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Varshney K, Mustafa AD. Trends in HIV incidence and mortality across Bharat (India) after the emergence of COVID-19. Int J STD AIDS 2024:9564624241271945. [PMID: 39106088 DOI: 10.1177/09564624241271945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) is a sexually transmitted infection impacting populations worldwide. While there have been major improvements in controlling HIV over recent years, the COVID-19 pandemic may have potentially resulted in major interruptions to this control of HIV. Bharat (India) is a country that has been greatly impacted by the COVID-19 pandemic, and we aimed to analyse the trends in HIV control since the start of the pandemic. METHODS In this study we evaluated changes in rates of HIV incidence and mortality across Bharat for the years both before, and after, the start of the COVID-19 pandemic. Percent and absolute changes were determined, and thereafter, both bivariate and multi linear regression was conducted to evaluate the relationship between COVID-19 burden and changes in HIV epidemiology across the nation. RESULTS It was shown that, despite the COVID-19 pandemic, annual incidence and deaths of HIV/AIDS have both decreased across Bharat. From 2019-2021, in Bharat, the total number of new HIV cases annually decreased by 9.03%, and the total number of HIV/AIDS deaths annually decreased by 28.82%. A similar trend was shown across most states/union territories; however, there were notable exceptions (such as Karnataka, Bihar, and Assam) where the rates have instead increased. CONCLUSIONS Our analysis has demonstrated that government efforts to control the HIV/AIDS epidemic have not been greatly impacted across the majority of Bharat since the emergence of COVID-19. The reduction in annual HIV/AIDS deaths in the country has been better than the world average, and the improvements from the period of 2019 to 2021 were greater than those from 2017 to 2019. Regardless, there are regions in the nation where the epidemic has instead worsened during this period.
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Affiliation(s)
- Karan Varshney
- School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Ashmit D Mustafa
- School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
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Pinto PFPS, Macinko J, Silva AF, Lua I, Jesus G, Magno L, Santos CAST, Ichihara MY, Barreto ML, Moucheraud C, Souza LE, Dourado I, Rasella D. The impact of primary health care on AIDS incidence and mortality: A cohort study of 3.4 million Brazilians. PLoS Med 2024; 21:e1004302. [PMID: 38991004 PMCID: PMC11272382 DOI: 10.1371/journal.pmed.1004302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 07/25/2024] [Accepted: 05/22/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Primary Health Care (PHC) is essential for effective, efficient, and more equitable health systems for all people, including those living with HIV/AIDS. This study evaluated the impact of the exposure to one of the largest community-based PHC programs in the world, the Brazilian Family Health Strategy (FHS), on AIDS incidence and mortality. METHODS AND FINDINGS A retrospective cohort study carried out in Brazil from January 1, 2007 to December 31, 2015. We conducted an impact evaluation using a cohort of 3,435,068 ≥13 years low-income individuals who were members of the 100 Million Brazilians Cohort, linked to AIDS diagnoses and deaths registries. We evaluated the impact of FHS on AIDS incidence and mortality and compared outcomes between residents of municipalities with low or no FHS coverage (unexposed) with those in municipalities with 100% FHS coverage (exposed). We used multivariable Poisson regressions adjusted for all relevant municipal and individual-level demographic, socioeconomic, and contextual variables, and weighted with inverse probability of treatment weighting (IPTW). We also estimated the FHS impact by sex and age and performed a wide range of sensitivity and triangulation analyses; 100% FHS coverage was associated with lower AIDS incidence (rate ratio [RR]: 0.76, 95% CI: 0.68 to 0.84) and mortality (RR: 0.68, 95%CI: 0.56 to 0.82). FHS impact was similar between men and women, but was larger in people aged ≥35 years old both for incidence (RR: 0.62, 95% CI: 0.53 to 0.72) and mortality (RR: 0.56, 95% CI: 0.43 to 0.72). The absence of important confounding variables (e.g., sexual behavior) is a key limitation of this study. CONCLUSIONS AIDS should be an avoidable outcome for most people living with HIV today and our study shows that FHS coverage could significantly reduce AIDS incidence and mortality among low-income populations in Brazil. Universal access to comprehensive healthcare through community-based PHC programs should be promoted to achieve the Sustainable Development Goals of ending AIDS by 2030.
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Affiliation(s)
- Priscila F. P. S. Pinto
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - James Macinko
- Departments of Health Policy and Management and Community Health Sciences, Fielding School of Public Health, University of California (UCLA), Los Angeles, California, United States of America
| | - Andréa F. Silva
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Iracema Lua
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Gabriela Jesus
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Laio Magno
- Department of Life Sciences, State University of Bahia (UNEB), Salvador, Brazil
| | | | - Maria Yury Ichihara
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Mauricio L. Barreto
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Corrina Moucheraud
- Departments of Health Policy and Management and Community Health Sciences, Fielding School of Public Health, University of California (UCLA), Los Angeles, California, United States of America
| | - Luis E. Souza
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- Instituto de Salud Global Barcelona (ISGlobal), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
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Chhun N, Oketch D, Agot K, Mangale DI, Badia J, Kibugi J, Jiang W, Kirk M, Richardson BA, Kohler PK, John‐Stewart G, Beima‐Sofie K. Using FRAME to characterize provider-identified adaptations to a stepped care intervention for adolescents and youth living with HIV in Kenya: a mixed methods approach. J Int AIDS Soc 2024; 27 Suppl 1:e26261. [PMID: 38965971 PMCID: PMC11224585 DOI: 10.1002/jia2.26261] [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] [Received: 08/28/2023] [Accepted: 04/19/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION The Data-informed Stepped Care (DiSC) study is a cluster-randomized trial implemented in 24 HIV care clinics in Kenya, aimed at improving retention in care for adolescents and youth living with HIV (AYLHIV). DiSC is a multi-component intervention that assigns AYLHIV to different intensity (steps) of services according to risk. We used the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to characterize provider-identified adaptations to the implementation of DiSC to optimize uptake and delivery, and determine the influence on implementation outcomes. METHODS Between May and December 2022, we conducted continuous quality improvement (CQI) meetings with providers to optimize DiSC implementation at 12 intervention sites. The meetings were guided by plan-do-study-act processes to identify challenges during early phase implementation and propose targeted adaptations. Meetings were audio-recorded and analysed using FRAME to categorize the level, context and content of planned adaptations and determine if adaptations were fidelity consistent. Providers completed surveys to quantify perceptions of DiSC acceptability, appropriateness and feasibility. Mixed effects linear regression models were used to evaluate these implementation outcomes over time. RESULTS Providers participated in eight CQI meetings per facility over a 6-month period. A total of 65 adaptations were included in the analysis. The majority focused on optimizing the integration of DiSC within the clinic (83%, n = 54), and consisted of improving documentation, addressing scheduling challenges and improving clinic workflow. Primary reasons for adaptation were to align delivery with AYLHIV needs and preferences and to increase reach among AYLHIV: with reminder calls to AYLHIV, collaborating with schools to ensure AYLHIV attended clinic appointments and addressing transportation challenges. All adaptations to optimize DiSC implementation were fidelity-consistent. Provider perceptions of implementation were consistently high throughout the process, and on average, slightly improved each month for intervention acceptability (β = 0.011, 95% CI: 0.002, 0.020, p = 0.016), appropriateness (β = 0.012, 95% CI: 0.007, 0.027, p<0.001) and feasibility (β = 0.013, 95% CI: 0.004, 0.022, p = 0.005). CONCLUSIONS Provider-identified adaptations targeted improved integration into routine clinic practices and aimed to reduce barriers to service access unique to AYLHIV. Characterizing types of adaptations and adaptation rationale may enrich our understanding of the implementation context and improve abilities to tailor implementation strategies when scaling to new settings.
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Affiliation(s)
- Nok Chhun
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | | | - Kawango Agot
- Impact Research and Development OrganizationKisumuKenya
| | - Dorothy I. Mangale
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of OncologyWashington UniversitySt. LouisMissouriUSA
| | - Jacinta Badia
- Impact Research and Development OrganizationKisumuKenya
| | - James Kibugi
- Impact Research and Development OrganizationKisumuKenya
| | - Wenwen Jiang
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Mary Kirk
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Barbra A. Richardson
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of BiostatisticsUniversity of WashingtonSeattleWashingtonUSA
| | - Pamela K. Kohler
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of Child, Family, and Population Health NursingUniversity of WashingtonSeattleWashingtonUSA
| | - Grace John‐Stewart
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
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Marquez C, Atukunda M, Nugent J, Charlebois ED, Chamie G, Mwangwa F, Ssemmondo E, Kironde J, Kabami J, Owaraganise A, Kakande E, Ssekaynzi B, Abbott R, Ayieko J, Ruel T, Kwariisima D, Kamya M, Petersen M, Havlir DV, Balzer LB. Community-Wide Universal HIV Test and Treat Intervention Reduces Tuberculosis Transmission in Rural Uganda: A Cluster-Randomized Trial. Clin Infect Dis 2024; 78:1601-1607. [PMID: 38226445 PMCID: PMC11175690 DOI: 10.1093/cid/ciad776] [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] [Received: 07/14/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) treatment reduces tuberculosis (TB) disease and mortality; however, the population-level impact of universal HIV-test-and-treat interventions on TB infection and transmission remain unclear. METHODS In a sub-study nested in the SEARCH trial, a community cluster-randomized trial (NCT01864603), we assessed whether a universal HIV-test-and-treat intervention reduced population-level incident TB infection in rural Uganda. Intervention communities received annual, population-level HIV testing and patient-centered linkage. Control communities received population-level HIV testing at baseline and endline. We compared estimated incident TB infection by arms, defined by tuberculin skin test conversion in a cohort of persons aged 5 and older, adjusting for participation and predictors of infection, and accounting for clustering. RESULTS Of the 32 trial communities, 9 were included, comprising 90 801 participants (43 127 intervention and 47 674 control). One-year cumulative incidence of TB infection was 16% in the intervention and 22% in the control; SEARCH reduced the population-level risk of incident TB infection by 27% (adjusted risk ratio = 0.73; 95% confidence interval [CI]: .57-.92, P = .005). In pre-specified analyses, the effect was largest among children aged 5-11 years and males. CONCLUSIONS A universal HIV-test-and-treat intervention reduced incident TB infection, a marker of population-level TB transmission. Investments in community-level HIV interventions have broader population-level benefits, including TB reductions.
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Affiliation(s)
- Carina Marquez
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | | | - Joshua Nugent
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Edwin D Charlebois
- Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, California, USA
| | - Gabriel Chamie
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | | | | | - Joel Kironde
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Jane Kabami
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Elijah Kakande
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Bob Ssekaynzi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Rachel Abbott
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - James Ayieko
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Theodore Ruel
- Department of Pediatrics, University of California, San Francisco, California, USA
| | | | - Moses Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- School of Medicine, Makerere University, Kampala, Uganda
| | - Maya Petersen
- Division of Biostatistics, School of Public Health University of California, Berkeley, California, USA
| | - Diane V Havlir
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - Laura B Balzer
- Division of Biostatistics, School of Public Health University of California, Berkeley, California, USA
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Haider A, Iqbal SZ, Bhatti IA, Alim MB, Waseem M, Iqbal M, Mousavi Khaneghah A. Food authentication, current issues, analytical techniques, and future challenges: A comprehensive review. Compr Rev Food Sci Food Saf 2024; 23:e13360. [PMID: 38741454 DOI: 10.1111/1541-4337.13360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/29/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024]
Abstract
Food authentication and contamination are significant concerns, especially for consumers with unique nutritional, cultural, lifestyle, and religious needs. Food authenticity involves identifying food contamination for many purposes, such as adherence to religious beliefs, safeguarding health, and consuming sanitary and organic food products. This review article examines the issues related to food authentication and food fraud in recent periods. Furthermore, the development and innovations in analytical techniques employed to authenticate various food products are comprehensively focused. Food products derived from animals are susceptible to deceptive practices, which can undermine customer confidence and pose potential health hazards due to the transmission of diseases from animals to humans. Therefore, it is necessary to employ suitable and robust analytical techniques for complex and high-risk animal-derived goods, in which molecular biomarker-based (genomics, proteomics, and metabolomics) techniques are covered. Various analytical methods have been employed to ascertain the geographical provenance of food items that exhibit rapid response times, low cost, nondestructiveness, and condensability.
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Affiliation(s)
- Ali Haider
- Food Safety and Toxicology Lab, Department of Applied Chemistry, Government College University, Faisalabad, Punjab, Pakistan
| | - Shahzad Zafar Iqbal
- Food Safety and Toxicology Lab, Department of Applied Chemistry, Government College University, Faisalabad, Punjab, Pakistan
| | - Ijaz Ahmad Bhatti
- Department of Chemistry, University of Agriculture, Faisalabad, Pakistan
| | | | - Muhammad Waseem
- Food Safety and Toxicology Lab, Department of Applied Chemistry, Government College University, Faisalabad, Punjab, Pakistan
| | - Munawar Iqbal
- Department of Chemistry, Division of Science and Technology, University of Education, Lahore, Pakistan
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Bekolo CE, Ndeso SA, Moifo LL, Mangala N, Ateudjieu J, Kouanfack C, Dzudie A, Thienemann F, Tendongfor N, Nsagha DS, Choukem SP. Changes in access to viral load testing, incidence rates of viral load suppression and rebound following the introduction of the 'universal test and treat' guidelines in Cameroon: A retrospective follow-up analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003042. [PMID: 38626049 PMCID: PMC11020606 DOI: 10.1371/journal.pgph.0003042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/25/2024] [Indexed: 04/18/2024]
Abstract
Cameroon adopted and started implementing in 2016, the 'universal test and treat' (UTT) guidelines to fast-track progress towards the 95-95-95 ambitious targets to end the HIV epidemic. Achieving the third 95 (viral load suppression) is the most desirable target in HIV care. We aimed to evaluate the effectiveness of this novel approach on access to viral load testing (VLT), viral suppression (VLS), and viral load rebound (VLR). A retrospective cohort study was conducted at The Nkongsamba Regional Hospital to compare VLT outcomes between the pre-UTT (2002 to 2015) and the post-UTT (2016 to 2020) periods. We used a data extraction form to collect routine data on adult patients living with HIV. We measured uptake levels of the first and serial VLT and compared the incidence rates of VLS (VL<1000 copies/ml) and viral load rebound (VLR) before and after introducing the UTT approach using Kaplan Meier plots and log-rank tests. Cox regression was used to screen for factors independently associated with VLS and VLR events between the guideline periods. Access to initial VLT increased significantly from 6.11% to 25.56% at 6 months and from 12.00% to 73.75% at 12 months before and after introducing the UTT guidelines respectively. After a total observation time at risk of 17001.63 person-months, the UTT group achieved an incidence rate of 90.36 VLS per 1000 person-months, four-fold higher than the 21.71 VLS per 1000 person-months observed in the pre-UTT group (p<0.0001). After adjusting for confounding, the VLS rate was about 6-fold higher in the UTT group than in the pre-UTT group (adjusted Hazard Rate (aHR) = 5.81 (95% confidence interval (95%CI): 4.43-7.60). The incidence of VLR increased from 12.60 (95%CI: 9.50-16.72) to 19.11 (95%CI: 14.22-25.67) per 1000 person-months before and after the introduction of UTT guidelines respectively. After adjusting, VLR was more than twice as high in the UTT group than in the pre-UTT group (aHR = 2.32, 95%CI: 1.30-4.13). Increased access to initial VLT and higher rates of VLS have been observed but there are concerns that the suppressed viral load may not be durable since the introduction of the UTT policy in this setting.
