagyu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Ning Fu
- Department of Economics, Shanghai University of Finance and Economics, Shanghai, China
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
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Mphande M, Campbell P, Hoffman RM, Phiri K, Nyirenda M, Gupta SK, Wong V, Dovel K. Barriers and facilitators to facility HIV self-testing in outpatient settings in Malawi: a qualitative study. BMC Public Health 2021; 21:2200. [PMID: 34856958 PMCID: PMC8638200 DOI: 10.1186/s12889-021-12213-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 08/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background Facility HIV self-testing (HIVST) within outpatient departments can increase HIV testing coverage by facilitating HIVST use in outpatient waiting spaces while clients wait for routine care. Facility HIVST allows for the majority of outpatients to test with minimal health care worker time requirements. However, barriers and facilitators to outpatients’ use of facility HIVST are still unknown. Methods As part of a cluster randomized trial on facility HIVST in Malawi, we conducted in-depth interviews with 57 adult outpatients (> 15 years) who were exposed to the HIVST intervention and collected observational journals that documented study staff observations from facility waiting spaces where HIVST was implemented. Translated and transcribed data were analyzed using constant comparison analysis in Atlas.ti. Results Facility HIVST was convenient, fast, and provided autonomy to outpatients. The strategy also had novel facilitators for testing, such as increased motivation to test due to seeing others test, immediate support for HIVST use, and easy access to additional HIV services in the health facility. Barriers to facility HIVST included fear of judgment from others and unwanted status disclosure due to lack of privacy. Desired changes to the intervention included private, separate spaces for kit use and interpretation and increased opportunity for disclosure and post-test counseling. Conclusions Facility HIVST was largely acceptable to outpatients in Malawi with novel facilitators that are unique to facility HIVST in OPD waiting spaces. Trial registration The parent trial is registered with ClinicalTrials.gov, NCT03271307, and Pan African Clinical Trials, PACTR201711002697316.
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Affiliation(s)
| | - Paula Campbell
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Risa M Hoffman
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Sundeep K Gupta
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Vincent Wong
- Office of HIV/AIDS, United States Agency for International Development, Washington D.C, USA
| | - Kathryn Dovel
- Partners in Hope, Box, 302, Lilongwe, Malawi.,Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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72
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Nyasulu PS, Tshuma N, Sigwadhi LN, Nyasulu J, Ogunrombi M, Chimoyi L. Factors associated with high HIV-related stigma among commuter populations in Johannesburg, South Africa. SAHARA J 2021; 18:149-155. [PMID: 34702146 PMCID: PMC8555515 DOI: 10.1080/17290376.2021.1989022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Stigma remains an important barrier to seeking and staying in care among individuals infected with Human Immunodeficiency Virus (HIV). Despite continued widespread information, education and communication campaigns to raise awareness about the infection. The aim of the study was to identify factors related to HIV stigma among a commuter population in the inner-city Johannesburg. A self-administered closed-ended questionnaire was loaded onto personal tablet computers during a community outreach campaign. The outcome was measured by asking the respondents to rate their perceptions of stigma as 'high or low'. About 1146 participants were enrolled in the study of which 585 (51.0%) reported high stigma levels. Overall, being married/cohabiting (Adjusted Prevalence Ratio (APR): 1.14 95%CI: 1.02-1.28), divorced (APR: 1.38 95%CI: 1.07-1.78), were associated with high levels of stigma; while being aware of HCT services (APR: 0.85 95%CI: 0.75-0.97) and employment status (APR: 0.78 95%CI: 0.71-0.87) were less likely associated with a high level of stigma. High HIV stigma still exists among those affected in our communities. Enhancement of health promotion intervention and reinforcing the benefits of knowing HIV status is essential to mitigate factors shown to influence stigma in the commuter population. Such an approach would help overcome stigma, an obstacle for expanding access to HIV testing and counselling.
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Affiliation(s)
- Peter S Nyasulu
- Division of Epidemiology & Biostatistics, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ndumiso Tshuma
- Best Health Solutions, Orange Grove, Johannesburg, South Africa
| | - Lovemore N Sigwadhi
- Division of Epidemiology & Biostatistics, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Juliet Nyasulu
- Division of Community Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Modupe Ogunrombi
- Department of Clinical Pharmacology, School of Medicine, Sefako Makgatho Health Science University, Pretoria, South Africa
| | - Lucy Chimoyi
- The Aurum Institute, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Intimate partner violence and the HIV care and treatment cascade among adolescent girls and young women in DREAMS, South Africa. J Acquir Immune Defic Syndr 2021; 89:136-142. [PMID: 34723930 PMCID: PMC8740602 DOI: 10.1097/qai.0000000000002843] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/27/2021] [Indexed: 12/02/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: Intimate partner violence (IPV) may affect the HIV-treatment cascade. Setting: Four high HIV-prevalence DREAMS health districts in South Africa. Methods: Secondary analysis of cross-sectional data collected March 2017–June 2018, using random household sample of young (12–24 years) girls and women. Face-to-face interviews assessed IPV and HIV-status knowledge, and finger-prick blood draws assessed ART (antiretroviral therapy) uptake and viral suppression. We used logistic regression to estimate crude and adjusted effects of IPV on HIV knowledge, ART uptake, and viral suppression. Results: Of 18,230 adolescent girls and young women, 8413 (46%) reported ever having had sex, of whom 1118 (13%) were HIV positive. The 90:90:90 benchmarks were 61% knew their status, 86% had ART present in their blood sample, and 91% were virally suppressed. Among the entire sample of young women living with HIV, 65.6% were virally suppressed. Past year IPV was reported by 15%. In adjusted models, IPV trended toward increasing the odds that a young woman was aware she was living with HIV [adjusted odds ratios (aOR) = 1.40, 2.00–9.98, P = 0.067]. There was no association between IPV and reduced treatment use (aOR = 0.73, 0.41–1.29). IPV was independently associated with reduced viral suppression (aOR = 0.30, 0.13–0.66). Conclusions: Addressing the role of IPV in undermining the treatment cascade for adolescent and young women is a critical issue for HIV programming.
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74
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Razzaq A, Raynes-Greenow C, Alam A. Barriers to uptaking HIV testing among pregnant women attending antenatal clinics in low- and middle-income countries: A systematic review of qualitative findings. Aust N Z J Obstet Gynaecol 2021; 61:817-829. [PMID: 34611883 DOI: 10.1111/ajo.13430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) testing is a gateway to HIV treatment, care and preventive services for pregnant women attending antenatal clinics. Despite this, uptake of HIV testing is not optimal among pregnant women in many low- and middle-income countries (LMICs) and it could negatively impact the effectiveness of prevention of mother-to-child transmission of HIV programs. AIM To understand the factors that hinder the uptake of HIV testing among pregnant women attending antenatal clinics in LMICs. MATERIALS AND METHODS A systematic search of the CINAHL, EMBASE, JSTOR, Medline, PubMed and Web of Science electronic databases was performed. We limited the search to peer-reviewed qualitative studies including mixed method studies. The titles and abstracts of the retrieved publications were screened for relevance then information was extracted. RESULTS Our search yielded 2179 citations, out of which 312 full-text articles were reviewed and 22 studies that met the eligibility criteria were included in this review. We found that a lack of HIV testing kits, poor health infrastructure and shortage of healthcare workers were the main health system-related factors. Poor HIV knowledge, fear of HIV test results, HIV-related stigma and social exclusion negatively influenced pregnant women's decision to be tested for HIV. CONCLUSION This review has identified that pregnant women faced a wide range of health system, individual, social and lack of women's empowerment related challenges that negatively influenced the uptake of HIV testing among pregnant women in LMICs. Our findings would be useful in developing strategies to overcome barriers that could enhance the uptake of HIV testing among pregnant women.