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Affiliation(s)
- C. E. Bekolo
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - S. A. Ndeso
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - L. L. Moifo
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - N. Mangala
- Department of Gynaecology and Obstetrics, University of Douala, Douala, Cameroon
| | - J. Ateudjieu
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - C. Kouanfack
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - A. Dzudie
- Department of Internal Medicine and Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - F. Thienemann
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - N. Tendongfor
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - D. S. Nsagha
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - S. P. Choukem
- Department of Internal Medicine and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
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Ayieko J, Charlebois ED, Maeri I, Owino L, Thorp M, Bukusi EA, Petersen ML, Kamya MR, Havlir DV, Camlin CS. Improving care engagement for mobile people living with HIV in rural western Kenya. PLoS One 2023; 18:e0288087. [PMID: 37992063 PMCID: PMC10664942 DOI: 10.1371/journal.pone.0288087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/20/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) assures major gains in health outcomes among people living with HIV, however, this benefit may not be realized by all due to care interruptions. Mobile populations comprise a subgroup that is likely to have sub-optimal care engagement, resulting in discontinuation of ART. We sought to evaluate the barriers to care engagement among highly mobile individuals living with HIV and explore options aimed at improving engagement in care for this group. METHODS Qualitative in-depth interviews were conducted in 2020 among a purposive sample of twelve persons living with HIV and eight health care providers in western Kenya, within a mixed methods study of mobility in communities participating in the SEARCH trial (NCT01864603). We explored the barriers to care engagement among mobile individuals living with HIV and explored different options aimed at enhancing care engagement. These included options such as a coded card containing treatment details, alternative drug packaging to conceal drug identity, longer refills to cover travel period, wrist bands with data storage capability to enable data transfer and "warm handoff" by providers to new clinics upon transfer. Data were inductively analyzed to understand the barriers and acceptability of potential interventions to address them. RESULTS Stigma and lack of disclosure, rigid work schedules, and unpredictability of travel were major barriers to care engagement for highly mobile individuals living with HIV. Additionally, lack of flexibility in clinic schedules and poor provider attitude were identified as health-system-associated barriers to care engagement. Options that enhance flexibility, convenience and access to care were viewed as the most effective means of addressing the barriers to care by both patients and providers. The most preferred option was a coded card with treatment details followed by alternative drug packaging to conceal drug identity due to stigma and longer refills to cover travel periods. CONCLUSION Highly mobile individuals living with HIV desire responsive, flexible, convenient and patient-centered care delivery models to enhance care engagement. They embraced simple health delivery improvements such as coded cards, alternative drug packaging and longer refills to address challenges of mobility.
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Affiliation(s)
- James Ayieko
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edwin D. Charlebois
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Irene Maeri
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lawrence Owino
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Marguerite Thorp
- Department of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Elizabeth A. Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Maya L. Petersen
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Diane V. Havlir
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Carol S. Camlin
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
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Ngcobo SJ, Makhado L, Sehularo LA. HIV Care Profiling and Delivery Status in the Mobile Health Clinics of eThekwini District in KwaZulu Natal, South Africa: A Descriptive Evaluation Study. NURSING REPORTS 2023; 13:1539-1552. [PMID: 37987408 PMCID: PMC10661302 DOI: 10.3390/nursrep13040129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/15/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
Mobile health clinics (MHCs) serve as an alternative HIV care delivery method for the HIV-burdened eThekwini district. This study aimed to describe and profile the HIV care services provided by the MHCs through process evaluation. A descriptive cross-sectional quantitative evaluation study was performed on 137 MHCs using total population sampling. An online data collection method using a validated 50-item researcher-developed instrument was administered to professional nurses who are MHC team leaders, following ethical approval from the local university and departments of health. Descriptive statistics were used to analyze the data. The results described that HIV care services are offered in open spaces (43%), community buildings (37%), solid built buildings called health posts (15%), vehicles (9%), and tents (2%) with no electricity (77%), water (55%), and sanitation (64%). Adults (97%) are the main recipients of HIV care in MHCs (90%) offering antiretroviral therapy (95%). Staff, monitoring, and retaining care challenges were noted, with good linkage (91%) and referral pathways (n = 123.90%). In conclusion, the standardization and prioritization of HIV care with specific contextual practice guidelines are vital.
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Affiliation(s)
| | - Lufuno Makhado
- Office of the Deputy Dean Research and Postgraduate Studies, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
| | - Leepile Alfred Sehularo
- NuMIQ Research Focus Area, Faculty of Health Sciences, North-West University, Mafikeng 2531, South Africa
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Pinto PFPS, Macinko J, Silva AF, Lua I, Jesus G, Magno L, Santos CAST, Ichihara MY, Barreto ML, Moucheraud C, Souza LE, Dourado I, Rasella D. The effect of primary health care on AIDS incidence and mortality: a cohort study of 3.4 million Brazilians. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.02.23296417. [PMID: 37873240 PMCID: PMC10593023 DOI: 10.1101/2023.10.02.23296417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Primary Health Care (PHC) is essential for the health and wellbeing of people living with HIV/AIDS. This study evaluated the effects of one of the largest community-based PHC programs in the world, the Brazilian Family Health Strategy (FHS), on AIDS incidence and mortality. Methods A retrospective cohort study carried out in Brazil, from January 1 2007 to December 31 2015. We conducted a quasi-experimental effect evaluation using a cohort of 3,435,068 ≥13 years low-income individuals who were members of the 100 Million Brazilians Cohort, linked to AIDS diagnoses and deaths registries. We evaluated the effect of FHS on AIDS incidence and mortality and comparing outcomes between residents of municipalities with no FHS coverage with those in municipalities with full FHS coverage. We used multivariable Poisson regressions adjusted for all relevant municipal and individual-level demographic, socioeconomic, and contextual variables, and weighted with inverse probability of treatment weighting (IPTW). We also estimated FHS effect by sex and age, and performed a wide range of sensitivity and triangulation analyses. Findings FHS coverage was associated with lower AIDS incidence (rate ratio [RR]:0.76, 95%CI:0.68-0.84) and mortality (RR:0.68,95%CI:0.56-0.82). FHS effect was similar between men and women, but was larger in people aged ≥35 years old both for incidence (RR 0.62, 95%CI:0.53-0.72) and mortality (RR 0.56, 95%CI:0.43-0.72). Conclusions AIDS should be an avoidable outcome for most people living with HIV today, and our study shows that FHS coverage could significantly reduce AIDS incidence and mortality among low-income populations in Brazil. Universal access to comprehensive healthcare through community-based PHC programs should be promoted to achieve the Sustainable Development Goals of ending AIDS by 2030.
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Affiliation(s)
- Priscila FPS Pinto
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - James Macinko
- Departments of Health Policy and Management and Community Health Sciences, Fielding School of Public Health, University of California (UCLA), Los Angeles, California, The United States of America (USA)
| | - Andréa F Silva
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Iracema Lua
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Gabriela Jesus
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Laio Magno
- Department of Life Sciences, State University of Bahia (UNEB), Salvador, Brazil
| | - Carlos AS Teles Santos
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Maria Yury Ichihara
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Mauricio L Barreto
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Corrina Moucheraud
- Departments of Health Policy and Management and Community Health Sciences, Fielding School of Public Health, University of California (UCLA), Los Angeles, California, The United States of America (USA)
| | - Luis E Souza
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- Instituto de Salud Global Barcelona (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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10
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Mayasi Ngongo N, Kamangu Ntambwe E, Situakibanza Nani-Tuma H, Mbula Mambimbi M, Mandina Ndona M, Longokolo Mashi M, Bepouka Izizag B, Lukiana T, Odio Ossam J, Mangala Sonzi D, Maes N, Moutschen M, El Moussaoui M, Darcis G. Human Immunodeficiency Virus Viral Load Monitoring and Rate of Virologic Suppression Among Patients Receiving Antiretroviral Therapy in Democratic Republic of the Congo, 2013-2020. Open Forum Infect Dis 2023; 10:ofad242. [PMID: 37363052 PMCID: PMC10287095 DOI: 10.1093/ofid/ofad242] [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: 02/28/2023] [Accepted: 05/02/2023] [Indexed: 06/28/2023] Open
Abstract
Background Antiretroviral therapy (ART) expansion and viral load as a treatment monitoring approach have increased the demand for viral load testing. Many hurdles affect the coverage, quality, and use of viral load results. Estimates of viral load monitoring and viral suppression rates are needed to assess the performance of ART programs and improve human immunodeficiency virus (HIV) management outcomes. Methods People with HIV (PWH) viral load monitoring data were routinely collected in 84 health facilities in Kinshasa, Democratic Republic of the Congo (DRC), between 2013 and 2020. The number of PWH under ART, the number of participants with at least 1 viral load test result, the rate of viral suppression (defined as ≤1000 HIV ribonucleic acid copies per mL), and the mean turnaround time from sample collection to release of viral load test results were collected together with clinical data. Results A total of 14 057 PWH were included in the analysis. People with HIV were mainly enrolled after the "test and treat" implementation. The patients were followed for a median period of 27 months. The proportion of PWH with at least 1 available viral load largely increased in recent years. The delay from sample collection to release of viral load test results decreased overtime, from 35 days in 2018 to 16 days in 2020. Pregnancy and advanced HIV disease were associated with a lower chance of viral suppression. Conclusions There has been considerable success in increasing viral load access for all PWH under therapy in DRC. Nevertheless, viral load testing should be intensified with a particular effort to be made in groups at higher risk of viral failure.
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Affiliation(s)
- Nadine Mayasi Ngongo
- Correspondence: Gilles Darcis, MD, PhD, Avenue de l’hôpital 1, 4000 Liège, Belgium (); Nadine Mayasi Ngongo, MD, PhD, Avenue de l’hôpital 1, 4000 Liège, Belgium (nadiamayas02@gmail)
| | - Erick Kamangu Ntambwe
- Department of Molecular Biology of Basic Sciences, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Hippolyte Situakibanza Nani-Tuma
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Marcel Mbula Mambimbi
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Madone Mandina Ndona
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Murielle Longokolo Mashi
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ben Bepouka Izizag
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Tuna Lukiana
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jérôme Odio Ossam
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Donatien Mangala Sonzi
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Nathalie Maes
- Biostatistics and Research Method Center (B-STAT), University Hospital of Liège, Liège, Belgium
| | - Michel Moutschen
- Department of Internal Medicine and Infectious Diseases, Liège University Hospital, Liège, Belgium
- AIDS Reference Laboratory, University of Liège, Liège, Belgium
| | - Majdouline El Moussaoui
- Department of Internal Medicine and Infectious Diseases, Liège University Hospital, Liège, Belgium
| | - Gilles Darcis
- Correspondence: Gilles Darcis, MD, PhD, Avenue de l’hôpital 1, 4000 Liège, Belgium (); Nadine Mayasi Ngongo, MD, PhD, Avenue de l’hôpital 1, 4000 Liège, Belgium (nadiamayas02@gmail)
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11
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Abuogi LL, Kulzer JL, Akama E, Odeny TA, Eshun-Wilson I, Petersen M, Shade SB, Montoya LM, Beres LK, Iguna S, Adhiambo HF, Osoro J, Opondo I, Sang N, Kwena Z, Bukusi EA, Geng EH. Adapt for Adolescents: Protocol for a sequential multiple assignment randomized trial to improve retention and viral suppression among adolescents and young adults living with HIV in Kenya. Contemp Clin Trials 2023; 127:107123. [PMID: 36813086 PMCID: PMC10075086 DOI: 10.1016/j.cct.2023.107123] [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] [Received: 11/16/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Adolescents and young adults living with HIV (AYAH) aged 14-24 years in Africa experience substantially higher rates of virological failure and HIV-related mortality than adults. We propose to utilize developmentally appropriate interventions with high potential for effectiveness, tailored by AYAH pre-implementation, in a sequential multiple assignment randomized trial (SMART) aimed at improving viral suppression for AYAH in Kenya. METHODS Using a SMART design, we will randomize 880 AYAH in Kisumu, Kenya to either youth-centered education and counseling (standard of care) or electronic peer navigation in which a peer provides support, information, and counseling via phone and automated monthly text messages. Those with a lapse in engagement (defined as either a missed clinic visit by ≥14 days or HIV viral load ≥1000 copies/ml) will be randomized a second time to one of three higher-intensity re-engagement interventions: This study will evaluate which interventions and which dynamic sequence of interventions improve sustained viral suppression and HIV care engagement in AYAH at 24 months post-enrollment and assess the cost-effectiveness of successful strategies. DISCUSSION The study utilizes promising interventions tailored to AYAH while optimizing resources by intensifying services only for those AYAH who need more support. Findings from this innovative study will offer evidence for public health programming to end the HIV epidemic as a public health threat for AYAH in Africa. TRIAL REGISTRATION Clinicaltrials.govNCT04432571, registered June 16, 2020.
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Affiliation(s)
- Lisa L Abuogi
- Department of Pediatrics, University of Colorado, Denver, Aurora, CO, USA.
| | - Jayne Lewis Kulzer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Eliud Akama
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Thomas A Odeny
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya; School of Medicine, Washington University, St. Louis, MO, USA
| | | | - Maya Petersen
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Starley B Shade
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Lina M Montoya
- Department of Biostatistics, University of North Carolina at Chapel Hill, NC, USA
| | - Laura K Beres
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah Iguna
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Harriet F Adhiambo
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Joseph Osoro
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Isaya Opondo
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Norton Sang
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Zachary Kwena
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth A Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elvin H Geng
- School of Medicine, Washington University, St. Louis, MO, USA
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12
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Odokonyero RF, Ocan M, Kinengyere AA, Nakasujja N, Muhwezi WW, Camlin CS, Hahn JA. Prevalence of, and factors associated with, alcohol use disorder among young adults (aged 15-24 years) living with HIV/AIDS in low-income and middle-income countries: protocol for a systematic review. BMJ Open 2023; 13:e068108. [PMID: 36599636 PMCID: PMC9815046 DOI: 10.1136/bmjopen-2022-068108] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Alcohol use is a global driver of HIV infection and disease progression, mediated through risky behaviour and poor antiretroviral adherence. Most studies about the burden of alcohol use among people living with HIV (PLWH)/AIDS have been done in adult populations, but less is known about young people with HIV, especially in low-income and middle-income countries (LMICs), despite the high level of alcohol use in these settings. The aim of this review is to collate evidence on the prevalence of, and factors associated with, alcohol use disorder (AUD) among young adults (aged 15-24 years) living with HIV/AIDS in LMICs. METHODS AND ANALYSIS Two experienced librarians will conduct an independent article search in PubMed, PsycINFO, Embase and Web of Science databases, using relevant Medical Subject Headings terms and Boolean operators ('AND', 'OR'). We will include English-language articles that were published in peer-reviewed journals from 1 January 2000, to 25 July 2022, that documented the prevalence of AUD among young people (15-24 years) living with HIV in LMICs. We shall exclude systematic review articles and qualitative studies. Two independent reviewers will screen the articles for eligibility and data will be extracted onto a preset Excel spreadsheet. Data analysis will be done using Stata V.14.0. Heterogeneity will be assessed by use of the I2 statistic and data will be pooled in meta-analyses where appropriate. Publication bias will be assessed using the funnel plot. ETHICS AND DISSEMINATION Ethical approval is not needed as this systematic review will be based on published studies. Findings from this study will be disseminated via submission for publication in a peer-reviewed journal, at conference presentations, and made available to health professionals, scientists and policy makers. Our data set can be made available on request. REGISTRATION DETAILS PROSPERO, CRD42022308955.
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Affiliation(s)
| | - Moses Ocan
- Pharmacology & Therapeutics, Makerere University College of Health Sciences, Kampala, Kampala, Uganda
| | - Alison Annet Kinengyere
- Albert Cook Library, Makerere University College of Health Sciences, Kampala, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Wilson W Muhwezi
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, USA
| | - J A Hahn
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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13
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Mwangwa F, Charlebois ED, Ayieko J, Olio W, Black D, Peng J, Kwarisiima D, Kabami J, Balzer LB, Petersen ML, Kapogiannis B, Kamya MR, Havlir DV, Ruel TD. Two or more significant life-events in 6-months are associated with lower rates of HIV treatment and virologic suppression among youth with HIV in Uganda and Kenya. AIDS Care 2023; 35:95-105. [PMID: 35578398 PMCID: PMC9666617 DOI: 10.1080/09540121.2022.2052260] [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] [Received: 07/19/2021] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
Youth living with HIV in sub-Saharan Africa have poor HIV care outcomes. We determined the association of recent significant life-events with HIV antiretroviral treatment (ART) initiation and HIV viral suppression in youth aged 15-24 years living with HIV in rural Kenya and Uganda. This was a cross-sectional analysis of 995 youth enrolled in the SEARCH Youth study. At baseline, providers assessed recent (within 6 months) life-events, defined as changes in schooling/employment, residence, partnerships, sickness, incarceration status, family strife or death, and birth/pregnancy, self-reported alcohol use, being a parent, and HIV-status disclosure. We examined the frequencies of events and their association with ART status and HIV viral suppression (<400 copies/ul). Recent significant life-events were prevalent (57.7%). Having >2 significant life-events (aOR = 0.61, 95% CI:0.45-0.85) and consuming alcohol (aOR = 0.61, 95% CI:0.43-0.87) were associated with a lower odds of HIV viral suppression, while disclosure of HIV-status to partner (aOR = 2.39, 95% CI:1.6-3.5) or to family (aOR = 1.86, 95% CI:1.3-2.7), being a parent (aOR = 1.8, 95% CI:1.2-2.5), and being single (aOR = 1.6, 95% CI:1.3-2.1) had a higher odds. This suggest that two or more recent life-events and alcohol use are key barriers to ART initiation and achievement of viral suppression among youth living with HIV in rural East Africa.Trial registration: ClinicalTrials.gov identifier: NCT03848728..
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Affiliation(s)
| | - Edwin D. Charlebois
- University of California, San Francisco, San Francisco, California, United States of America
| | - James Ayieko
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Winter Olio
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Douglas Black
- University of California, San Francisco, San Francisco, California, United States of America
| | - James Peng
- University of California, San Francisco, San Francisco, California, United States of America
| | | | - Jane Kabami
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Laura B. Balzer
- University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Maya L. Petersen
- University of California, Berkeley School of Public Health, Berkeley, California, United States of America
| | - Bill Kapogiannis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health, Bethesda, Maryland, United States of America
| | - Moses R. Kamya
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Diane V. Havlir
- University of California, San Francisco, San Francisco, California, United States of America
| | - Theodore D. Ruel
- University of California, San Francisco, San Francisco, California, United States of America
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14
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Driver M, Katz DA, Manyeki V, Mungala C, Otiso L, Mugo C, McClelland S, Kohler P, Simoni JM, Inwani I, Wilson K. Condom Use Behaviors, Risk Perception, and Partner Communication Following Oral HIV Self-testing Among Adolescents and Young Adults in Kenya: A Cohort Study. AIDS Behav 2022; 27:1727-1740. [PMID: 36520337 DOI: 10.1007/s10461-022-03904-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 12/23/2022]
Abstract
HIV self-testing (HIVST) can improve testing completion among adolescents and young adults (AYA), although its influence on sexual behaviors is unclear. We evaluated whether HIVST was associated with changes in talking with sexual partners about HIVST, condom use, and HIV risk perception among AYA ages 15-24 years in a study of HIVST distribution through homes, pharmacies, and nightclubs in Nairobi, Kenya. All participants had negative HIVST results. Regression models were used to evaluate changes between pre-HIVST and 4 months post-HIVST. Overall, there was a significant increase in talking with sexual partners about HIVST. There was a significant reduction in number of condomless sex acts among AYA recruited through pharmacies and homes. Unexpectedly, among females, there was a significant decrease in consistent condom use with casual partners. HIVST services for AYA may benefit from including strategies to support condom use and partner communication about self-testing adapted to specific populations and partnerships.
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Affiliation(s)
- Matthew Driver
- Department of Epidemiology, University of Washington, Seattle, USA
| | - David A Katz
- Department of Global Health, University of Washington, Seattle, USA
| | - Vivianne Manyeki
- University of Nairobi/Kenyatta National Hospital, Nairobi, Kenya
| | - Caroline Mungala
- University of Nairobi/Kenyatta National Hospital, Nairobi, Kenya
| | | | - Cyrus Mugo
- Department of Global Health, University of Washington, Seattle, USA
- University of Nairobi/Kenyatta National Hospital, Nairobi, Kenya
| | - Scott McClelland
- Department of Epidemiology, University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
- Department of Medicine, University of Washington, Seattle, USA
| | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, USA
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, USA
| | - Jane M Simoni
- Department of Global Health, University of Washington, Seattle, USA
- Department of Psychology, University of Washington, Seattle, USA
| | - Irene Inwani
- University of Nairobi/Kenyatta National Hospital, Nairobi, Kenya
| | - Kate Wilson
- Department of Global Health, University of Washington, Seattle, USA.
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15
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Achieving the UNAIDS 90-90-90 targets: a comparative analysis of four large community randomised trials delivering universal testing and treatment to reduce HIV transmission in sub-Saharan Africa. BMC Public Health 2022; 22:2333. [PMID: 36514036 PMCID: PMC9746009 DOI: 10.1186/s12889-022-14713-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Four large community-randomized trials examining universal testing and treatment (UTT) to reduce HIV transmission were conducted between 2012-2018 in Botswana, Kenya, Uganda, Zambia and South Africa. In 2014, the UNAIDS 90-90-90 targets were adopted as a useful metric to monitor coverage. We systematically review the approaches used by the trials to measure intervention delivery, and estimate coverage against the 90-90-90 targets. We aim to provide in-depth understanding of the background contexts and complexities that affect estimation of population-level coverage related to the 90-90-90 targets. METHODS Estimates were based predominantly on "process" data obtained during delivery of the interventions which included a combination of home-based and community-based services. Cascade coverage data included routine electronic health records, self-reported data, survey data, and active ascertainment of HIV viral load measurements in the field. RESULTS The estimated total adult populations of trial intervention communities included in this study ranged from 4,290 (TasP) to 142,250 (Zambian PopART Arm-B). The estimated total numbers of PLHIV ranged from 1,283 (TasP) to 20,541 (Zambian PopART Arm-B). By the end of intervention delivery, the first-90 target (knowledge of HIV status among all PLHIV) was met by all the trials (89.2%-94.0%). Three of the four trials also achieved the second- and third-90 targets, and viral suppression in BCPP and SEARCH exceeded the UNAIDS target of 73%, while viral suppression in the Zambian PopART Arm-A and B communities was within a small margin (~ 3%) of the target. CONCLUSIONS All four UTT trials aimed to implement wide-scale testing and treatment for HIV prevention at population level and showed substantial increases in testing and treatment for HIV in the intervention communities. This study has not uncovered any one estimation approach which is superior, rather that several approaches are available and researchers or policy makers seeking to measure coverage should reflect on background contexts and complexities that affect estimation of population-level coverage in their specific settings. All four trials surpassed UNAIDS targets for universal testing in their intervention communities ahead of the 2020 milestone. All but one of the trials also achieved the 90-90 targets for treatment and viral suppression. UTT is a realistic option to achieve 95-95-95 by 2030 and fast-track the end of the HIV epidemic.
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16
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Atukunda M, Kabami J, Mutungi G, Twinamatsiko B, Nangendo J, Shade SB, Charlebois E, Grosskurth H, Kamya M, Okello E. Rationale and design of leveraging the HIV platform for hypertension control in Africa: protocol of a cluster-randomised controlled trial in Uganda. BMJ Open 2022; 12:e063227. [PMID: 36600388 PMCID: PMC9743290 DOI: 10.1136/bmjopen-2022-063227] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION There is a high burden of hypertension (HTN) among HIV-infected people in Uganda. However, capacity to prevent, diagnose and treat HTN is suboptimal. This study seeks to leverage the existing HIV-related infrastructure in primary care health facilities (HFs) using the integrated HIV/HTN care model to improve health outcomes of patients with HIV and HTN. METHODS AND ANALYSIS Integrated HIV/HTN study a type-1 effectiveness/implementation cluster randomised trial, will evaluate the effectiveness of a multicomponent model intervention in 13 districts randomised to the intervention arm compared with 13 districts randomised to control. Two randomly selected HFs per district and their patients will be eligible to participate. The intervention will comprise training of primary healthcare (PHC) providers followed by regular supervision, integration of HTN care into HIV clinics, improvement of the health management information system, IT-based messaging to improve communication among frontline PHCs and district-level managers. HTN care guidelines, sphygmomanometers, patient registers and a buffer stock of essential drugs will be provided to HFs in both study arms. We will perform cross-sectional surveys at baseline, 12 and 24 months, on a random sample of patients attending HFs to measure effectiveness of the integrated care model between 2021 and 2024. We will perform in-depth interviews of providers, patients and healthcare managers to assess barriers and facilitators of integrated care. We will measure the cost of the intervention through microcosting and time-and-motion studies. The outcomes will be analysed taking the clustered structure of the data set into account. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Research Ethics Committees at London School of Hygiene and Tropical Medicine, and Makerere University School of Medicine. All participants will provide informed consent prior to study inclusion. Strict confidentiality will be applied throughout. Findings will be disseminated to public through meetings, and publications. TRIAL REGISTRATION NUMBER NCT04624061.
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Affiliation(s)
| | - Jane Kabami
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Gerald Mutungi
- Non-Communicable Diseases prevention and control Department, Uganda Ministry of Health, Kampala, Uganda
| | | | | | - Starley B Shade
- University of California, San Francisco, San Francisco, California, USA
| | - Edwin Charlebois
- University of California, San Francisco, San Francisco, California, USA
| | - Heiner Grosskurth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Ayieko J, Thorp M. Transitioning youth living with HIV to adult HIV care. Lancet HIV 2022; 9:e810-e811. [PMID: 36309039 DOI: 10.1016/s2352-3018(22)00303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Affiliation(s)
- James Ayieko
- Kenya Medical Research Institute, Kisumu, Kenya.
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18
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Odokonyero RF, Musanje K, Mpirirwe R, Namisi CP. Promoting HIV-Related Behavioral and Social Science Research Training in Africa: A Case of Uganda. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:1381-1384. [PMID: 36388750 PMCID: PMC9664997 DOI: 10.2147/amep.s387198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
HIV/AIDS is a major contributor to morbidity and mortality in Sub-Saharan Africa (SSA). Several gaps in HIV/AIDS care persist despite advancements in bio-medical care approaches. Socio-behavioral approaches have been identified to have the capacity to plug these gaps. This calls for HIV- related behavioral and social science research (BSSR) capacity building. Adopting BSSR in HIV may provide insights into the HIV care continuum that is contextual and cost-effective and reveal the missing layer in the fight against HIV on the African continent. The Makerere University Behavioral and Social Sciences Research (Mak-BSSR) program has responded to the call to strengthen capacity in BSSR. This commentary is a call to promote, support, and sustain the collaborations needed to integrate behavioral and social science research into HIV in SSA.