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Affiliation(s)
- Amina Razzaq
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Camille Raynes-Greenow
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ashraful Alam
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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75
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Armoon B, Higgs P, Fleury MJ, Bayat AH, Moghaddam LF, Bayani A, Fakhri Y. Socio-demographic, clinical and service use determinants associated with HIV related stigma among people living with HIV/AIDS: a systematic review and meta-analysis. BMC Health Serv Res 2021; 21:1004. [PMID: 34551772 PMCID: PMC8459487 DOI: 10.1186/s12913-021-06980-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 09/02/2021] [Indexed: 01/11/2023] Open
Abstract
Background Defining HIV-related stigma (HRS) can be problematic due to structural inequalities, cultural differences, discrimination by health care providers and the limitations of tools measuring stigma for people living with HIV (PLWH). This meta-analysis aimed to determine self-reported HRS and its association with socio-demographic and clinical determinants. Methods PubMed, Scopus, Web of Science, PsycInfo, SciELO and Cochrane electronic databases were searched and after reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes criteria. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR) and 95% confidence intervals. Results Thirty-one studies containing 10,475 participants met the eligibility criteria. Among the potential risk factors: age > 30 years (OR = 0.93, 95%CI = 0.86, 1), living with a spouse (OR = 0.07, 95%CI = 0.02, 0.17), CD4 count < 200 (OR = 0.5, 95% CI = 0.31, 0.68), medication adherence (OR = 0.96, 95%CI = 0.94, 0.99), poor access to care (OR = 0.79, 95%CI = 0.65, 0.93), time since diagnosis, and accessibility to care (OR = 0.37, 95%CI = 0.11, 0.86) were all significantly associated with self-reported HIV stigma among PWLH. Conclusion Stigma is correlated with numerous negative consequences in marginalised populations including PLWH. Considering the negative association that stigma has on HIV prevention and treatment targeted evidence-based stigma reduction interventions are recommended. Interventions that are focused on a particular group, such as healthcare professionals are warranted. Rigorously designed studies with specific and validated outcome measures associated with targeted interventions may help to improve the reduction of HRS for PLWH.
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Affiliation(s)
- Bahram Armoon
- Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
| | - Peter Higgs
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Marie-Josée Fleury
- Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.,Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC, H3A 1A1, Canada.,Management, Evaluation and Health Policies Department, School of Public Health, Université de Montréal, 7101 av. du Parc, Montreal, QC, H3X1X9, Canada
| | - Amir-Hossien Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Ladan Fattah Moghaddam
- Department of nursing, faculty of nursing and midwifery, Tehran medical sciences, Islamic Azad University, Tehran, Iran
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yadollah Fakhri
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Meyerson K, Hoddinott G, Nicholson T, Meehan SA. Underlying reasons why some people haven't tested for HIV - a discourse analysis of qualitative data from Cape Town, South Africa. SAHARA J 2021; 18:105-112. [PMID: 34514958 PMCID: PMC8439247 DOI: 10.1080/17290376.2021.1977686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Reported barriers to HIV testing over the last 15 years have remained consistent, despite improved service offerings. We aimed to probe deeper by exploring how people who have never tested construct HIV testing in their talk. We used this to suggest underlying psychosocial barriers to testing even when there is high availability. We enrolled 14 participants who reported that they had never tested for HIV and conducted individual, open-ended interviews. The data were organised thematically with theory-generative interpretations informed by discourse analysis. Reasons for not testing reported reflect similar barriers identified in previous research. Deeper probing identified three discursive processes by which participants explained why they had never tested for HIV, suggesting that the way participants used ‘reasons’ in their talk is an indicator that the participants were repeating ‘tropes’. While aware of HIV testing facilities, participants still chose not to test. Influences on the choice to test or not were positioned as outside of the person’s control. These findings suggest that there are deeper reasons why some people have not tested and that these will not be resolved through merely increasing accessibility to testing services. We recommend increased consideration of the psychosocial implications of testing in service delivery.
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Affiliation(s)
- Kyla Meyerson
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Graeme Hoddinott
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Tamryn Nicholson
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Sue-Ann Meehan
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
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HIV testing and ethnicity among adolescent girls and young women aged 15-24 years in Ghana: what really matters? J Biosoc Sci 2021; 54:812-828. [PMID: 34511162 DOI: 10.1017/s0021932021000456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Despite the high prevalence of HIV among adolescent girls and young women (AGYW) aged 15-24 years in Ghana, HIV testing remains low among this population. The objective of this study was to examine the relationship between ethnicity and HIV testing among AGYW in Ghana. The 2014 Ghana Demographic and Health Survey data were used and analyses were restricted to 3325 female participants aged 15-24 years. Chi-squared tests and a logistic regression model were used to assess the association between ethnicity and HIV testing. Furthermore, the PEN-3 cultural model informed the conceptual framework that explained the relationship between ethnicity and HIV testing behaviour. Results from the bivariate analysis showed an association between ethnicity and HIV testing among AGYW (p<0.05). However, when controlling for other behavioural and socioeconomic determinants of HIV testing in the logistic regression, there was no association between ethnicity and HIV testing. The significant predictors of HIV testing were marital status, having multiple sexual partners, and condom use. The AGYW who were married (adjusted odds ratio [aOR] = 4.56, CI: 3.46-6.08) or previously married (aOR = 4.30, CI: 2.00-9.23) were more likely to test for HIV compared with those who were never married. Having multiple sexual partners (aOR = 0.41, CI: 0.20-0.85) and condom use (aOR = 0.56, CI: 0.38-0.84) were associated with lower odds of HIV testing. The results provide evidence that ethnicity is not associated with HIV testing among AGYW in Ghana, as the bivariate association was attenuated when other behavioural and socioeconomic determinants of HIV testing were accounted for. These findings highlight the importance of considering individual-level factors, community-level factors, and other socio-cultural factors as they really matter in the development of HIV prevention programmes for adolescent girls and young women in Ghana.
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Understanding the Reasons for Deferring ART Among Patients Diagnosed Under the Same-Day-ART Policy in Johannesburg, South Africa. AIDS Behav 2021; 25:2779-2792. [PMID: 33534055 PMCID: PMC8373761 DOI: 10.1007/s10461-021-03171-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 12/20/2022]
Abstract
We aimed to examine the correlates of antiretroviral therapy (ART) deferral to inform ART demand creation and retention interventions for patients diagnosed with HIV during the Universal Test and Treat (UTT) policy in South Africa. We conducted a cohort study enrolling newly diagnosed HIV-positive adults (≥ 18 years), at four primary healthcare clinics in Johannesburg between October 2017 and August 2018. Patients were interviewed immediately after HIV diagnosis, and ART initiation was determined through medical record review up to six-months post-test. ART deferral was defined as not starting ART six months after HIV diagnosis. Participants who were not on ART six-months post-test were traced and interviewed telephonically to determine reasons for ART deferral. Modified Poisson regression was used to evaluate correlates of six-months ART deferral. We adjusted for baseline demographic and clinical factors. We present crude and adjusted risk ratios (aRR) associated with ART deferral. Overall, 99/652 (15.2%) had deferred ART by six months, 20.5% men and 12.2% women. Baseline predictors of ART deferral were older age at diagnosis (adjusted risk ratio (aRR) 1.5 for 30-39.9 vs 18-29.9 years, 95% confidence intervals (CI): 1.0-2.2), disclosure of intentions to test for HIV (aRR 2.2 non-disclosure vs disclosure to a partner/spouse, 95% CI: 1.4-3.6) and HIV testing history (aRR 1.7 for > 12 months vs < 12 months/no prior test, 95% CI: 1.0-2.8). Additionally, having a primary house in another country (aRR 2.1 vs current house, 95% CI: 1.4-3.1) and testing alone (RR 4.6 vs partner/spouse support, 95% CI: 1.2-18.3) predicted ART deferral among men. Among the 43/99 six-months interviews, women (71.4%) were more likely to self-report ART initiation than men (RR 0.4, 95% CI: 0.2-0.8) and participants who relocated within SA (RR 2.1 vs not relocated, 95% CI: 1.2-3.5) were more likely to still not be on ART. Under the treat-all ART policy, nearly 15.2% of study participants deferred ART initiation up to six months after the HIV diagnosis. Our analysis highlighted the need to pay particular attention to patients who show little social preparation for HIV testing and mobile populations.
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Dovel K, Balakasi K, Gupta S, Mphande M, Robson I, Khan S, Amberbir A, Stilson C, van Oosterhout JJ, Doi N, Nichols BE. Frequency of visits to health facilities and HIV services offered to men, Malawi. Bull World Health Organ 2021; 99:618-626. [PMID: 34475599 PMCID: PMC8381098 DOI: 10.2471/blt.20.278994] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To determine how often men in Malawi attend health facilities and if testing for human immunodeficiency virus (HIV) is offered during facility visits. Methods We conducted a cross-sectional, community-representative survey of men (15–64 years) from 36 villages in Malawi. We excluded men who ever tested HIV-positive. Primary outcomes were: health facility visits in the past 12 months (for their own health (client visit) or to support the health services of others (guardian visit)); being offered HIV testing during facility visits; and being tested that same day. We disaggregated all results by HIV testing history: tested ≤ 12 months ago, or in need of testing (never tested or tested > 12 months before). Findings We included 1116 men in the analysis. Mean age was 34 years (standard deviation: 13.2) and 55% (617/1116) of men needed HIV testing. Regarding facility visits, 82% (920/1116) of all men and 70% (429/617) of men in need of testing made at least one facility visit in the past 12 months. Men made a total of 1973 visits (mean two visits): 39% (765/1973) were as guardians and 84% (1657/1973) were to outpatient departments. Among men needing HIV testing, only 7% (30/429) were offered testing during any visit. The most common reason for not testing was not being offered services (37%; 179/487). Conclusion Men in Malawi attend health facilities regularly, but few of those in need of HIV testing are offered testing services. Health screening services should capitalize on men’s routine visits to outpatient departments as clients and guardians.