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Affiliation(s)
- Raymond Felix Odokonyero
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Khamisi Musanje
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Educational, Social and Organizational Psychology, School of Psychology, College of Humanities and Social Sciences, Makerere University, Kampala, Uganda
| | - Ruth Mpirirwe
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Patrick Namisi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Dean’s Office, School of Medicine, Uganda Martyrs’ University, Mother Kevin Postgraduate School, Kampala, Uganda
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Kohler P, Agot K, Njuguna IN, Dyer J, Badia J, Jiang W, Beima-Sofie K, Chhun N, Inwani I, Shah SK, Richardson BA, Chaktoura N, John-Stewart G. Data-informed stepped care to improve youth engagement in HIV care in Kenya: a protocol for a cluster randomised trial of a health service intervention. BMJ Open 2022; 12:e062134. [PMID: 36316073 PMCID: PMC9628651 DOI: 10.1136/bmjopen-2022-062134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/10/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Adolescents and youth living with HIV (AYLHIV) have lower retention in care, adherence to treatment, and viral suppression compared with adults. Stepped care is a process by which clients are assigned to increasingly intensive services or 'steps' according to level of need. Differentiated care, in which stable clients access less frequent services, can be combined with stepped care to align needs and preferences of youth to promote optimal engagement in care. METHODS AND ANALYSIS This hybrid type I effectiveness implementation cluster randomised trial aims to evaluate a data-informed stepped care (DiSC) intervention for AYLHIV. AYLHIV ages 10-24 receiving care at 24 HIV treatment facilities in Kisumu, Homabay and Migori counties in Kenya will be enrolled. Twelve facilities will be randomised to the DiSC intervention, and 12 will provide standard care. A clinical assignment tool developed by the study team will be used at intervention sites to assign AYLHIV to one of four steps based on risk for loss to follow-up: differentiated care, standard care, counselling services or intensive support services. The primary clinical outcome is retention in care, specifically missed visits (failure to return within 30 days for any visit) and 12-month loss to follow-up. Implementation outcomes are based on the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Proportions of missed visits will be compared using mixed effect models clustered by facility and participant. ETHICS AND DISSEMINATION This study has been approved by the University of Washington Institutional Review Board (STUDY00011096), Maseno University Ethical Review Committee (MUERC/00917/20) and the Kenya National Commission for Science, Technology and Innovation (444824). AYLHIV provide written informed consent when legally permitted, or assent with caregiver permission for minors. Study staff will work with a Community Advisory Board, including youth members, to disseminate results via discussions, presentations, journal publications and local or international conferences. TRIAL REGISTRATION NUMBER NCT05007717.
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Affiliation(s)
- Pamela Kohler
- Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
- Global Health, University of Washington, Seattle, Washington, USA
| | - Kawango Agot
- Impact Research and Development Organisation, Kisumu, Kenya
| | - Irene N Njuguna
- Global Health, University of Washington, Seattle, Washington, USA
- Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Jessica Dyer
- Global Health, University of Washington, Seattle, Washington, USA
| | - Jacinta Badia
- Impact Research and Development Organisation, Kisumu, Kenya
| | - Wenwen Jiang
- Epidemiology, University of Washington, Seattle, Washington, USA
| | | | - Nok Chhun
- Global Health, University of Washington, Seattle, Washington, USA
| | - Irene Inwani
- Pediatrics, Kenyatta National Hospital, Nairobi, Kenya
| | - Seema K Shah
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Barbra A Richardson
- Global Health, Biostatistics, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Nahida Chaktoura
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Washington, District of Columbia, USA
| | - Grace John-Stewart
- Global Health, Epidemiology, Pediatrics, Medicine, University of Washington, Seattle, Washington, USA
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20
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Yi JA, Hakimi A, Vavra AK. Application of dissemination and implementation science frameworks to surgical research. Semin Vasc Surg 2022; 35:456-463. [DOI: 10.1053/j.semvascsurg.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/27/2022] [Accepted: 10/04/2022] [Indexed: 11/17/2022]
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21
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Li H, Rosete S, Coyle J, Phillips RV, Hejazi NS, Malenica I, Arnold BF, Benjamin-Chung J, Mertens A, Colford JM, van der Laan MJ, Hubbard AE. Evaluating the robustness of targeted maximum likelihood estimators via realistic simulations in nutrition intervention trials. Stat Med 2022; 41:2132-2165. [PMID: 35172378 PMCID: PMC10362909 DOI: 10.1002/sim.9348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 12/18/2022]
Abstract
Several recently developed methods have the potential to harness machine learning in the pursuit of target quantities inspired by causal inference, including inverse weighting, doubly robust estimating equations and substitution estimators like targeted maximum likelihood estimation. There are even more recent augmentations of these procedures that can increase robustness, by adding a layer of cross-validation (cross-validated targeted maximum likelihood estimation and double machine learning, as applied to substitution and estimating equation approaches, respectively). While these methods have been evaluated individually on simulated and experimental data sets, a comprehensive analysis of their performance across real data based simulations have yet to be conducted. In this work, we benchmark multiple widely used methods for estimation of the average treatment effect using ten different nutrition intervention studies data. A nonparametric regression method, undersmoothed highly adaptive lasso, is used to generate the simulated distribution which preserves important features from the observed data and reproduces a set of true target parameters. For each simulated data, we apply the methods above to estimate the average treatment effects as well as their standard errors and resulting confidence intervals. Based on the analytic results, a general recommendation is put forth for use of the cross-validated variants of both substitution and estimating equation estimators. We conclude that the additional layer of cross-validation helps in avoiding unintentional over-fitting of nuisance parameter functionals and leads to more robust inferences.
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Affiliation(s)
- Haodong Li
- Divisions of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, California, USA
| | - Sonali Rosete
- Divisions of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, California, USA
| | - Jeremy Coyle
- Divisions of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, California, USA
| | - Rachael V Phillips
- Divisions of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, California, USA
| | - Nima S Hejazi
- Divisions of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, California, USA
| | - Ivana Malenica
- Divisions of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, California, USA
| | - Benjamin F Arnold
- Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Jade Benjamin-Chung
- Epidemiology & Population Health, Stanford University, Stanford, California, USA
| | - Andrew Mertens
- Divisions of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, California, USA
| | - John M Colford
- Divisions of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, California, USA
| | - Mark J van der Laan
- Divisions of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, California, USA
| | - Alan E Hubbard
- Divisions of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, California, USA
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22
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Nardell MF, Adeoti O, Peters C, Kakuhikire B, Govathson-Mandimika C, Long L, Pascoe S, Tsai AC, Katz IT. Men missing from the HIV care continuum in sub-Saharan Africa: a meta-analysis and meta-synthesis. J Int AIDS Soc 2022; 25:e25889. [PMID: 35324089 PMCID: PMC8944222 DOI: 10.1002/jia2.25889] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 02/01/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Men are missing along the HIV care continuum. However, the estimated proportions of men in sub-Saharan Africa meeting the UNAIDS 95-95-95 goals vary substantially between studies. We sought to estimate proportions of men meeting each of the 95-95-95 goals across studies in sub-Saharan Africa, describe heterogeneity, and summarize qualitative evidence on factors influencing care engagement. METHODS We systematically searched PubMed and Embase for peer-reviewed articles published between 1 January 2014 and 16 October 2020. We included studies involving men ≥15 years old, with data from 2009 onward, reporting on at least one 95-95-95 goal in sub-Saharan Africa. We estimated pooled proportions of men meeting these goals using DerSimonion-Laird random effects models, stratifying by study population (e.g. studies focusing exclusively on men who have sex with men vs. studies that did not), facility setting (healthcare vs. community site), region (eastern/southern Africa vs. western/central Africa), outcome measurement (e.g. threshold for viral load suppression), median year of data collection (before vs. during or after 2017) and quality criteria. Data from qualitative studies exploring barriers to men's HIV care engagement were summarized using meta-synthesis. RESULTS AND DISCUSSION We screened 14,896 studies and included 129 studies in the meta-analysis, compiling data over the data collection period. Forty-seven studies reported data on knowledge of serostatus, 43 studies reported on antiretroviral therapy use and 74 studies reported on viral suppression. Approximately half of men with HIV reported not knowing their status (0.49 [95% CI, 0.41-0.58; range, 0.09-0.97]) or not being on treatment (0.58 [95% CI, 0.51-0.65; range, 0.07-0.97]), while over three-quarters of men achieved viral suppression on treatment (0.79 [95% CI, 0.77-0.81; range, 0.39-0.97]. Heterogeneity was high, with variation in estimates across study populations, settings and outcomes. The meta-synthesis of 40 studies identified three primary domains in which men described risks associated with engagement in HIV care: perceived social norms, health system challenges and poverty. CONCLUSIONS Psychosocial and systems-level interventions that change men's perceptions of social norms, improve trust in and accessibility of the health system, and address costs of accessing care are needed to better engage men, especially in HIV testing and treatment.
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Affiliation(s)
- Maria F Nardell
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Oluwatomi Adeoti
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Carson Peters
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Bernard Kakuhikire
- Faculty of Business and Management Sciences, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Caroline Govathson-Mandimika
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Long
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sophie Pascoe
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Alexander C Tsai
- Harvard Medical School, Boston, Massachusetts, USA
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ingrid T Katz
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Global Health Institute, Cambridge, Massachusetts, USA
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23
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Mulholland GE, Markiewicz M, Arimi P, Ssengooba F, Weir S, Edwards JK. HIV Prevalence and the HIV Treatment Cascade Among Female Sex Workers in Cross-Border Areas in East Africa. AIDS Behav 2022; 26:556-568. [PMID: 34379274 DOI: 10.1007/s10461-021-03411-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/14/2022]
Abstract
In cross-border areas of East Africa, sexual networks include partnerships across resident, migrant, and mobile populations, and risky behaviors can coincide with fragmented health services given the challenges of cross-border coordination. Among those most at risk are female sex workers (FSWs). We map HIV prevalence among FSWs in 14 cross-border areas, estimate associations between FSW characteristics and HIV and undiagnosed HIV, and estimate progress towards the UNAIDS 90-90-90 targets. The 2016-2017 East Africa Cross-Border Integrated Health Study recruited 4040 women; 786 were classified as FSWs. Overall HIV prevalence among FSWs was 10.8% (95% CI 8.2%, 13.3%), though area-specific estimates varied considerably. Among FSWs living with HIV, 46.1% (95% CI 33.2%, 59.0%) knew their status, 80.6% (95% CI 66.3%, 94.9%) of FSWs who knew their status were on ART, and 84.8% (95% CI 66.1%, 100.0%) of FSWs on ART were virally suppressed. Results indicate a need for expanded HIV testing.
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Affiliation(s)
- Grace E Mulholland
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB 7435, Chapel Hill, NC, 27599-7435, USA.
| | - Milissa Markiewicz
- MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Peter Arimi
- Centre for Research, Innovation and Grants Advancement, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Freddie Ssengooba
- Department of Health Policy Planning and Management, Makerere School of Public Health, Kampala, Uganda
| | - Sharon Weir
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB 7435, Chapel Hill, NC, 27599-7435, USA
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB 7435, Chapel Hill, NC, 27599-7435, USA
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24
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24-hour ambulatory blood pressure monitoring and hypertension related risk among HIV-positive and HIV-negative individuals: cross sectional study findings from rural Uganda. J Hum Hypertens 2022; 36:144-152. [PMID: 33767392 PMCID: PMC8463623 DOI: 10.1038/s41371-020-00464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 10/28/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023]
Abstract
Hypertension is diagnosed and treated based on blood pressure (BP) readings obtained in the clinic setting. Positive HIV status is associated with a higher prevalence of abnormal diurnal BP patterns, diagnosed with ambulatory BP monitoring rather than the conventional method of BP measurement. Little is known about ambulatory BP profiles in people living with HIV (PLHIV) in low-income countries, especially within sub-Saharan Africa. In this study, we compared 24-h ambulatory BP profiles of 140 HIV-positive individuals vs. profiles in 166 HIV negative individuals living in rural Uganda. HIV was well-controlled, with all HIV seropositive participants reporting use of anti-retroviral therapy, and ~123 (88%) having undetectable viral load. Most participants reported ART use duration of less than 10 years. Compared to HIV negative participants, HIV positive participants had lower median 24-h systolic BP (110.4 mmHg (IQR: 105.7, 118.7) vs 117.7 mmHg (IQR: 110.8, 129.8), p < 0.001), and 24-h diastolic BP (69.2 mmHg (IQR: 65.0, 74.9) vs. 71.9 mmHg (IQR: 67.2, 78.1), p = 0.004). Adjusted results showed greater percentage systolic nocturnal dipping among PLHIV compared to HIV negative individuals (difference = 2.70 (IQR: 0.94, 4.47), p < 0.05). Results of the adjusted Poisson regression suggested lower prevalence of 24-h and night hypertension among HIV positives compared to HIV negative, but were not statistically significant. Our data suggest that continuous 24-h BP measurements are lower in PLHIV on ART compared to HIV negative individuals.
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25
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Wilson K, Onyango A, Mugo C, Guthrie B, Slyker J, Richardson B, John-Stewart G, Inwani I, Bukusi D, Wamalwa D, Kohler P. Kenyan HIV Clinics With Youth-Friendly Services and Trained Providers Have a Higher Prevalence of Viral Suppression Among Adolescents and Young Adults: Results From an Observational Study. J Assoc Nurses AIDS Care 2022; 33:45-53. [PMID: 34939987 PMCID: PMC10329499 DOI: 10.1097/jnc.0000000000000302] [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] [Received: 09/18/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT Sustained viral suppression in adolescents and young adults living with HIV (AYALWH) is necessary for epidemic control. We evaluated facility and individual correlates of viral suppression using programmatic data from AYALWH between ages 10 and 24 years at 24 HIV clinics in Kenya. Binomial regression was used to evaluate correlates of viral load (VL) suppression (<1,000 copies/ml). Of 5,316 AYALWH on antiretroviral therapy ≥6 months, 2,081 (39%) had VLs available in the medical record, of which 76% were virally suppressed. In multivariable analyses, antiretroviral therapy initiation among AYALWH older than 10 years was associated with higher viral suppression than initiation younger than 10 years (adjusted risk ratio [aRR] 10-14 = 1.03, 95% confidence interval [CI] 0.97-1.10; aRR 15-19 = 1.30, 95% CI 1.19-1.41; aRR 20-24 = 1.43, 95% CI 1.24-1.63). Facilities with both youth-friendly services (YFS) and trained providers had significantly higher VL suppression compared with facilities without YFS or trained providers (adjusted odds ratio: 2.07, 95% CI: 1.71-2.52). Viral suppression remains suboptimal among AYALWH. YFS and trained providers plus greater use of VL data may help increase viral suppression among AYALWH.
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Affiliation(s)
- Kate Wilson
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Alvin Onyango
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Cyrus Mugo
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Brandon Guthrie
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Jennifer Slyker
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Barbra Richardson
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Grace John-Stewart
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Irene Inwani
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - David Bukusi
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Dalton Wamalwa
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Pamela Kohler
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
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Effect of universal HIV testing and treatment on socioeconomic wellbeing in rural Kenya and Uganda: a cluster-randomised controlled trial. Lancet Glob Health 2022; 10:e96-e104. [DOI: 10.1016/s2214-109x(21)00458-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/20/2021] [Accepted: 09/15/2021] [Indexed: 12/24/2022]
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Okere NE, Sambu V, Ndungile Y, van Praag E, Hermans S, Naniche D, de Wit TFR, Maokola W, Gomez GB. The Shinyanga Patient: A Patient's Journey through HIV Treatment Cascade in Rural Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8418. [PMID: 34444166 PMCID: PMC8393654 DOI: 10.3390/ijerph18168418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/23/2021] [Accepted: 08/04/2021] [Indexed: 12/30/2022]
Abstract
The 2016-2017 Tanzania HIV Impact Survey (THIS) reported the accomplishments towards the 90-90-90 global HIV targets at 61-94-87, affirming the need to focus on the first 90 (i.e., getting 90% of people living with HIV (PLHIV) tested). We conducted a patient-pathway analysis to understand the gap observed, by assessing the alignment between where PLHIV seek healthcare and where HIV services are available in the Shinyanga region, Tanzania. We used existing and publicly available data from the National AIDS Control program, national surveys, registries, and relevant national reports. Region-wide, the majority (n = 458/722, 64%) of THIS respondents accessed their last HIV test at public sector facilities. There were 65.9%, 45.1%, and 74.1% who could also access antiretroviral therapy (ART), CD4 testing, and HIV viral load testing at the location of their last HIV test, respectively. In 2019, the viral suppression rate estimated among PLHIV on ART in the Shinyanga region was 91.5%. PLHIV access HIV testing mostly in public health facilities; our research shows that synergies can be achieved to improve access to services further down the cascade in this sector. Furthermore, effective engagement with the private sector (not-for-profit and for-profit) will help to achieve the last mile toward ending the HIV epidemic.
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Affiliation(s)
- Nwanneka E Okere
- Department of Global Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.H.); (T.F.R.d.W.)
- Amsterdam Institute for Global Health and Development, 1105 BP Amsterdam, The Netherlands;
| | - Veryeh Sambu
- National AIDS Control Programme, Dodoma 41110, Tanzania; (V.S.); (W.M.)
| | - Yudas Ndungile
- Regional Health Management Team, Shinyanga 37103, Tanzania;
| | - Eric van Praag
- Amsterdam Institute for Global Health and Development, 1105 BP Amsterdam, The Netherlands;
| | - Sabine Hermans
- Department of Global Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.H.); (T.F.R.d.W.)
- Amsterdam Institute for Global Health and Development, 1105 BP Amsterdam, The Netherlands;
| | - Denise Naniche
- ISGlobal-Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain;
| | - Tobias F Rinke de Wit
- Department of Global Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.H.); (T.F.R.d.W.)
- Amsterdam Institute for Global Health and Development, 1105 BP Amsterdam, The Netherlands;
| | - Werner Maokola
- National AIDS Control Programme, Dodoma 41110, Tanzania; (V.S.); (W.M.)
| | - Gabriela B Gomez
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
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Jewell BL, BALZER LB, CLARK TD, CHARLEBOIS ED, KWARISIIMA D, KAMYA MR, HAVLIR DV, PETERSEN ML, BERSHTEYN A. Predicting HIV Incidence in the SEARCH Trial: A Mathematical Modeling Study. J Acquir Immune Defic Syndr 2021; 87:1024-1031. [PMID: 33770065 PMCID: PMC8217115 DOI: 10.1097/qai.0000000000002684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The SEARCH study provided community-based HIV and multidisease testing and antiretroviral therapy (ART) to 32 communities in East Africa and reported no statistically significant difference in 3-year HIV incidence. We used mathematical modeling to estimate the effect of control arm viral suppression and community mixing on SEARCH trial outcomes. SETTING Uganda and Kenya. METHODS Using the individual-based HIV modeling software EMOD-HIV, we configured a new model of SEARCH communities. The model was parameterized using demographic, HIV prevalence, male circumcision, and viral suppression data and calibrated to HIV prevalence, ART coverage, and population size. Using assumptions about ART scale-up in the control arm, degree of community mixing, and effect of baseline testing, we estimated comparative HIV incidence under multiple scenarios. RESULTS Before the trial results, we predicted that SEARCH would report a 4%-40% reduction between arms, depending on control arm ART linkage rates and community mixing. With universal baseline testing followed by rapidly expanded ART eligibility and uptake, modeled effect sizes were smaller than the study was powered to detect. Using interim viral suppression data, we estimated 3-year cumulative incidence would have been reduced by up to 27% in the control arm and 43% in the intervention arm compared with a counterfactual without universal baseline testing. CONCLUSIONS Our model suggests that the active control arm substantially reduced expected effect size and power of the SEARCH study. However, compared with a counterfactual "true control" without increased ART linkage because of baseline testing, SEARCH reduced HIV incidence by up to 43%.
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Affiliation(s)
- Britta L. Jewell
- University of California, Berkeley, Berkeley, USA
- Institute for Disease Modeling, Bellevue, USA
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Simoni JM, Beima-Sofie K, Wanje G, Mohamed ZH, Tapia K, McClelland RS, Ho RJY, Collier AC, Graham SM. "Lighten This Burden of Ours": Acceptability and Preferences Regarding Injectable Antiretroviral Treatment Among Adults and Youth Living With HIV in Coastal Kenya. J Int Assoc Provid AIDS Care 2021; 20:23259582211000517. [PMID: 33685272 PMCID: PMC7952847 DOI: 10.1177/23259582211000517] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Long-acting injectable (LAI) antiretroviral therapy (ART) may offer persons living with HIV (PLWH) an attractive alternative to pill-based treatment options, yet acceptability data remain scant, especially in sub-Saharan Africa. Methods: We conducted 6 focus group discussions with PLWH, including key stake holder groups, and analyzed data with content analysis. Results: Initial reactions to the idea of LAI-ART were often positive. The primary advantages voiced were potential to facilitate improved adherence and alleviate the burden of daily pill-taking while avoiding inadvertent disclosure and HIV stigma. Potential side effects were a particular concern of the women. Most participants preferred clinic-based administration over self-injections at home due to concerns about safety, privacy, and potential need for refrigeration. Conclusions: LAI-ART may be acceptable in Kenya, provided injections are infrequent and delivered in a clinic setting. However, HIV stigma, fear of potential side effects, and limited clinical capacity would need to be addressed.
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Affiliation(s)
- Jane M Simoni
- Department of Psychology, 7284University of Washington, Seattle Washington, USA.,Department of Global Health, 7284University of Washington, Seattle Washington, USA.,Department of Gender, Women and Sexuality Studies, 7284University of Washington, Seattle Washington, USA
| | - Kristin Beima-Sofie
- Department of Global Health, 7284University of Washington, Seattle Washington, USA
| | - George Wanje
- Department of Medical Microbiology, 107854University of Nairobi, Nairobi, Kenya
| | - Zahra H Mohamed
- Department of Global Health, 7284University of Washington, Seattle Washington, USA
| | - Kenneth Tapia
- Department of Global Health, 7284University of Washington, Seattle Washington, USA
| | - R Scott McClelland
- Department of Global Health, 7284University of Washington, Seattle Washington, USA.,Department of Medical Microbiology, 107854University of Nairobi, Nairobi, Kenya.,Department of Medicine, 7284University of Washington, Seattle Washington, USA.,Department of Epidemiology, 7284University of Washington, Seattle Washington, USA
| | - Rodney J Y Ho
- Department of Pharmaceutics, 7284University of Washington, Seattle Washington, USA.,Department of Bioengineering, 7284University of Washington, Seattle Washington, USA
| | - Ann C Collier
- Department of Medicine, 7284University of Washington, Seattle Washington, USA
| | - Susan M Graham
- Department of Global Health, 7284University of Washington, Seattle Washington, USA.,Department of Medicine, 7284University of Washington, Seattle Washington, USA.,Department of Epidemiology, 7284University of Washington, Seattle Washington, USA
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30
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Qiu M, Paina L, Rodríguez DC, Wilhelm JA, Eze-Ajoku E, Searle A, Zakumumpa H, Ssengooba F, MacKenzie C, Bennett S. Exploring perceived effects from loss of PEPFAR support for outreach in Kenya and Uganda. Global Health 2021; 17:80. [PMID: 34273988 PMCID: PMC8285775 DOI: 10.1186/s12992-021-00729-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 06/29/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction In 2015, the President’s Emergency Plan for AIDS Relief undertook policy shifts to increase efficiencies in its programming, including transitioning HIV/AIDS funding away from low burden areas. We examine the impact of these changes on HIV outreach in Kenya and Uganda. Methods Qualitative data collection was conducted as a part of a broader mixed-methods evaluation. Two rounds of facility-level case studies and national-level interviews were conducted in Kenya and Uganda, with health facility, sub-national and central Ministry of Health staff, HIV clients, and implementing partners. Results In both countries, the loss of outreach support affected community-based HIV/AIDS education, testing, peer support, and defaulter tracing. Discussion Loss of external support for outreach raises concerns for countries’ ability to reach the 90–90-90 UNAIDS target, as key linkages between vulnerable communities and health systems can be adversely affected. Conclusion Development partners should consider how to mitigate potential consequences of transition policies to prevent negative effects at the community level.
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Affiliation(s)
- Mary Qiu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Ligia Paina
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daniela C Rodríguez
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jess A Wilhelm
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ezinne Eze-Ajoku
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexandra Searle
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Henry Zakumumpa
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Suryana K. The Impact of Universal Test and Treat Program on Highly Active Anti Retroviral Therapy Outcomes (Coverage, Adherence and Lost to Follow Up) at Wangaya Hospital in Denpasar, Bali-Indonesia: A Retrospective Cohort Study. Open AIDS J 2021. [DOI: 10.2174/1874613602115010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
World Health Organization (WHO) (2015) recommended that all people diagnosed with human immunodeficiency virus (HIV)-positive initiate Highly Active Anti Retroviral Therapy (HAART) immediately (less than a week), irrespective of CD4 count (Universal Test and Treat / UTT) Program.
Objective:
To evaluate the impact of UTT as a current therapeutic program on HIV treatment outcomes, coverage, adherence, and lost to follow-up (LTFU) at Wangaya Hospital in Denpasar, Bali, Indonesia.
Methods:
A Retrospective cohort study was conducted during July 2017 - June 2018 (Pre-UTT) and September 2018 – August 2019 (Post-UTT). Around 402 medical records were selected, reviewed, and enrolled. Data were analyzed using SPSS software for windows version 24.0. Bivariate analysis (Chi-square test) was performed on all variables with a statistically significant t level of 0.05.
Results:
Among 4,322 new visitors; 3,585 (82.95%) agreed to take HIV test and 402(11.21%) were confirmed HIV reactive. Most participants confirmed HIV reactive occured at age 25-34 years old and 230 (57.21%) were male. The majority education level were primary (Junior high school) 302(75.12%), 379(94.28%) were employed and 281 (69.90%) stayed in Denpasar. About 350 (87.06%) received HAART, 298 (85.14%) with high adherence and 52 (14.86%) LTFU. Pre-UTT, HAART coverage; 83.03% (181), were statistically significant increased to 91.85% (169) post UTT (p=0.000). High adherence pre-UTT; 79.56% (144) was significantly increased to 91.12% (154) post UTT (p=0.006) and LTFU were significantly decreased; 20.44% (37) to 8.87% (15) (p=0.006).
Conclusion:
UTT program significantly improve the HIV treatment outcome (increased coverage, adherence, and decreased LTFU).
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Akatukwasa C, Getahun M, El Ayadi AM, Namanya J, Maeri I, Itiakorit H, Owino L, Sanyu N, Kabami J, Ssemmondo E, Sang N, Kwarisiima D, Petersen ML, Charlebois ED, Chamie G, Clark TD, Cohen CR, Kamya MR, Bukusi EA, Havlir DV, Camlin CS. Dimensions of HIV-related stigma in rural communities in Kenya and Uganda at the start of a large HIV 'test and treat' trial. PLoS One 2021; 16:e0249462. [PMID: 33999961 PMCID: PMC8128261 DOI: 10.1371/journal.pone.0249462] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 03/18/2021] [Indexed: 11/19/2022] Open
Abstract
HIV-related stigma is a frequently cited barrier to HIV testing and care engagement. A nuanced understanding of HIV-related stigma is critical for developing stigma-reduction interventions to optimize HIV-related outcomes. This qualitative study documented HIV-related stigma across eight communities in east Africa during the baseline year of a large HIV test-and-treat trial (SEARCH, NCT: 01864603), prior to implementation of widespread community HIV testing campaigns and efforts to link individuals with HIV to care and treatment. Findings revealed experiences of enacted, internalized and anticipated stigma that were highly gendered, and more pronounced in communities with lower HIV prevalence; women, overwhelmingly, both held and were targets of stigmatizing attitudes about HIV. Past experiences with enacted stigma included acts of segregation, verbal discrimination, physical violence, humiliation and rejection. Narratives among women, in particular, revealed acute internalized stigma including feelings of worthlessness, shame, embarrassment, and these resulted in anxiety and depression, including suicidality among a small number of women. Anticipated stigma included fears of marital dissolution, verbal and physical abuse, gossip and public ridicule. Anticipated stigma was especially salient for women who held internalized stigma and who had experienced enacted stigma from their partners. Anticipated stigma led to care avoidance, care-seeking at remote facilities, and hiding of HIV medications. Interventions aimed at reducing individual and community-level forms of stigma may be needed to improve the lives of PLHIV and fully realize the promise of test-and-treat strategies.