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Affiliation(s)
- Kathryn Dovel
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, United States of America (USA)
| | | | - Sundeep Gupta
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, United States of America (USA)
| | | | | | | | | | | | | | - Naoko Doi
- Clinton Health Access Initiative, Boston, USA
| | - Brooke E Nichols
- Department of Global Health, School of Public Health, Boston University, Boston, USA
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Jooste S, Mabaso M, Taylor M, North A, Shean Y, Simbayi LC. Socio-economic differences in the uptake of HIV testing and associated factors in South Africa. BMC Public Health 2021; 21:1591. [PMID: 34445996 PMCID: PMC8390264 DOI: 10.1186/s12889-021-11583-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 08/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improved understanding of barriers to HIV testing is important for reaching the first of the UNAIDS 90-90-90 targets, which states that 90% of HIV positive individuals ought to know their HIV status. This study examined socio-economic status (SES) differences in HIV testing uptake and associated factors among youth and adults 15 years and older in South Africa. METHODS This study used data from a national cross-sectional, population-based household survey conducted in 2017 using a multi-stage sampling design. A composite SES score was created using multiple correspondence analyses of household assets; households were classified into wealth quintiles and dichotomised into low SES/poorest (lowest 3 quintiles) and high SES/less-poor (highest 2 quintiles). Bivariate and multivariate logistic regression models were used to examine factors associated with the uptake of HIV testing in low and high SES households. RESULTS HIV testing uptake was 73.8 and 76.7% among low and high SES households, respectively, both of which were below the first 90 targets. Among both low and high SES households, increased HIV testing uptake was significantly associated with females than males. The decreased likelihood was significantly associated with residing in rural formal areas than urban areas, those with no education or low levels of educational attainment and alcohol drinkers among low SES households. Whites and Indians/Asians had a decreased likelihood than Black Africans in high SES households. CONCLUSIONS HIV testing interventions should target males, residents in rural formal areas, those with no or low education and those that consume alcohol in low SES households, including Whites and Indians/Asians from high SES households in order to bridge socio-economic disparities in the uptake of HIV testing. This should entail expanding HIV testing beyond traditional centres for voluntary counselling and testing through outreach efforts, including mobile testing and home-based testing.
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Affiliation(s)
- Sean Jooste
- Human and Social Capabilities Research Division, Human Sciences Research Council, 118 Buitengracht St, Cape Town City Centre, Cape Town, 8000, South Africa.
- University of KwaZulu-Natal, School of Nursing and Public Health, 238 Mazisi Kunene Rd, Glenwood, Durban, 4041, South Africa.
| | - Musawenkosi Mabaso
- Human and Social Capabilities Research Division, Human Sciences Research Council, 118 Buitengracht St, Cape Town City Centre, Cape Town, 8000, South Africa
| | - Myra Taylor
- University of KwaZulu-Natal, School of Nursing and Public Health, 238 Mazisi Kunene Rd, Glenwood, Durban, 4041, South Africa
| | - Alicia North
- Human and Social Capabilities Research Division, Human Sciences Research Council, 118 Buitengracht St, Cape Town City Centre, Cape Town, 8000, South Africa
| | - Yolande Shean
- Human and Social Capabilities Research Division, Human Sciences Research Council, 118 Buitengracht St, Cape Town City Centre, Cape Town, 8000, South Africa
| | - Leickness Chisamu Simbayi
- Deputy CEO for Research, Human Sciences Research Council, 118 Buitengracht St, Cape Town City Centre, Cape Town, 8000, South Africa
- Department of Psychiatry & Mental Health, University of Cape Town, Groote Schuur Dr, Observatory, Cape Town, 7700, South Africa
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Manirankunda L, Wallace A, Ddungu C, Nöstlinger C. Stigma Mechanisms and Outcomes among Sub-Saharan African Descendants in Belgium-Contextualizing the HIV Stigma Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168635. [PMID: 34444384 PMCID: PMC8393566 DOI: 10.3390/ijerph18168635] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/29/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022]
Abstract
HIV-related stigma and discrimination are recognized barriers to HIV prevention, testing and treatment among people of Sub-Saharan African descent (SSA) origin living in Belgium, but insights into HIV related-stigma mechanisms and outcomes are lacking for this population with high HIV prevalence. Guided by Earnshaw and Chaudoir’s stigma framework (2009), we conducted this qualitative study using 10 focus-groups with 76 SSA community members and 20 in-depth interviews with SSA descendants living with HIV to explore specific HIV-stigma mechanisms and outcomes and underlying drivers. Inductive and deductive thematic analysis showed high degrees of stigma among SSA communities driven by fear of HIV acquisition and misconceptions in a migration context, negatively affecting SSA descendants living with HIV. The results allowed for contextualization of the framework: At the community level, prejudices and stereotypes were major stigma mechanisms, while physical distancing, gossips, sexual rejection, violence and increased HIV prevalence emerged as stigma outcomes. Among SSA descendants living with HIV, enacted, anticipated and internalized stigmas were validated as stigma mechanisms, with witnessed stigma as an additional mechanism. Self-isolation, community avoidance and low utilization of non-HIV specialized healthcare were additional outcomes. These results are relevant for tailoring interventions to reduce HIV-related stigma.
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Affiliation(s)
- Lazare Manirankunda
- Institute of Tropical Medicine Antwerp, 2000 Antwerp, Belgium; (C.D.); (C.N.)
- Correspondence:
| | - Aletha Wallace
- Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel, 1050 Brussels, Belgium;
| | - Charles Ddungu
- Institute of Tropical Medicine Antwerp, 2000 Antwerp, Belgium; (C.D.); (C.N.)
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Lulseged S, Belete W, Ahmed J, Gelibo T, Teklie H, West CW, Melaku Z, Demissie M, Farhani M, Eshetu F, Birhanu S, Getaneh Y, Patel H, Voetsch AC. Factors associated with unawareness of HIV-positive status in urban Ethiopia: Evidence from the Ethiopia population-based HIV impact assessment 2017-2018. PLoS One 2021; 16:e0255163. [PMID: 34380145 PMCID: PMC8357455 DOI: 10.1371/journal.pone.0255163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/09/2021] [Indexed: 01/07/2023] Open
Abstract
Background The HIV epidemic in Ethiopia is concentrated in urban areas. Ethiopia conducted a Population-based HIV Impact Assessment (EPHIA) in urban areas between October 2017 and April 2018 to measure the status of the country’s response to the epidemic. Methods We conducted field data collection and HIV testing in randomly selected households using the national, rapid testing algorithm with laboratory confirmation of seropositive samples using a supplemental assay. In addition to self-report on HIV diagnosis and treatment, all HIV-positive participants were screened for a set of HIV antiretroviral (ARV) drugs indicative of the first- and second-line regimens. We calculated weighted frequencies and 95% confidence intervals to assess regional variation in participants’ level of unawareness of their HIV-positive status (adjusted for ARV status). Results We interviewed 20,170 survey participants 15–64 years of age, of which 19,136 (95%) were tested for HIV, 614 (3.2%) tested positive, and 119 (21%) of HIV-positive persons were unaware of their HIV status. Progress towards the UNAIDS first 90 target (90% of people living with HIV would be aware of their HIV status by 2020) substantially differed by administrative region of the country. In the bivariate analysis using log binomial regression, three regions (Oromia, Addis Ababa, and Harari), male gender, and young age (15–24 years) were significantly associated with awareness of HIV positive status. In multivariate analysis, the same variables were associated with awareness of HIV-positive status. Conclusion One-fifth of the HIV-positive urban population were unaware of their HIV-positive status. The number of unaware HIV-positive individuals has a different distribution than the HIV prevalence. National and regional planning and monitoring activities could address this potentially substantial source of undetected HIV infection by increasing HIV testing among young people, men and individuals who do not use condoms.
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Affiliation(s)
- Sileshi Lulseged
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University, Addis Ababa, Ethiopia
- * E-mail:
| | - Wudinesh Belete
- Department of HIV and Tuberculosis Research, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Jelaludin Ahmed
- United States Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Terefe Gelibo
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University, Addis Ababa, Ethiopia
| | - Habtamu Teklie
- Department of HIV and Tuberculosis Research, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Christine W. West
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Zenebe Melaku
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University, Addis Ababa, Ethiopia
| | - Minilik Demissie
- Department of HIV and Tuberculosis Research, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Mansoor Farhani
- ICAP. Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Frehywot Eshetu
- United States Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Sehin Birhanu
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Yimam Getaneh
- Department of HIV and Tuberculosis Research, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Hetal Patel
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Andrew C. Voetsch
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Yang LH, Poku OB, Misra S, Mehta HT, Rampa S, Eisenberg MM, Yang LS, Dai Cao TX, Blank LI, Becker TD, Link BG, Entaile P, Opondo PR, Arscott-Mills T, Ho-Foster AR, Blank MB. Stigma, Structural Vulnerability, and "What Matters Most" Among Women Living With HIV in Botswana, 2017. Am J Public Health 2021; 111:1309-1317. [PMID: 34110916 PMCID: PMC8493151 DOI: 10.2105/ajph.2021.306274] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objectives. To explore whether beneficial health care policies, when implemented in the context of gender inequality, yield unintended structural consequences that stigmatize and ostracize women with HIV from "what matters most" in local culture. Methods. We conducted 46 in-depth interviews and 5 focus groups (38 individuals) with men and women living with and without HIV in Gaborone, Botswana, in 2017. Results. Cultural imperatives to bear children bring pregnant women into contact with free antenatal services including routine HIV testing, where their HIV status is discovered before their male partners'. National HIV policies have therefore unintentionally reinforced disadvantage among women with HIV, whereby men delay or avoid testing by using their partner's status as a proxy for their own, thus facilitating blame toward women diagnosed with HIV. Gossip then defines these women as "promiscuous" and as violating the essence of womanhood. We identified cultural and structural ways to resist stigma for these women. Conclusions. Necessary HIV testing during antenatal care has inadvertently perpetuated a structural vulnerability that propagates stigma toward women. Individual- and structural-level interventions can address stigma unintentionally reinforced by health care policies.
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Affiliation(s)
- Lawrence H. Yang
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Ohemaa B. Poku
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Supriya Misra
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Haitisha T. Mehta
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Shathani Rampa
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Marlene M. Eisenberg
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Lyla S. Yang
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Thi Xuan Dai Cao
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Lilo I. Blank
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Timothy D. Becker
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Bruce G. Link
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Patlo Entaile
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Philip R. Opondo
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Tonya Arscott-Mills
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Ari R. Ho-Foster
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
| | - Michael B. Blank
- Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the
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Misra S, Mehta HT, Eschliman EL, Rampa S, Poku OB, Wang WQ, Ho-Foster AR, Mosepele M, Becker TD, Entaile P, Arscott-Mills T, Opondo PR, Blank MB, Yang LH. Identifying "What Matters Most" to Men in Botswana to Promote Resistance to HIV-Related Stigma. QUALITATIVE HEALTH RESEARCH 2021; 31:1680-1696. [PMID: 33764233 PMCID: PMC9287436 DOI: 10.1177/10497323211001361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Despite a comprehensive national program of free HIV services, men living with HIV in Botswana participate at lower rates and have worse outcomes than women. Directed content analysis of five focus groups (n = 38) and 50 in-depth interviews with men and women with known and unknown HIV status in Gaborone, Botswana in 2017 used the "what matters most" (WMM) and "structural vulnerability" frameworks to examine how the most valued cultural aspects of manhood interact with HIV-related stigma. WMM for manhood in Botswana included fulfilling male responsibilities by being a capable provider and maintaining social status. Being identified with HIV threatened WMM, which fear of employment discrimination could further exacerbate. Our findings indicate how cultural and structural forces interact to worsen or mitigate HIV-related stigma for urban men in Botswana. These threats to manhood deter HIV testing and treatment, but interventions could capitalize on cultural capabilities for manhood to promote stigma resistance.
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Affiliation(s)
- Supriya Misra
- Department of Public Health, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132, United States
| | - Haitisha T. Mehta
- Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, United States
| | - Evan L. Eschliman
- Mailman School of Public Health, Columbia University, 722 West 168th St. NY, NY 10032, United States
| | - Shathani Rampa
- Department of Psychology, University of Botswana, Private Bag UB 00705, Gaborone, Botswana
| | - Ohemaa B. Poku
- Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, United States
| | - Wei-Qian Wang
- Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, United States
| | - Ari R. Ho-Foster
- Faculty of Medicine, University of Botswana, Private Bag UB 0022, Gaborone, Botswana; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19104, United States
| | - Mosepele Mosepele
- Faculty of Medicine, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Timothy D. Becker
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States
| | - Patlo Entaile
- Botswana-UPenn Partnership, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Tonya Arscott-Mills
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19104, United States
| | - Phillip R. Opondo
- Department of Psychiatry, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Michael B. Blank
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19104, United States
| | - Lawrence H. Yang
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, 715 Broadway 12 Floor, New York, NY 10003, United States; Mailman School of Public Health, Columbia University, 722 West 168th St. NY, NY 10032, United States
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Kariithi E, Sharma M, Kemunto E, Lagat H, Otieno G, Wamuti BM, Katz DA, Obong'o C, Macharia P, Bosire R, Masyuko S, Mugambi M, Levin CE, Liu W, Roy Paladhi U, Weiner BJ, Farquhar C. Using Assisted Partner Services for HIV Testing and the Treatment of Males and Their Female Sexual Partners: Protocol for an Implementation Science Study. JMIR Res Protoc 2021; 10:e27262. [PMID: 34014172 PMCID: PMC8176338 DOI: 10.2196/27262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/01/2021] [Accepted: 04/12/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite the effective scale-up of HIV testing and treatment programs, only 75% of people living with HIV (PLWH) globally know their status, and this rate is lower among men. This highlights the importance of implementing HIV testing and linkage interventions with a high uptake in this population. In a cluster randomized controlled trial conducted in Kenya between 2013 and 2015, we found that assisted partner services (APS) for HIV-exposed partners of newly diagnosed PLWH safely reached more HIV-exposed individuals with HIV testing compared with client referral alone. However, more data are needed to evaluate APS implementation in a real-world setting. OBJECTIVE This study aims to evaluate the effectiveness, acceptability, fidelity, and cost of APS when integrated into existing HIV testing services (HTS) in Western Kenya. METHODS Our study team from the University of Washington and PATH is integrating APS into 31 health facilities in Western Kenya. We are enrolling females newly diagnosed with HIV (index clients) who consent to receiving APS, their male sexual partners, and female sexual partners of male sexual partners who tested HIV positive. Female index clients and sexual partners testing HIV positive will be followed up at 6 weeks, 6 months, and 12 months postenrollment to assess linkage to care, antiretroviral therapy initiation, and HIV viral load suppression. We will evaluate the acceptability, fidelity, and cost of real-world implementation of APS via in-depth interviews conducted with national, county, and subcounty-level policy makers responsible for HTS. Facility health staff providing HTS and APS, in addition to staff working with the study project team, will also be interviewed. We will also conduct direct observations of facility infrastructure and clinical procedures and extract data from the facilities and county and national databases. RESULTS As of March 2020, we have recruited 1724 female index clients, 3201 male partners, and 1585 female partners. We have completed study recruitment as well as 6-week (2936/2973, 98.75%), 6-month (1596/1641, 97.25%), and 12-month (725/797, 90.9%) follow-up visits. Preliminary analyses show that facilities scaling up APS identify approximately 12-18 new HIV-positive males for every 100 men contacted and tested. We are currently completing the remaining follow-up interviews and incorporating an HIV self-testing component into the study in response to the COVID-19 pandemic. CONCLUSIONS The results will help bridge the gap between clinical research findings and real-world practice and provide guidance regarding optimal strategies for APS integration into routine HIV service delivery. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/27262.
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Affiliation(s)
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | | | | | - Beatrice M Wamuti
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - David A Katz
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Christopher Obong'o
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Paul Macharia
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Rose Bosire
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Sarah Masyuko
- Department of Global Health, University of Washington, Seattle, WA, United States
- Ministry of Health, Nairobi, Kenya
| | | | - Carol E Levin
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Wenjia Liu
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Unmesha Roy Paladhi
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
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Hussein MR, Dongarwar D, Yusuf RA, Yusuf Z, Aliyu GG, Elmessan GR, Salihu HM. Health Insurance Status of Pregnant Women and the Likelihood of Receipt of Antenatal Screening for HIV in Sub-Saharan Africa. Curr HIV Res 2021; 19:248-259. [PMID: 33622225 DOI: 10.2174/1570162x19666210223124835] [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: 08/04/2020] [Revised: 01/08/2021] [Accepted: 01/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND We investigated if initiating preventive care against HIV vertical transmission by antenatal HIV screening is independent of the patients' source of financial reimbursement for the care received in sub-Saharan Africa (SSA). METHODS Using information from the WHO's Global Health Expenditure Database and the Demographic Health Surveys Database for 27 sub-Saharan countries, we used Spearman's correlation and adjusted survey logistic regression to determine the potential relationship between enrollment in health insurance and the likelihood that expectant mothers would be offered antenatal HIV screening. RESULTS We found that expectant mothers covered by health insurance were more than twice as likely to be offered antenatal screening for HIV compared to the uninsured. The likelihood differed by the type of insurance plan the expectant mother carried. DISCUSSION Health insurance is more of a financial tool that this study finds to be necessary to boost the uptake of preventive and therapeutic HIV care in SSA. CONCLUSION The ensuing disparity in receiving proper care could hinder the goals of 90-90-90 and the forthcoming 95-95-95 plan in SSA.