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Affiliation(s)
| | - Monica Getahun
- Department of Obstetrics, Bixby Center for Global Reproductive Health, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, United States of America
| | - Alison M. El Ayadi
- Department of Obstetrics, Bixby Center for Global Reproductive Health, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, United States of America
| | - Judith Namanya
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Irene Maeri
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Lawrence Owino
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Naomi Sanyu
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Jane Kabami
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Norton Sang
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Maya L. Petersen
- Divisions of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, United States of America
| | - Edwin D. Charlebois
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States of America
| | - Gabriel Chamie
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco, CA, United States of America
| | - Tamara D. Clark
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco, CA, United States of America
| | - Craig R. Cohen
- Department of Obstetrics, Bixby Center for Global Reproductive Health, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, United States of America
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Elizabeth A. Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Diane V. Havlir
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco, CA, United States of America
| | - Carol S. Camlin
- Department of Obstetrics, Bixby Center for Global Reproductive Health, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, United States of America
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States of America
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Khan S, Spiegelman D, Walsh F, Mazibuko S, Pasipamire M, Chai B, Reis R, Mlambo K, Delva W, Khumalo G, Zwane M, Fleming Y, Mafara E, Hettema A, Lejeune C, Chao A, Bärnighausen T, Okello V. Early access to antiretroviral therapy versus standard of care among HIV-positive participants in Eswatini in the public health sector: the MaxART stepped-wedge randomized controlled trial. J Int AIDS Soc 2021; 23:e25610. [PMID: 32949103 PMCID: PMC7507004 DOI: 10.1002/jia2.25610] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 06/10/2020] [Accepted: 07/15/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction The WHO recommends antiretroviral treatment (ART) for all HIV‐positive patients regardless of CD4 count or disease stage, referred to as “Early Access to ART for All” (EAAA). The health systems effects of EAAA implementation are unknown. This trial was implemented in a government‐managed public health system with the aim to examine the “real world” impact of EAAA on care retention and viral suppression. Methods In this stepped‐wedge randomized controlled trial, 14 public sector health facilities in Eswatini were paired and randomly assigned to stepwise transition from standard of care (SoC) to EAAA. ART‐naïve participants ≥18 years who were not pregnant or breastfeeding were eligible for enrolment. We used Cox proportional hazard models with censoring at clinic transition to estimate the effects of EAAA on retention in care and retention and viral suppression combined. Results Between September 2014 and August 2017, 3405 participants were enrolled. In SoC and EAAA respectively, 12‐month HIV care retention rates were 80% (95% CI: 77 to 83) and 86% (95% CI: 83 to 88). The 12‐month combined retention and viral suppression endpoint rates were 44% (95% CI: 40 to 48) under SoC compared to 80% (95% CI: 77 to 83) under EAAA. EAAA increased both retention (HR: 1·60, 95% CI: 1·15 to 2·21, p = 0.005) and retention and viral suppression combined (HR: 4.88, 95% CI: 2.96 to 8.05, p < 0.001). We also identified significant gaps in current health systems ability to provide viral load (VL) monitoring with 80% participants in SoC and 66% in EAAA having a missing VL at last contact. Conclusions The observed improvement in retention in care and on the combined retention and viral suppression provides an important co‐benefit of EAAA to HIV‐positive adults themselves, at least in the short term. Our results from this “real world” health systems trial strongly support EAAA for Eswatini and countries with similar HIV epidemics and health systems. VL monitoring needs to be scaled up for appropriate care management.
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Affiliation(s)
- Shaukat Khan
- Clinton Health Access Initiative (CHAI), Mbabane, Swaziland
| | - Donna Spiegelman
- Center on Methods for Implementation and Prevention Science and Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.,Departments of Epidemiology, Biostatistics, Nutrition and Global Health, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Fiona Walsh
- Clinton Health Access Initiative (CHAI), Boston, MA, USA
| | - Sikhatele Mazibuko
- Eswatini National ART program (SNAP), Ministry of Health, Mbabane, Swaziland
| | | | - Boyang Chai
- Department of Nutrition, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Ria Reis
- Leiden University Medical Center, Leiden University, Leiden, the Netherlands.,Amsterdam Institute for Social Science, University of Amsterdam, Amsterdam, the Netherlands.,Children's Institute, University of Cape Town, Cape Town, South Africa
| | - Khudzie Mlambo
- Clinton Health Access Initiative (CHAI), Mbabane, Swaziland
| | - Wim Delva
- The South African Department of Science and Technology - National Research Foundation (DST-NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.,Center for Statistics, Hasselt University, Diepenbeek, Belgium.,International Centre for Reproductive Health, Ghent University, Gent, Belgium.,KU Leuven, Rega Institute for Medical Research, Leuven, Belgium.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Gavin Khumalo
- Eswatini National Network of People Living with HIV (SWANNEPHA), Mbabane, Swaziland
| | | | | | - Emma Mafara
- Clinton Health Access Initiative (CHAI), Mbabane, Swaziland
| | - Anita Hettema
- Clinton Health Access Initiative (CHAI), Mbabane, Swaziland
| | | | - Ariel Chao
- Center on Methods for Implementation and Prevention Science and Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Till Bärnighausen
- Heidelberg Institute of Public Health, University of Heidelberg, Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Velephi Okello
- Directorate Office, Ministry of Health, Mbabane, Swaziland
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Wu C, Zhang B, Dai Z, Zheng Q, Duan Z, He Q, Zhu C. Impact of immediate initiation of antiretroviral therapy among men who have sex with men infected with HIV in Chengdu, southwest China: trends analysis, 2008-2018. BMC Public Health 2021; 21:689. [PMID: 33832451 PMCID: PMC8034144 DOI: 10.1186/s12889-021-10580-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 03/07/2021] [Indexed: 02/01/2023] Open
Abstract
Background Given the rampant HIV epidemic among men who have sex with men (MSM) in Chengdu, southwest China, Treat All policy, defined as immediate antiretroviral therapy (ART) initiation after HIV diagnosis, was implemented since 2014. Real-world research evaluating impacts of immediate ART on HIV epidemics is needed to optimize policy-making as national and international guidelines have been lowering ART eligibility threshold. The purpose of this study is to: assess temporal trends of the HIV epidemic and impacts of Treat All policy among MSM; and lay foundation for HIV-related policy evaluation using longitudinal routine data from health information systems. Methods Data used in this study were HIV sentinel seroprevalence, annual reported HIV cases and ART coverage rate among MSM in Chengdu from 2008 to 2018, derived from national HIV/AIDS information system. Temporal trends of the HIV epidemic were described using Joinpoint Regression Program. Interrupted time-series method was deployed to evaluate Treat All policy. Results HIV sentinel seroprevalence rose from 11.20% in 2008 to 17.67% in 2013 and Annual Percent Change (APC) was 8.25% (95% CI − 2.40%, 20.07%), then decreased to 5.17% in 2018 (APC = − 19.63%, 95% CI − 27.54%, − 10.86%). Newly reported HIV cases increased from 168 cases in 2008 to 1232 cases in 2015 (APC = 26.99%, 95% CI 21.32%, 32.93%), and reduced to 1014 cases in 2018 (APC = − 8.80%, 95% CI − 18.45%, 2.01%). ART coverage rate has been climbing from 11.11% in 2008 to 92.29% in 2018 and Average Annual Percent Change was 16.09% (95% CI 11.76%, 20.59%). Results of interrupted time-series models showed that compared to an annual increase of 0.87% during pre-policy period, there was a decline of 3.08% (95% CI − 0.0366%, − 0.0250%) per year of HIV sentinel seroprevalence since 2014; and compared to an annual increase of 116 cases before 2014, there was an annual drop of 158 newly reported HIV cases (95% CI − 194.87%, − 121.69%) during the post-policy period. Conclusions Immediate ART after HIV diagnosis could potentially curb HIV transmission at population level among MSM, along with other strategies. Future assessment of HIV prevention and control policy can be carried out using routinely collected longitudinal data from health information systems.
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Affiliation(s)
- Chenyao Wu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, 610041 No. 17 Section 3, Renmin South Road, Chengdu, Sichuan, China
| | - Baiyang Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, 610041 No. 17 Section 3, Renmin South Road, Chengdu, Sichuan, China
| | - Zhen Dai
- Department of AIDS&STD Control and Prevention, Chengdu Center for Disease Control and Prevention, 610041 No. 4 Longxiang Road, Sichuan, Chengdu, China
| | - Qianwen Zheng
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, 610041 No. 17 Section 3, Renmin South Road, Chengdu, Sichuan, China
| | - Zhenhua Duan
- Department of AIDS&STD Control and Prevention, Chengdu Center for Disease Control and Prevention, 610041 No. 4 Longxiang Road, Sichuan, Chengdu, China
| | - Qinying He
- Department of AIDS&STD Control and Prevention, Chengdu Center for Disease Control and Prevention, 610041 No. 4 Longxiang Road, Sichuan, Chengdu, China.
| | - Cairong Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, 610041 No. 17 Section 3, Renmin South Road, Chengdu, Sichuan, China.
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Grabowski MK, Patel EU, Nakigozi G, Ssempijja V, Ssekubugu R, Ssekasanvu J, Ndyanabo A, Kigozi G, Nalugoda F, Gray RH, Kalibbala S, Serwadda DM, Laeyendecker O, Wawer MJ, Chang LW, Quinn TC, Kagaayi J, Tobian AAR, Reynolds SJ. Prevalence and Predictors of Persistent Human Immunodeficiency Virus Viremia and Viral Rebound After Universal Test and Treat: A Population-Based Study. J Infect Dis 2021; 223:1150-1160. [PMID: 33471100 PMCID: PMC8030722 DOI: 10.1093/infdis/jiab021] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/13/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There are limited data on individual human immunodeficiency virus (HIV) viral load (VL) trajectories at the population-level after the introduction of universal test and treat (UTT) in sub-Saharan Africa. METHODS Human immunodeficiency virus VLs were assessed among HIV-positive participants through 3 population-based surveys in 4 Ugandan fishing communities surveyed between November 2011 and August 2017. The unit of analysis was a visit-pair (2 consecutive person-visits), which were categorized as exhibiting durable VL suppression, new/renewed VL suppression, viral rebound, or persistent viremia. Adjusted relative risks (adjRRs) and 95% confidence intervals (CIs) of persistent viremia were estimated using multivariate Poisson regression. RESULTS There were 1346 HIV-positive participants (n = 1883 visit-pairs). The population-level prevalence of durable VL suppression increased from 29.7% to 67.9% during UTT rollout, viral rebound declined from 4.4% to 2.7%, and persistent viremia declined from 20.8% to 13.3%. Younger age (15-29 vs 40-49 years; adjRR = 1.80; 95% CI = 1.19-2.71), male sex (adjRR = 2.09, 95% CI = 1.47-2.95), never being married (vs currently married; adjRR = 1.88, 95% CI = 1.34-2.62), and recent migration to the community (vs long-term resident; adjRR = 1.91, 95% CI = 1.34-2.73) were factors associated with persistent viremia. CONCLUSIONS Despite increases in durable VL suppression during roll out of UTT in hyperendemic communities, a substantial fraction of the population, whose risk profile tended to be younger, male, and mobile, remained persistently viremic.
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Affiliation(s)
- M Kate Grabowski
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Rakai Health Sciences Program, Entebbe, Uganda
| | - Eshan U Patel
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Victor Ssempijja
- Rakai Health Sciences Program, Entebbe, Uganda
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Sponsored by the National Cancer Institute, Bethesda, Maryland, USA
| | | | - Joseph Ssekasanvu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Rakai Health Sciences Program, Entebbe, Uganda
| | | | | | | | - Ronald H Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Rakai Health Sciences Program, Entebbe, Uganda
| | | | - David M Serwadda
- Rakai Health Sciences Program, Entebbe, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| | - Oliver Laeyendecker
- Makerere University School of Public Health, Kampala, Uganda
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Maria J Wawer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Rakai Health Sciences Program, Entebbe, Uganda
| | - Larry W Chang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Rakai Health Sciences Program, Entebbe, Uganda
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Thomas C Quinn
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Rakai Health Sciences Program, Entebbe, Uganda
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, Bethesda, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Rakai Health Sciences Program, Entebbe, Uganda
| | - Steven J Reynolds
- Rakai Health Sciences Program, Entebbe, Uganda
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, Bethesda, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Pathmanathan I, Nelson R, de Louvado A, Thompson R, Pals S, Casavant I, Cardoso MJA, Ujamaa D, Bonzela J, Mikusova S, Chivurre V, Tamele S, Sleeman K, Zhang G, Zeh C, Dobbs T, Vubil A, Auld A, Briggs-Hagen M, Vergara A, Couto A, MacKellar D. High Coverage of Antiretroviral Treatment With Annual Home-Based HIV Testing, Follow-up Linkage Services, and Implementation of Test and Start: Findings From the Chókwè Health Demographic Surveillance System, Mozambique, 2014-2019. J Acquir Immune Defic Syndr 2021; 86:e97-e105. [PMID: 33252546 PMCID: PMC7970427 DOI: 10.1097/qai.0000000000002583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Early antiretroviral therapy (ART) is necessary for HIV epidemic control and depends on early diagnosis and successful linkage to care. Since 2014, annual household-based HIV testing and counseling and linkage services have been provided through the Chókwè Health and Demographic Surveillance System for residents testing HIV positive in this high HIV-burden district. METHODS District-wide Test and Start [T&S, ART for all people living with HIV (PLHIV)] began in August 2016, supported by systematic interventions to improve linkage to care and treatment. Annual rounds (R) of random household surveys were conducted to assess trends in population prevalence of ART use and viral load suppression (<1000 viral RNA copies/mL). RESULTS Between R1 (April 2014-April 2015) and R5 (April 2018-Mar 2019), 46,090 (67.2%) of 68,620 residents aged 15-59 years were tested for HIV at home at least once, and 3711 were newly diagnosed with HIV and provided linkage services. Population prevalence of current ART use among PLHIV increased from 65.0% to 87.5% between R1 and R5. ART population prevalence was lowest among men aged 25-34 years (67.8%) and women aged 15-24 (78.0%), and highest among women aged 35-44 years (93.6%) and 45-59 years (93.7%) in R5. Viral load suppression prevalence increased among all PLHIV aged 15-59 years from 52.0% in R1 to 78.3% in R5. DISCUSSION Between 2014 and 2019, Chókwè Health and Demographic Surveillance System residents surpassed the UNAIDS targets of ≥81% of PLHIV on ART and ≥73% virally suppressed. This achievement supports the combination of efforts from household-based HIV testing and counseling, support for linkage to care and treatment, and continued investments in T&S implementation.