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Affiliation(s)
- Muhammad Ragaa Hussein
- Department of Management, Policy, and Community Health (MPACH), University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Houston, TX, United States
| | - Deepa Dongarwar
- Center of Excellence in Health Equity, Training & Research, Baylor College of Medicine, Houston, TX, United States
| | - Rafeek A Yusuf
- Department of Management, Policy, and Community Health (MPACH), University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Houston, TX, United States
| | - Zenab Yusuf
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA; Houston VA Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston TX, USA and VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
| | | | - George Ryan Elmessan
- Center of Excellence in Health Equity, Training & Research, Baylor College of Medicine, Houston, TX, United States
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training & Research, Baylor College of Medicine, Houston, TX, United States
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87
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Idris AM, Crutzen R, Van den Borne HW. Social-Cognitive Determinants of HIV Testing Among Tuberculosis Infected Patients in Kassala State, Sudan. Front Public Health 2021; 9:521511. [PMID: 33996703 PMCID: PMC8116518 DOI: 10.3389/fpubh.2021.521511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Use of HIV testing and counselling (HTC) services remains low among TB patients in Sudan. Identifying the social-cognitive (sub) determinants associated with HTC uptake is essential before developing interventions to promote uptake. This study aims to assess the sub-determinants of intention to use and actual behaviour of using HTC services among TB patients in Sudan and to ascertain the most relevant beliefs to inform future interventions. Methods: A cross-sectional study was carried out in five health facilities selected randomly in Kassala State. First, a small elicitation study (N = 25) was conducted to inform the Reasoned Action Approach (RAA) based questionnaire. A total of 411 TB patients completed the survey questionnaire. Confidence Interval Based Estimation of Relevance analysis (CIBER) was employed to establish the sub-determinants' relevance. Result: The studied beliefs explained 38-52% of the variance in the intention and 20-35% in the behaviour variance. The beliefs that "Using HTC services increases my fear of being tested positive for HIV" and "Using HTC services increases my fear of losing my partner if I have a positive test result" were negatively associated with intentions and use of HTC services; and both were highly relevant for intervention. The belief "If I use HTC services, I would know my HIV status" was positively associated with intentions and use of HTC services. However, it was less relevant for intervention. Perceived susceptibility to HIV infection was not associated with intention and only weakly associated with use of HTC services. Its relevance was low for intervention. Conclusions: The study showed that the social-cognitive beliefs (sub-determinants) vary in their relationship with the intention and use of HTC services among TB patients; with variable relevance for intervention. Interventions to enhance the use of HTC services should address the most relevant beliefs to maximise the effectiveness of interventions. Further studies are needed to identify other relevant sub-determinants of HTC use behaviour.
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Affiliation(s)
- Almutaz M Idris
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, Netherlands.,College of Applied Medical Sciences, Buraydah Colleges, Buraydah, Saudi Arabia
| | - Rik Crutzen
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, Netherlands
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88
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Logie CH, Okumu M, Kibuuka Musoke D, Hakiza R, Mwima S, Kyambadde P, Abela H, Gittings L, Musinguzi J, Mbuagbaw L, Baral S. Intersecting stigma and HIV testing practices among urban refugee adolescents and youth in Kampala, Uganda: qualitative findings. J Int AIDS Soc 2021; 24:e25674. [PMID: 33713571 PMCID: PMC7955780 DOI: 10.1002/jia2.25674] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/06/2021] [Accepted: 01/26/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction HIV‐related risks may be exacerbated in humanitarian contexts. Uganda hosts 1.3 million refugees, of which 60% are aged under 18. There are knowledge gaps regarding HIV testing facilitators and barriers, including HIV and intersecting stigmas, among urban refugee youth. In response, we explored experiences and perspectives towards HIV testing strategies, including HIV self‐testing, with urban refugee youth in Kampala, Uganda. Methods We implemented a qualitative study with refugee cisgender youth aged 16 to 24 living in Kampala's informal settlements from February‐April 2019. We conducted five focus groups with refugee youth, including two with adolescent boys and young men, two with adolescent girls and young women and one with female sex workers. We also conducted five key informant (KI) interviews with government, non‐government and community refugee agencies and HIV service providers. We conducted thematic analyses to understand HIV testing experiences, perspectives and recommendations. Results Participants (n = 49) included young men (n = 17) and young women (n = 27) originally from the Democratic Republic of Congo [DRC] (n = 29), Rwanda (n = 11), Burundi (n = 3) and Sudan (n = 1), in addition to five KI (gender: n = 3 women, n = 2 men; country of origin: n = 2 Rwanda, n = 2 Uganda, n = 1 DRC). Participant narratives revealed stigma drivers included fear of HIV infection; misinformation that HIV is a “Ugandan disease”; and blame and shame for sexual activity. Stigma facilitators included legal precarity regarding sex work, same‐sex practices and immigration status, alongside healthcare mistreatment and confidentiality concerns. Stigma experiences were attributed to the social devaluation of intersecting identities (sex work, youth, refugees, sexual minorities, people living with HIV, women). Participants expressed high interest in HIV self‐testing. They recommended HIV self‐testing implementation strategies to be peer supported and expressed concerns regarding sexual‐ and gender‐based violence with partner testing. Conclusions Intersecting stigma rooted in fear, misinformation, blame and shame, legal precarity and healthcare mistreatment constrain current HIV testing strategies with urban refugee youth. Findings align with the Health Stigma and Discrimination Framework that conceptualizes stigma drivers and facilitators that devalue intersecting health conditions and social identities. Findings can inform multi‐level strategies to foster enabling HIV testing environments with urban refugee youth, including tackling intersecting stigma and leveraging refugee youth peer support.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Moses Okumu
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
| | | | - Robert Hakiza
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | - Simon Mwima
- National AIDS Control Program, Ministry of Health, Kampala, Uganda
| | - Peter Kyambadde
- National AIDS Control Program, Ministry of Health, Kampala, Uganda.,Most At Risk Population Initiative Clinic, Mulago Hospital, Kampala, Uganda
| | - Heather Abela
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Lesley Gittings
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Joshua Musinguzi
- National AIDS Control Program, Ministry of Health, Kampala, Uganda
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Stefan Baral
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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89
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Colombini M, Scorgie F, Stangl A, Harvey S, Ramskin L, Khoza N, Mashauri E, Baron D, Lees S, Kapiga S, Watts C, Delany-Moretlwe S. Exploring the feasibility and acceptability of integrating screening for gender-based violence into HIV counselling and testing for adolescent girls and young women in Tanzania and South Africa. BMC Public Health 2021; 21:433. [PMID: 33658000 PMCID: PMC7927237 DOI: 10.1186/s12889-021-10454-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 02/17/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Gender-based violence (GBV) undermines HIV prevention and treatment cascades, particularly among women who report partner violence. Screening for violence during HIV testing, and prior to offering pre-exposure prophylaxis (PrEP) to HIV uninfected women, provides an opportunity to identify those at heightened HIV risk and greater potential for non-adherence or early discontinuation of PrEP. The paper describes our experience with offering integrated GBV screening and referral as part of HIV counselling and testing. This component was implemented within EMPOWER, a demonstration project offering combination HIV prevention, including daily oral PrEP, to young women in South Africa and Tanzania. METHODS Between February 2017 and March 2018, a process evaluation was conducted to explore views, experiences and practices of stakeholders (study participants and study clinical staff) during implementation of the GBV screening component. This article assesses the feasibility and acceptability of the approach from multiple stakeholder perspectives, drawing on counselling session observations (n = 10), in-depth interviews with participants aged 16-24 (n = 39) and clinical staff (n = 13), and notes from debriefings with counsellors. Study process data were also collected (e.g. number of women screened and referred). Following a thematic inductive approach, qualitative data were analysed using qualitative software (NVivo 11). RESULTS Findings show that 31% of young women screened positive for GBV and only 10% requested referrals. Overall, study participants accessing PrEP were amenable to being asked about violence during HIV risk assessment, as this offered the opportunity to find emotional relief and seek help, although a few found this traumatic. In both sites, the sensitive and empathetic approach of the staff helped mitigate distress of GBV disclosure. In general, the delivery of GBV screening in HCT proved to be feasible, provided that the basic principles of confidentiality, staff empathy, and absence of judgment were observed. However, uptake of linkage to further care remained low in both sites. CONCLUSION Most stakeholders found GBV screening acceptable and feasible. Key principles that should be in place for young women to be asked safely about GBV during HIV counselling and testing included respect for confidentiality, a youth-friendly and non-judgmental environment, and a functioning referral network.