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Affiliation(s)
| | - Robert Nelson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ricardo Thompson
- Chókwè Health Research and Training Center, National Institute of Health, Maputo, Mozambique
| | - Sherri Pals
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Dawud Ujamaa
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Juvêncio Bonzela
- Chókwè Health Research and Training Center, National Institute of Health, Maputo, Mozambique
| | - Silvia Mikusova
- Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique
| | - Victor Chivurre
- Provincial Directorate of Public Health, Xai-Xai, Gaza, Mozambique
| | - Stelio Tamele
- District Directorate of Public Health, Chókwè, Gaza, Mozambique
| | - Katrina Sleeman
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Guoqing Zhang
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Clement Zeh
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Trudy Dobbs
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adolfo Vubil
- National Institute of Health, Maputo, Mozambique
| | - Andrew Auld
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Alfredo Vergara
- Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Aleny Couto
- Mozambique Ministry of Health (MISAU), Maputo, Mozambique
| | - Duncan MacKellar
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Kamya MR, Petersen ML, Kabami J, Ayieko J, Kwariisima D, Sang N, Clark TD, Schwab J, Charlebois ED, Cohen CR, Bukusi EA, Peng J, Jain V, Chen YH, Chamie G, Balzer LB, Havlir DV. SEARCH Human Immunodeficiency Virus (HIV) Streamlined Treatment Intervention Reduces Mortality at a Population Level in Men With Low CD4 Counts. Clin Infect Dis 2021; 73:e1938-e1945. [PMID: 33783495 DOI: 10.1093/cid/ciaa1782] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We tested the hypothesis that patient-centered, streamlined human immunodeficiency virus (HIV) care would achieve lower mortality than the standard treatment model for persons with HIV and CD4 ≤ 350/uL in the setting of population-wide HIV testing. METHODS In the SEARCH (Sustainable East Africa Research in Community Health) Study (NCT01864603), 32 communities in rural Uganda and Kenya were randomized to country-guided antiretroviral therapy (ART) versus streamlined ART care that included rapid ART start, visit spacing, flexible clinic hours, and welcoming environment. We assessed persons with HIV and CD4 ≤ 350/uL, ART eligible in both arms, and estimated the effect of streamlined care on ART initiation and mortality at 3 years. Comparisons between study arms used a cluster-level analysis with survival estimates from Kaplan-Meier; estimates of ART start among ART-naive persons treated death as a competing risk. RESULTS Among 13 266 adults with HIV, 2973 (22.4%) had CD4 ≤ 350/uL. Of these, 33% were new diagnoses, and 10% were diagnosed but ART-naive. Men with HIV were almost twice as likely as women with HIV to have CD4 ≤ 350/uL and be untreated (15% vs 8%, respectively). Streamlined care reduced mortality by 28% versus control (risk ratio [RR] = 0.72; 95% confidence interval [CI]: .56, .93; P = .02). Despite eligibility in both arms, persons with CD4 ≤ 350/uL started ART faster under streamlined care versus control (76% vs 43% by 12 months, respectively; P < .001). Mortality was reduced substantially more among men (RR = 0.61; 95% CI: .43, .86; P = .01) than among women (RR = 0.90; 95% CI: .62, 1.32; P = .58). CONCLUSIONS After population-based HIV testing, streamlined care reduced population-level mortality among persons with HIV and CD4 ≤ 350/uL, particularly among men. Streamlined HIV care models may play a key role in global efforts to reduce AIDS deaths.
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Affiliation(s)
- Moses R Kamya
- Makerere University, Kampala, Uganda.,Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Maya L Petersen
- University of California Berkeley, Berkeley, California, USA
| | - Jane Kabami
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | | | - Tamara D Clark
- University of California San Francisco, San Francisco, California, USA
| | - Joshua Schwab
- University of California Berkeley, Berkeley, California, USA
| | | | - Craig R Cohen
- University of California San Francisco, San Francisco, California, USA
| | | | - James Peng
- University of California San Francisco, San Francisco, California, USA
| | - Vivek Jain
- University of California San Francisco, San Francisco, California, USA
| | - Yea-Hung Chen
- University of California San Francisco, San Francisco, California, USA
| | - Gabriel Chamie
- University of California San Francisco, San Francisco, California, USA
| | - Laura B Balzer
- University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Diane V Havlir
- University of California San Francisco, San Francisco, California, USA
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Abstract
BACKGROUND Population-level estimates of disease prevalence and control are needed to assess prevention and treatment strategies. However, available data often suffer from differential missingness. For example, population-level HIV viral suppression is the proportion of all HIV-positive persons with suppressed viral replication. Individuals with measured HIV status, and among HIV-positive individuals those with measured viral suppression, likely differ from those without such measurements. METHODS We discuss three sets of assumptions to identify population-level suppression in the intervention arm of the SEARCH Study (NCT01864603), a community randomized trial in rural Kenya and Uganda (2013-2017). Using data on nearly 100,000 participants, we compare estimates from (1) an unadjusted approach assuming data are missing-completely-at-random (MCAR); (2) stratification on age group, sex, and community; and (3) targeted maximum likelihood estimation to adjust for a larger set of baseline and time-updated variables. RESULTS Despite high measurement coverage, estimates of population-level viral suppression varied by identification assumption. Unadjusted estimates were most optimistic: 50% (95% confidence interval [CI] = 46%, 54%) of HIV-positive persons suppressed at baseline, 80% (95% CI = 78%, 82%) at year 1, 85% (95% CI = 83%, 86%) at year 2, and 85% (95% CI = 83%, 87%) at year 3. Stratifying on baseline predictors yielded slightly lower estimates, and full adjustment reduced estimates meaningfully: 42% (95% CI = 37%, 46%) of HIV-positive persons suppressed at baseline, 71% (95% CI = 69%, 73%) at year 1, 76% (95% CI = 74%, 78%) at year 2, and 79% (95% CI = 77%, 81%) at year 3. CONCLUSIONS Estimation of population-level disease burden and control requires appropriate adjustment for missing data. Even in large studies with limited missingness, estimates relying on the MCAR assumption or baseline stratification should be interpreted cautiously.
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Inwani I, Chhun N, Agot K, Cleland CM, Rao SO, Nduati R, Kinuthia J, Kurth AE. Preferred HIV Testing Modalities Among Adolescent Girls and Young Women in Kenya. J Adolesc Health 2021; 68:497-507. [PMID: 32792256 DOI: 10.1016/j.jadohealth.2020.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 06/17/2020] [Accepted: 07/08/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To improve testing coverage, it is imperative to determine adolescent girls and young women (AGYW) preferences about HIV testing modality and where they prefer receiving services. METHODS Participants were enrolled between May 2017 and April 2018 from three sites in Homa Bay County, Nyanza region, western Kenya. We explored two recruitment approaches (home-based vs. mobile-event based) and three HIV testing options (oral self-test, staff-administered, or referral to health facility). Exact logistic regression compared yield of newly diagnosed HIV and high-risk HIV-negatives from the recruitment and testing option strategies. RESULTS A total of 1,198 participants were enrolled, 1,046 (87.3%) at home and 152 (12.7%) at mobile events. Most participants (928, 77.5%) chose staff-aided testing either at home or at a mobile event; 268 (22.4%) chose self-testing; and only 2 (.2%) chose facility referral. Prevalence of newly diagnosed HIV-positives was 2.7% (32/1,198) and 36.8% (429/1,166) of HIV-negative AGYW were identified as high risk. We identified more newly diagnosed HIV infection among AGYW recruited at mobile events than at home (OR = 3.11; 95% CI: 1.33-6.74; p = .02). High-risk status was related to neither recruitment strategy nor testing modality. Older age was associated with increased odds of selecting an oral self-test (OR = 1.85; 95% CI: 1.06-3.22). CONCLUSIONS More than one-third of AGYW were at elevated risk of HIV infection, and those unaware of their HIV infection were more likely to be identified at a mobile outreach. Though self-testing was not the dominant preferred strategy, self-tests were performed accurately and with high confidence. These findings can help inform efficient identification of undiagnosed HIV infection and high risk for seroconversion among AGYW in similar settings.
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Affiliation(s)
- Irene Inwani
- Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Nok Chhun
- Yale University School of Nursing, Orange, Connecticut
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Charles M Cleland
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Samwel O Rao
- Impact Research and Development Organization, Kisumu, Kenya
| | - Ruth Nduati
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Ann E Kurth
- Yale University School of Nursing, Orange, Connecticut.
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Shanaube K, Schaap A, Hoddinott G, Mubekapi-Musadaidzwa C, Floyd S, Bock P, Hayes R, Fidler S, Ayles H. Impact of a community-wide combination HIV prevention intervention on knowledge of HIV status among adolescents. AIDS 2021; 35:275-285. [PMID: 33048875 PMCID: PMC7810414 DOI: 10.1097/qad.0000000000002722] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the impact of a community-wide combination HIV-prevention package (PopART Intervention) that includes universal testing and treatment (UTT) on knowledge of HIV status, among adolescents aged 15--19 years. DESIGN The HPTN 071 (PopART) for Youth (P-ART-Y) study was nested within HPTN 071 (PopART), a three-arm, cluster-randomized trial conducted from 2013 through 2018 in 21 communities in Zambia and South Africa. Communities were randomly assigned to arm A (combination prevention intervention with universal ART), arm B (prevention intervention with ART provided according to local guidelines), or arm C (standard-of-care). METHODS Knowledge of HIV status was measured using data collected during the third round of the PopART intervention in arms A and B (October 2016 to December 2017) and by conducting a cross-sectional survey (August to November 2017) in arm C communities to provide comparative data. The survey was conducted among ∼200 randomly selected adolescents in each community. We used linear regression of the 21 community-level values to make comparisons among trial arms. RESULTS Knowledge of HIV status was 78.2% (23 544/30 089) in arm A and 76.0% (24 417/32 148) in arm B communities, compared with 32.9% (698/2120) in arm C communities. Knowledge of HIV status varied by country, triplet, sex, and age. The adjusted mean difference was 42.3% between arm A with arm C, 95% CI 28.1-56.6, P less than 0.001 and 40.4% between arm B with arm C, 95% CI 24.6-56.2, P < 0.001). CONCLUSION Implementation of a community-wide combination HIV-prevention package that includes UTT substantially enhanced knowledge of HIV status among adolescents.
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Affiliation(s)
| | - Ab Schaap
- Zambart, Lusaka, Zambia
- London School of Hygiene and Tropical Medicine
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | - Sian Floyd
- London School of Hygiene and Tropical Medicine
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | - Sarah Fidler
- Imperial College, London, UK & Imperial College NIHR BRC, London, UK
| | - Helen Ayles
- Zambart, Lusaka, Zambia
- London School of Hygiene and Tropical Medicine
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Mwangwa F, Getahun M, Itiakorit H, Jain V, Ayieko J, Owino L, Akatukwasa C, Maeri I, Koss CA, Chamie G, Clark TD, Kabami J, Atukunda M, Kwarisiima D, Sang N, Bukusi EA, Kamya MR, Petersen ML, Cohen CR, Charlebois ED, Havlir DV, Camlin CS. Provider and Patient Perspectives of Rapid ART Initiation and Streamlined HIV Care: Qualitative Insights From Eastern African Communities. J Int Assoc Provid AIDS Care 2021; 20:23259582211053518. [PMID: 34841945 PMCID: PMC8641109 DOI: 10.1177/23259582211053518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022] Open
Abstract
The Sustainable East Africa Research in Community Health (SEARCH), a universal test and treat (UTT) trial, implemented 'Streamlined Care'-a multicomponent strategy including rapid linkage to care and antiretroviral therapy (ART) start, 3-monthly refills, viral load counseling, and accessible, patient-centered care provision. To understand patient and provider experiences of Streamlined Care to inform future care innovations, we conducted in-depth interviews with patients (n = 18) and providers (n = 28) at baseline (2014) and follow-up (2015) (n = 17 patients; n = 21 providers). Audio recordings were transcribed, translated, and deductively and inductively coded. Streamlined Care helped to decongest clinic spaces and de-stigmatize human immunodeficiency virus (HIV) care. Patients credited the individualized counselling, provider-assisted HIV status disclosure, and providers' knowledge of patient's drug schedules, availability, and phone call reminders for their care engagement. However, for some, denial (repeated testing to disprove HIV+ results), feeling healthy, limited understanding of the benefits of early ART, and anticipated side-effects, and mistrust of researchers hindered rapid ART initiation. Patients' short and long-term mobility proved challenging for both patients and providers. Providers viewed viral load counselling as a powerful tool to convince otherwise healthy and high-CD4 patients to initiate ART. Patient-centered HIV care models should build on the successes of Streamlined Care, while addressing persistent barriers.#NCT01864683-https://clinicaltrials.gov/ct2/show/NCT01864603.