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Affiliation(s)
- Manuela Colombini
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Fiona Scorgie
- Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | - Anne Stangl
- International Center for Research on Women, Washington, DC USA
| | - Sheila Harvey
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Lethabo Ramskin
- Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | - Nomhle Khoza
- Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | | | - Deborah Baron
- Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | - Shelley Lees
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Charlotte Watts
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | - on behalf of the EMPOWER study team
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
- Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
- International Center for Research on Women, Washington, DC USA
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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90
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Hamilton A, Thompson N, Choko AT, Hlongwa M, Jolly P, Korte JE, Conserve DF. HIV Self-Testing Uptake and Intervention Strategies Among Men in Sub-Saharan Africa: A Systematic Review. Front Public Health 2021; 9:594298. [PMID: 33681120 PMCID: PMC7933016 DOI: 10.3389/fpubh.2021.594298] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/18/2021] [Indexed: 12/16/2022] Open
Abstract
Background: HIV testing is an essential gateway to HIV prevention and treatment services. However, HIV testing uptake remains low among men due to stigma, discrimination, and confidentiality concerns. HIV self-testing (HIVST) is an alternative HIV testing method that can address many of these barriers for men. We conducted a systematic review to examine HIVST uptake and intervention strategies among Men in Sub-Saharan Africa. Methods: We used a systematic approach to survey literature published from January 2010 to June 2020 using five electronic databases (PubMed-Medline, CINAHL Complete, PsychINFO, Google Scholar, and Web of Science) and a manual search. Studies were included if they were peer-reviewed, published in English, and examined HIVST willingness, uptake, and/or linkage to care and included men in Sub-Saharan Africa. Results: Sixty-three articles related to HIVST were reviewed. Of the included articles, 37 discussed HIVST uptake/acceptability and 24 discussed intervention strategies. Both oral swab and finger-prick methods had high acceptability with ease of access and availability of the test cited as important by men. Free HIVST kits were preferred by men. Secondary distribution of kits via peers, sexual partners, and female sex workers were successful. Conclusion: HIV self-testing is highly acceptable to men. More efforts are needed to develop policies to implement HIVST programs targeting men in Sub-Saharan Africa, including a focus on linkage to care in sub-Saharan Africa. Future interventions should directly target men independently in tandem with using peers and their romantic partners to promote self-testing among men in sub-Saharan Africa. HIVST kit distribution strategies should be combined with services that can offer confirmatory tests and counseling for men as well as linkage to care.
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Affiliation(s)
- Akeen Hamilton
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, SC, United States
| | - Noah Thompson
- Department of Biological Sciences, University of South Carolina, Columbia, SC, United States
| | - Augustine T Choko
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mbuzeleni Hlongwa
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Pauline Jolly
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jeffrey E Korte
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Donaldson F Conserve
- Department of Prevention and Community Health, The George Washington University, Washington, DC, United States
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91
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Broderick K, Ponticiello M, Nabukalu D, Tushemereirwe P, Nuwagaba G, King R, Mwanga-Amumpaire J, Sundararajan R. Shortening "the Road" to Improve Engagement with HIV Testing Resources: A Qualitative Study Among Stakeholders in Rural Uganda. AIDS Patient Care STDS 2021; 35:56-62. [PMID: 33471578 PMCID: PMC7885900 DOI: 10.1089/apc.2020.0235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In HIV-endemic areas, traditional healers are frequently used with, or instead of, biomedical resources for health care needs. Studies show healers are interested in and capable of supporting patients in the HIV care cascade. However, adults who receive care from healers have low engagement with HIV services. To achieve epidemic control, we must understand gaps between the needs of HIV-endemic communities and the potential for healers to improve HIV service uptake. This study's objective was to characterize stakeholder perspectives on barriers to HIV testing and approaches to mitigate barriers in a medically pluralistic, HIV-endemic region. This study was conducted in Mbarara District, a rural area of southwestern Uganda with high HIV prevalence. Participants included HIV clinical staff, traditional healers, and adults receiving care from healers. Fifty-six participants [N = 30 females (52%), median age 40 years (interquartile range, 32-51.5)] were recruited across three stakeholder groups for minimally structured interviews. Themes were identified using an inductive, grounded theory approach and linked together to create a framework explaining stakeholder perspectives on HIV testing. Stakeholders described the "road" to HIV testing as time-consuming, expensive, and stigmatizing. All agreed healers could mitigate barriers by delivering HIV testing at their practices. Collaborations between biomedical and traditional providers were considered essential to a successful healer-delivered HIV testing program. This work describes a novel approach to "shorten the road" to HIV testing, suggesting that traditional healer-delivered HIV testing holds promise to expand uptake of testing among communities with limited access to existing programs.
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Affiliation(s)
| | - Matthew Ponticiello
- Department of Global and Public Health Sciences, Cornell University, Ithaca, New York, USA
| | - Doreen Nabukalu
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Patricia Tushemereirwe
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Gabriel Nuwagaba
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rachel King
- Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Juliet Mwanga-Amumpaire
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
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92
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Nyblade L, Srinivasan K, Raj T, Oga EA, Heylen E, Mazur A, Devadass D, Steward WT, Pereira M, Ekstrand ML. HIV Transmission Worry Predicts Discrimination Intentions Among Nursing Students and Ward Staff in India. AIDS Behav 2021; 25:389-396. [PMID: 32804318 PMCID: PMC7855682 DOI: 10.1007/s10461-020-03001-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Health facility stigma impedes HIV care and treatment. Worry of contracting HIV while caring for people living with HIV is a key driver of health facility stigma, however evidence for this relationship is largely cross-sectional. This study evaluates this relationship longitudinally amongst nursing students and ward staff in India. Worry of contracting HIV and other known predictors of intent to discriminate were collected at baseline and 6 months in 916 nursing students and 747 ward staff. Using fixed effects regression models, we assessed the effect of key predictors on intent to discriminate over a 6-month period. Worry of contracting HIV predicted intent to discriminate for nursing students and ward staff in care situations with low and high-risk for bodily fluid exposure, confirming prior cross-sectional study results and underscoring the importance of addressing worry of contracting HIV as part of health facility HIV stigma-reduction interventions.
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Affiliation(s)
- Laura Nyblade
- Global Health Division, International Development Group, RTI International, 13th St., NW, Suite 750, Washington, DC, 20005, USA.
| | - Krishnamachari Srinivasan
- St. Johns Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Tony Raj
- St. Johns Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Emmanuel A Oga
- Center for Applied Public Health Research, RTI International, Rockville, MD, USA
| | - Elsa Heylen
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
| | - Amanda Mazur
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
| | - Dhinagaran Devadass
- St. Johns Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Wayne T Steward
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
| | - Matilda Pereira
- St. Johns Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Maria L Ekstrand
- St. Johns Research Institute, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
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93
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Yang LH, Ho-Foster AR, Becker TD, Misra S, Rampa S, Poku OB, Entaile P, Goodman M, Blank MB. Psychometric Validation of a Scale to Assess Culturally-Salient Aspects of HIV Stigma Among Women Living with HIV in Botswana: Engaging "What Matters Most" to Resist Stigma. AIDS Behav 2021; 25:459-474. [PMID: 32839870 PMCID: PMC8530255 DOI: 10.1007/s10461-020-03012-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Perceived stigma deters engagement in HIV care and is powerfully shaped by culture. Yet few stigma measures consider how cultural capabilities that signify "full personhood" could be engaged to resist stigma. By applying a theory conceptualizing how culturally-salient mechanisms can worsen or mitigate HIV stigma in relation to "what matters most" (WMM), we developed the WMM Cultural Stigma Scale for Women Living with HIV in Botswana (WMM-WLHIV-BW) and psychometrically evaluated it among 201 respondents with known and unknown HIV status. The two subscales, Cultural Factors Shape Stigma (CFSS) and Cultural Capabilities Protect against Stigma (CCPS) were reliable (both [Formula: see text]). Among WLHIV, the CFSS Subscale showed initial construct validity with depressive symptoms (r = .39, p = .005), similar to an established HIV stigma scale, whereas the CCPS Subscale showed initial construct validity with self-esteem (r = .32, p = .026) and social support number (r = .29, p = .047), suggesting that achieving local cultural capabilities mitigates stigma and is linked with positive psychosocial outcomes. This culturally-derived scale could help WLHIV in Botswana experience improved stigma-related outcomes.
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Affiliation(s)
- Lawrence H Yang
- School of Global Public Health, New York University, 715 Broadway, New York, NY, 10003, USA.
- Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Ari R Ho-Foster
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy D Becker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Supriya Misra
- School of Global Public Health, New York University, 715 Broadway, New York, NY, 10003, USA
| | - Shathani Rampa
- Department of Psychology, University of Botswana, Gaborone, Botswana
| | - Ohemaa B Poku
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Melody Goodman
- School of Global Public Health, New York University, 715 Broadway, New York, NY, 10003, USA
| | - Michael B Blank
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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94
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Nyblade L, Mingkwan P, Stockton MA. Stigma reduction: an essential ingredient to ending AIDS by 2030. Lancet HIV 2021; 8:e106-e113. [PMID: 33539757 DOI: 10.1016/s2352-3018(20)30309-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/12/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022]
Abstract
Ending the AIDS epidemic by 2030 will require addressing stigma more systematically and at a larger scale than current efforts. Existing global evidence shows that stigma is a barrier to achieving each of the 90-90-90 targets; it undermines HIV testing, linkage to care, treatment adherence, and viral load suppression. However, findings from both research studies and programmatic experience have helped to inform the growing body of knowledge regarding how to reduce stigma, leading to key principles for HIV stigma reduction. These principles include immediately addressing actionable drivers of stigma, centring groups affected by stigma at the core of the response, and engaging opinion leaders and building partnerships between affected groups and opinion leaders. Although there is still room to strengthen research on stigma measurement and reduction, in particular for intersectional stigma, the proliferation of evidence over the past several decades on how to measure and address stigma provides a solid foundation for immediate and comprehensive action.
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Affiliation(s)
- Laura Nyblade
- Global Health Division, International Development Group, Research Triangle Institute, Washington, DC, USA.
| | - Pia Mingkwan
- Global Health Division, International Development Group, Research Triangle Institute, Washington, DC, USA
| | - Melissa A Stockton
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, NY, USA
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95
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Diress G, Ahmed M, Adane S, Linger M, Alemnew B. Barriers and Facilitators for HIV Testing Practice Among Ethiopian Women Aged 15-24 years: Analysis of the 2016 Ethiopian Demographic and Health Survey. HIV AIDS (Auckl) 2021; 12:963-970. [PMID: 33447085 PMCID: PMC7801903 DOI: 10.2147/hiv.s280590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/24/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In developing countries, youth women are most at risk of HIV infection. Center for Disease Control recommends that people who participate in high-risk behaviors get tested for HIV at least annually. In 2016, the Ethiopian Ministry of Health set goals to identify 90% of the people living with HIV by 2030. But undiagnosed HIV infections are still high in the country. To alleviate the problem, it is vital to identify the factors that hinder HIV testing practice. Therefore, this study aimed to identify the facilitators and barriers of HIV testing practice among Ethiopian youth women. METHODS The analysis was done on 6401 women aged 15-24 years using data from the 2016 Ethiopia Demographic Health Survey (EDHS). The main outcome variable was self-reported HIV testing practice. Multivariable logistic regression was used to identify the facilitators and barriers of HIV testing practice. RESULTS In this study, 37.7% [95% CI: (33.6, 39.1)] of youth women were tested for HIV in their life. Being married (AOR=4.7; 95% CI: (3.67, 6.01)), divorced [AOR=6.2; 95% CI: (3.98-9.54)], having primary level of education [AOR=2.4;95% CI: (1.79-3.13)], and secondary level of education [AOR=4.0; 95% CI: (2.87-5.63)], being rich [AOR=2.3;95% CI: (1.39-3.91)] and being in the highest wealth index catagory [AOR=2.6;95% CI: (1.30-5.16)] increase the odds of HIV testing. However, lack of media acccess [AOR = 0.7; 95 CI %: (0.54-0.87)], lack of comprehensive HIV knowledge [AOR = 0.68; 65% CI: (0.53-0.86)] and having discriminatory attitude towards PLHIV[AOR=0.79;95% CI: (0.64-0.97)] decrease the odds of HIV testing. CONCLUSION The practice of HIV testing among youth populations was low as compared to national recommendations. Lack of media access, lack of comprehensive knowledge about HIV, and having discriminatory attitudes were the barriers to HIV testing practice. Marriage, secondary or higher education attainment, and high wealth index category were the facilitators for HIV testing. Improving HIV-related knowledge, improving media access, and minimizing discriminatory attitudes are strongly recommended to promote HIV testing practice.
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Affiliation(s)
- Gedefaw Diress
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Mohammed Ahmed
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Seteamlak Adane
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Melese Linger
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Birhan Alemnew
- Department of Medical Laboratory Science, College of Health Science, Woldia University, Woldia, Ethiopia
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96
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Nwaozuru U, Tahlil KM, Obiezu-Umeh C, Gbaja-Biamila T, Asuquo SE, Idigbe I, BeLue R, Oladele D, Muessig KE, Rosenberg NE, Ong JJ, Musa AZ, Tang W, Ezechi O, Iwelunmor J, Tucker JD. Tailoring youth-friendly health services in Nigeria: a mixed-methods analysis of a designathon approach. Glob Health Action 2021; 14:1985761. [PMID: 34904539 PMCID: PMC8676684 DOI: 10.1080/16549716.2021.1985761] [Citation(s) in RCA: 2] [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: 05/10/2021] [Accepted: 09/21/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Young people in low- and middle-income countries are often neglected in designing youth-friendly health services, especially HIV testing and preventive services. Designathons, which are time-bounded co-creation events where individuals gather in teams to develop solutions to a problem, could promote youth participation and ownership of health services. OBJECTIVE The purpose of this study is to examine youth participation in a designathon to create youth-friendly health services in Nigeria. METHODS Our designathon was based on crowdsourcing principles and informed by a human-centered design approach. The designathon included an open call for Nigerian youths between 14 and 24 years to share ideas on how to promote uptake of HIV self-testing services and a three-day sprint event that brought together diverse teams to develop strategies enhancing linkage to care. Teams pitched their solutions to a panel of five independent experts who scored ideas based on the desirability, feasibility, potential impact, and teamwork. We used descriptive statistics to summarize participants' demographics and conducted a content analysis to synthesize themes from youth proposals. RESULTS Nine hundred seventy-six youth across Nigeria applied to join the designathon. Forty-eight youth in 13 teams participated in the designathon with a median age of 20 years (IQR: 17-22]. Boys and young men were 48.5% (446/919) of the total applicants, 62.5% (30/48) of the designathon participants, and 63.6% (7/11) of the finalists. Students, from all educational levels, represented 91.2% (841/922) of the total applicants, 88.4% (38/43) of the designathon participants, and 90.0% (9/10) of the finalists. About twenty-three percent (3/13) of the final proposals were top ranked. The three finalist approaches to optimize youth-friendly health services centered on decentralizing service delivery to young people through mobile health technologies, use of mobile tents, or peer support services. CONCLUSIONS Our open call engaged diverse groups of Nigerian youth, including young women and students. Our data suggest that designathons may be useful for developing tailored youth-friendly health services. Further research is needed to understand the designathon process and the effectiveness of the finalist submissions.
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Affiliation(s)
- Ucheoma Nwaozuru
- College for Public Health and Social Justice, Saint Louis University, Saint, Louis, MO, USA
| | - Kadija M. Tahlil
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chisom Obiezu-Umeh
- College for Public Health and Social Justice, Saint Louis University, Saint, Louis, MO, USA
| | | | - Sarah E. Asuquo
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ifeoma Idigbe
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Rhonda BeLue
- College for Public Health and Social Justice, Saint Louis University, Saint, Louis, MO, USA
| | - David Oladele
- College for Public Health and Social Justice, Saint Louis University, Saint, Louis, MO, USA
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Kathryn E. Muessig
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nora E. Rosenberg
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason J. Ong
- Central Clinical School, Monash University, Melbourne, Australia
- London School of Hygiene and Tropical Medicine, London, UK
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | | | - Weiming Tang
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Oliver Ezechi
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, Saint, Louis, MO, USA
| | - Joseph D. Tucker
- London School of Hygiene and Tropical Medicine, London, UK
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Hargreaves JR, Pliakas T, Hoddinott G, Mainga T, Mubekapi-Musadaidzwa C, Donnell D, Piwowar-Manning E, Agyei Y, Mandla NF, Dunbar R, Macleod D, Floyd S, Bock P, Fidler S, Hayes RJ, Seeley J, Stangl A, Bond V, Ayles H. HIV Stigma and Viral Suppression Among People Living With HIV in the Context of Universal Test and Treat: Analysis of Data From the HPTN 071 (PopART) Trial in Zambia and South Africa. J Acquir Immune Defic Syndr 2020; 85:561-570. [PMID: 32991336 PMCID: PMC7654947 DOI: 10.1097/qai.0000000000002504] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/05/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The impact of HIV stigma on viral suppression among people living with HIV (PLHIV) is not well characterized. SETTING Twenty-one communities in Zambia and South Africa, nested within the HPTN 071 (PopART) trial. METHODS We analyzed data on viral suppression (<400 copies HIV RNA/mL) among 5662 laboratory-confirmed PLHIV aged 18-44 years who were randomly sampled within the PopART trial population cohort 24 months after enrolment (PC24). We collected data on experiences and internalization of stigma from those PLHIV who self-reported their HIV status (n = 3963/5662) and data on perceptions of stigma from a 20% random sample of all PLHIV (n = 1154/5662). We also measured stigma at the community-level among PLHIV, community members, and health workers. We analyzed the association between individual- and community-level measures of HIV stigma and viral suppression among PLHIV, adjusting for confounding. RESULTS Of all 5662 PLHIV, 69.1% were virally suppressed at PC24. Viral suppression was highest among those 3963 cohort participants who self-reported living with HIV and were on ART (88.3%), and lower among those not on treatment (37.5%). Self-identifying PLHIV who reported internalized stigma were less likely to be virally suppressed (75.0%) than those who did not (80.7%; adjusted risk ratio, 0.94 95% CI: 0.89 to 0.98). Experiences, perceptions, and community-level measures of stigma were not associated with viral suppression. CONCLUSION Internalized stigma among PLHIV was associated with a lower level of viral suppression; other dimensions of stigma were not. Stigma reduction approaches that address internalized stigma should be an integral component of efforts to control the HIV epidemic.
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Affiliation(s)
- James R. Hargreaves
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Triantafyllos Pliakas
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tila Mainga
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Constance Mubekapi-Musadaidzwa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | - Yaw Agyei
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nomhle F. Mandla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rory Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - David Macleod
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sian Floyd
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sarah Fidler
- Imperial College NIHR BRC, Imperial College London, London, United Kingdom; and
| | - Richard J. Hayes
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Janet Seeley
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anne Stangl
- International Center for Research on Women, Washington, DC
| | - Virginia Bond
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Helen Ayles
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
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Sharma M, Ong JJ, Celum C, Terris-Prestholt F. Heterogeneity in individual preferences for HIV testing: A systematic literature review of discrete choice experiments. EClinicalMedicine 2020; 29-30:100653. [PMID: 33305199 PMCID: PMC7710637 DOI: 10.1016/j.eclinm.2020.100653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/25/2020] [Accepted: 11/06/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Understanding variations in HIV testing preferences can help inform optimal combinations of testing services to maximize coverage. We conducted a systematic review of Discrete Choice Experiments (DCEs) eliciting HIV testing preference. METHODS We searched the published literature for papers that conducted DCEs to assess user preferences for HIV testing. FINDINGS We identified 237 publications; 14 studies conducted in 10 countries met inclusion criteria. Overall, test cost was one of the strongest drivers of preference, with participants preferring free or very low-cost testing. Confidentiality was a salient concern, particularly among key populations and persons who never tested. Participants in resource-limited settings preferred short travel distance and integration of HIV testing with other services. There was substantial heterogeneity across participant characteristics. For example, while women preferred home testing, high-risk groups (e.g. male porters, female bar workers) and men who had not tested in the last year preferred traveling a short distance for testing. HIV self-testing (HIVST) had high acceptability, particularly among those who had never HIV tested, although most users preferred blood-based sample collection over oral swabs. Participants highly valued post-test counselling availability after HIVST. INTERPRETATION Overall, participants value low-cost, confidential testing with short travel distance. HIVST is a promising strategy to increase testing coverage but post-test counseling and support should be made available. Educational campaigns to increase familiarity and build confidence in results of oral testing can improve the success of HIVST. DCEs conducted within clinic settings likely have limited generalizability to those not seeking care, particularly for key populations.
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Affiliation(s)
- Monisha Sharma
- Department of Global Health, University of Washington, School of Public Health, 908 Jefferson St, Seattle, WA 98104, United States
- Corresponding author.
| | - Jason J. Ong
- Department of Clinical Research and Development, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Central Clinical School, Monash University, Melbourne, Australia
| | - Connie Celum
- Department of Global Health, University of Washington, School of Public Health, 908 Jefferson St, Seattle, WA 98104, United States
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Using repeated home-based HIV testing services to reach and diagnose HIV infection among persons who have never tested for HIV, Chókwè health demographic surveillance system, Chókwè district, Mozambique, 2014-2017. PLoS One 2020; 15:e0242281. [PMID: 33216773 PMCID: PMC7678994 DOI: 10.1371/journal.pone.0242281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/29/2020] [Indexed: 11/19/2022] Open
Abstract
Background HIV prevalence in Mozambique (12.6%) is one of the highest in the world, yet ~40% of people living with HIV (PLHIV) do not know their HIV status. Strategies to increase HIV testing uptake and diagnosis among PLHIV are urgently needed. Home-based HIV testing services (HBHTS) have been evaluated primarily as a 1-time campaign strategy. Little is known about the potential of repeating HBHTS to diagnose HIV infection among persons who have never been tested (NTs), nor about factors/reasons associated with never testing in a generalized epidemic setting. Methods During 2014–2017, counselors visited all households annually in the Chókwè Health and Demographic Surveillance System (CHDSS) and offered HBHTS. Cross-sectional surveys were administered to randomly selected 10% or 20% samples of CHDSS households with participants aged 15–59 years before HBHTS were conducted during the visit. Descriptive statistics and logistic regression were used to assess the proportion of NTs, factors/reasons associated with never having been tested, HBHTS acceptance, and HIV-positive diagnosis among NTs. Results The proportion of NTs decreased from 25% (95% confidence interval [CI]:23%–26%) during 2014 to 12% (95% CI:11% –13%), 7% (95% CI:6%–8%), and 7% (95% CI:6%–8%) during 2015, 2016, and 2017, respectively. Adolescent boys and girls and adult men were more likely than adult women to be NTs. In each of the four years, the majority of NTs (87%–90%) accepted HBHTS. HIV-positive yield among NTs subsequently accepting HBHTS was highest (13%, 95% CI:10%–15%) during 2014 and gradually reduced to 11% (95% CI:8%–15%), 9% (95% CI:6%–12%), and 2% (95% CI:0%–4%) during 2015, 2016, and 2017, respectively. Conclusions Repeated HBHTS was helpful in increasing HIV testing coverage and identifying PLHIV in Chókwè. In high HIV-prevalence settings with low testing coverage, repeated HBHTS can be considered to increase HIV testing uptake and diagnosis among NTs.
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Abstract
Objectives: To assess the impact of a combination HIV prevention intervention including universal testing and treatment (UTT) on HIV stigma among people living with HIV, and among community members and health workers not living with HIV. Design: This HIV stigma study was nested in the HPTN 071 (PopART) trial, a three-arm cluster randomised trial conducted between 2013 and 2018 in 21 urban/peri-urban communities (12 in Zambia and nine in South Africa). Methods: Using an adjusted two-stage cluster-level analysis, controlling for baseline imbalances, we compared multiple domains of stigma between the trial arms at 36 months. Different domains of stigma were measured among three cohorts recruited across all study communities: 4178 randomly sampled adults aged 18–44 who were living with HIV, and 3487 randomly sampled adults and 1224 health workers who did not self-report living with HIV. Results: Prevalence of any stigma reported by people living with HIV at 36 months was 20.2% in arm A, 26.1% in arm B, and 19.1% in arm C (adjusted prevalence ratio, A vs. C 1.01 95% CI 0.49–2.08, B vs. C 1.34 95% CI 0.65–2.75). There were no significant differences between arms in any other measures of stigma across all three cohorts. All measures of stigma reduced over time (0.2--4.1% reduction between rounds) with most reductions statistically significant. Conclusion: We found little evidence that UTT either increased or decreased HIV stigma measured among people living with HIV, or among community members or health workers not living with HIV. Stigma reduced over time, but slowly. ClinicalTrials.gov number: NCT01900977.
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