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Affiliation(s)
| | | | | | - Vivek Jain
- University of California San Francisco, San Francisco, USA
| | - James Ayieko
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Irene Maeri
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Gabriel Chamie
- University of California San Francisco, San Francisco, USA
| | | | - Jane Kabami
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | - Norton Sang
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | | | | | - Carol S. Camlin
- University of California San Francisco, San Francisco, USA
- University of California, San Francisco, San Francisco, CA, USA
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Camlin CS, Charlebois ED, Getahun M, Akatukwasa C, Atwine F, Itiakorit H, Bakanoma R, Maeri I, Owino L, Onyango A, Chamie G, Clark TD, Cohen CR, Kwarisiima D, Kabami J, Sang N, Kamya MR, Bukusi EA, Petersen ML, V Havlir D. Pathways for reduction of HIV-related stigma: a model derived from longitudinal qualitative research in Kenya and Uganda. J Int AIDS Soc 2020; 23:e25647. [PMID: 33283986 PMCID: PMC7720278 DOI: 10.1002/jia2.25647] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION The rollout of antiretroviral therapy (ART) has been associated with reductions in HIV-related stigma, but pathways through which this reduction occurs are poorly understood. In the newer context of universal test and treat (UTT) interventions, where rapid diffusion of ART uptake takes place, there is an opportunity to understand the processes through which HIV-related stigma can decline, and how UTT strategies may precipitate more rapid and widespread changes in stigma. This qualitative study sought to evaluate how a UTT intervention influenced changes in beliefs, attitudes and behaviours related to HIV. METHODS Longitudinal qualitative in-depth semi-structured interview data were collected within a community-cluster randomized UTT trial, the Sustainable East Africa Research in Community Health (SEARCH) study, annually over three rounds (2014 to 2016) from two cohorts of adults (n = 32 community leaders, and n = 112 community members) in eight rural communities in Uganda and Kenya. Data were inductively analysed to develop new theory for understanding the pathways of stigma decline. RESULTS We present an emergent theoretical model of pathways through which HIV-related stigma may decline: internalized stigma may be reduced by two processes accelerated through the uptake and successful usage of ART: first, a reduced fear of dying and increased optimism for prolonged and healthy years of life; second, a restoration of perceived social value and fulfilment of subjective role expectations via restored physical strength and productivity. Anticipated stigma may be reduced in response to widespread engagement in HIV testing, leading to an increasing number of HIV status disclosures in a community, "normalizing" disclosure and reducing fears. Improvements in the perceived quality of HIV care lead to people living with HIV (PLHIV) seeking care in nearby facilities, seeing other known community members living with HIV, reducing isolation and facilitating opportunities for social support and "solidarity." Finally, enacted stigma may be reduced in response to the community viewing the healthy bodies of PLHIV successfully engaged in treatment, which lessens the fears that trigger enacted stigma; it becomes no longer socially normative to stigmatize PLHIV. This process may be reinforced through public health messaging and anti-discrimination laws. CONCLUSIONS Declines in HIV-related stigma appear to underway and explained by social processes accelerated by UTT efforts. Widespread implementation of UTT shows promise for reducing multiple dimensions of stigma, which is critical for improving health outcomes among PLHIV.
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Affiliation(s)
- Carol S Camlin
- Department of ObstetricsGynecology & Reproductive SciencesUniversity of California San FranciscoSan FranciscoCAUSA
- Department of MedicineCenter for AIDS Prevention StudiesUniversity of California San FranciscoSan FranciscoCAUSA
| | - Edwin D Charlebois
- Department of MedicineCenter for AIDS Prevention StudiesUniversity of California San FranciscoSan FranciscoCAUSA
| | - Monica Getahun
- Department of ObstetricsGynecology & Reproductive SciencesUniversity of California San FranciscoSan FranciscoCAUSA
| | | | | | | | | | - Irene Maeri
- Kenya Medical Research InstituteNairobiKenya
| | | | | | - Gabriel Chamie
- Division of HIVDepartment of MedicineInfectious Diseases, and Global MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Tamara D Clark
- Division of HIVDepartment of MedicineInfectious Diseases, and Global MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Craig R Cohen
- Department of ObstetricsGynecology & Reproductive SciencesUniversity of California San FranciscoSan FranciscoCAUSA
| | | | - Jane Kabami
- Infectious Diseases Research CollaborationKampalaUganda
| | - Norton Sang
- Kenya Medical Research InstituteNairobiKenya
| | - Moses R Kamya
- Infectious Diseases Research CollaborationKampalaUganda
- School of MedicineMakerere UniversityKampalaUganda
| | | | - Maya L Petersen
- Divisions of Biostatistics and EpidemiologySchool of Public HealthUniversity of California BerkeleyBerkeleyCAUSA
| | - Diane V Havlir
- Division of HIVDepartment of MedicineInfectious Diseases, and Global MedicineUniversity of California San FranciscoSan FranciscoCAUSA
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Chamie G, Hickey MD, Kwarisiima D, Ayieko J, Kamya MR, Havlir DV. Universal HIV Testing and Treatment (UTT) Integrated with Chronic Disease Screening and Treatment: the SEARCH study. Curr HIV/AIDS Rep 2020; 17:315-323. [PMID: 32507985 DOI: 10.1007/s11904-020-00500-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The growing burden of untreated chronic disease among persons with HIV (PWH) threatens to reverse heath gains from ART expansion. Universal test and treat (UTT)'s population-based approach provides opportunity to jointly identify and treat HIV and other chronic diseases. This review's purpose is to describe SEARCH UTT study's integrated disease strategy and related approaches in Sub-Saharan Africa. RECENT FINDINGS In SEARCH, 97% of adults were HIV tested, 85% were screened for hypertension, and 79% for diabetes at health fairs after 2 years, for an additional $1.16/person. After 3 years, population-level hypertension control was 26% higher in intervention versus control communities. Other mobile/home-based multi-disease screening approaches have proven successful, but data on multi-disease care delivery are extremely limited and show little effect on clinical outcomes. Integration of chronic disease into HIV in the UTT era is feasible and can achieve population level effects; however, optimization and implementation remain a huge unmet need.
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Affiliation(s)
- Gabriel Chamie
- Division of HIV, Infectious Diseases & Global Medicine, San Francisco General Hospital / University of California, San Francisco, UCSF Box 0874, San Francisco, CA, 94143-0874, USA.
| | - Matthew D Hickey
- Division of HIV, Infectious Diseases & Global Medicine, San Francisco General Hospital / University of California, San Francisco, UCSF Box 0874, San Francisco, CA, 94143-0874, USA
| | | | | | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Makerere University College of Health Sciences, Kampala, Uganda
| | - Diane V Havlir
- Division of HIV, Infectious Diseases & Global Medicine, San Francisco General Hospital / University of California, San Francisco, UCSF Box 0874, San Francisco, CA, 94143-0874, USA
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Green D, Tordoff DM, Kharono B, Akullian A, Bershteyn A, Morrison M, Garnett G, Duerr A, Drain PK. Evidence of sociodemographic heterogeneity across the HIV treatment cascade and progress towards 90-90-90 in sub-Saharan Africa - a systematic review and meta-analysis. J Int AIDS Soc 2020; 23:e25470. [PMID: 32153117 PMCID: PMC7062634 DOI: 10.1002/jia2.25470] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 01/24/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction Heterogeneity of sociodemographics and risk behaviours across the HIV treatment cascade could influence the public health impact of universal ART in sub‐Saharan Africa if those not virologically suppressed are more likely to be part of a risk group contributing to onward infections. Sociodemographic and risk heterogeneity across the treatment cascade has not yet been comprehensively described or quantified and we seek to systematically review and synthesize research on this topic among adults in Africa. Methods We conducted a systematic review of peer‐reviewed literature in Embase and MEDLINE databases as well as grey literature sources published in English between 2014 and 2018. We included studies that included people living with HIV (PLHIV) aged ≥15 years, and reported a 90‐90‐90 outcome: awareness of HIV‐positive status, ART use among those diagnosed or viral suppression among those on ART. We summarized measures of association between sociodemographics, within each outcome, and as a composite measure of population‐wide viral suppression. Results and discussion From 3533 screened titles, we extracted data from 92 studies (50 peer‐reviewed, 42 grey sources). Of included studies, 32 reported on awareness, 53 on ART use, 32 on viral suppression and 23 on population‐wide viral suppression. The majority of studies were conducted in South Africa, Uganda, and Malawi and reported data for age and gender. When stratified, PLHIV ages 15 to 24 years had lower median achievement of the treatment cascade (60‐49‐81), as compared to PLHIV ≥25 years (70‐63‐91). Men also had lower median achievement of the treatment cascade (66‐72‐85), compared to women (79‐76‐89). For population‐wide viral suppression, women aged ≥45 years had achieved the 73% target, while the lowest medians were among 15‐ to 24‐year‐old men (37%) and women (49%). Conclusions Considerable heterogeneity exists by age and gender for achieving the HIV 90‐90‐90 treatment goals. These results may inform delivery of HIV testing and treatment in sub‐Saharan Africa, as targeting youth and men could be a strategic way to maximize the population‐level impact of ART.
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Affiliation(s)
- Dylan Green
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA, USA
| | - Diana M Tordoff
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA, USA
| | - Brenda Kharono
- Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Adam Akullian
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Institute for Disease Modeling (IDM), Bellevue, WA, USA
| | | | | | | | - Ann Duerr
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA, USA.,Vaccine and Infectious Disease, Public Health Science Divisions, Fred Hutchinson Cancer Resesarch Center, HIV Vaccine Trials Network, Seattle, WA, USA
| | - Paul K Drain
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
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Nakalega R, Mukiza N, Kiwanuka G, Makanga-Kakumba R, Menge R, Kataike H, Maena J, Akello C, Atuhaire P, Matovu-Kiweewa F, Ndikuno-Kuteesa C, Debem H, Mujugira A. Non-uptake of viral load testing among people receiving HIV treatment in Gomba district, rural Uganda. BMC Infect Dis 2020; 20:727. [PMID: 33023498 PMCID: PMC7539500 DOI: 10.1186/s12879-020-05461-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/30/2020] [Indexed: 02/08/2023] Open
Abstract
Background Viral load (VL) testing is the gold-standard approach for monitoring human immunodeficiency virus (HIV) treatment success and virologic failure, but uptake is suboptimal in resource-limited and rural settings. We conducted a cross-sectional study of risk factors for non-uptake of VL testing in rural Uganda. Methods We conducted a cross-sectional analysis of uptake of VL testing among randomly selected people with HIV (PWH) receiving anti-retroviral treatment (ART) for at least 6 months at all eight primary health centers in Gomba district, rural Uganda. Socio-demographic and clinical data were extracted from medical records for the period January to December 2017. VL testing was routinely performed 6 months after ART initiation and 12 months thereafter for PWH stable on ART. We used descriptive statistics and multivariable logistic regression to evaluate factors associated with non-uptake of VL testing (the primary outcome). Results Of 414 PWH, 60% were female, and the median age was 40 years (interquartile range [IQR] 31–48). Most (62.3%) had been on ART > 2 years, and the median duration of treatment was 34 months (IQR 14–55). Thirty three percent did not receive VL testing: 36% of women and 30% of men. Shorter duration of ART (≤2 years) (adjusted odds ratio [AOR] 2.38; 95% CI:1.37–4.12; p = 0.002), younger age 16–30 years (AOR 2.74; 95% CI:1.44–5.24; p = 0.002) and 31–45 years (AOR 1.92; 95% CI 1.12–3.27; p = 0.017), and receipt of ART at Health Center IV (AOR 2.85; 95% CI: 1.78–4.56; p < 0.001) were significantly associated with non-uptake of VL testing. Conclusions One-in-three PWH on ART missed VL testing in rural Uganda. Strategies to improve coverage of VL testing, such as VL focal persons to flag missed tests, patient education and demand creation for VL testing are needed, particularly for recent ART initiates and younger persons on treatment, in order to attain the third Joint United Nations Program on HIV/AIDS (UNAIDS) 95–95-95 target – virologic suppression for 95% of PWH on ART.
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Affiliation(s)
- Rita Nakalega
- Makerere University-Johns Hopkins University (MU-JHU) Care LTD, Kampala, Uganda.
| | - Nelson Mukiza
- Baylor College of Medicine Children's Foundation, Kampala, Uganda
| | - George Kiwanuka
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Robert Menge
- School of Social Sciences, College of Humanities and Social Sciences, Makerere University Kampala, Kampala, Uganda
| | - Hajira Kataike
- Makerere University-Johns Hopkins University (MU-JHU) Care LTD, Kampala, Uganda
| | - Joel Maena
- Makerere University-Johns Hopkins University (MU-JHU) Care LTD, Kampala, Uganda
| | - Carolyne Akello
- Makerere University-Johns Hopkins University (MU-JHU) Care LTD, Kampala, Uganda
| | - Patience Atuhaire
- Makerere University-Johns Hopkins University (MU-JHU) Care LTD, Kampala, Uganda
| | | | | | - Henry Debem
- Department of Public Health and Preventive Medicine, School of Medicine, University of Liverpool, Liverpool, UK
| | - Andrew Mujugira
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.,Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
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Barnabas RV, van Rooyen H. Data-driven HIV programming to maximise health benefits. Lancet HIV 2020; 7:e662-e663. [PMID: 32888414 PMCID: PMC7462571 DOI: 10.1016/s2352-3018(20)30235-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ruanne V Barnabas
- Department of Global Health, and Division of Allergy and Infectious Diseases, and Department of Epidemiology, University of Washington, Seattle, WA 98104, USA; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Heidi van Rooyen
- Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa; Medical Research Council, Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, South Africa
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Iwuji C, Chimukuche RS, Zuma T, Plazy M, Larmarange J, Orne-Gliemann J, Siedner M, Shahmanesh M, Seeley J. Test but not treat: Community members' experiences with barriers and facilitators to universal antiretroviral therapy uptake in rural KwaZulu-Natal, South Africa. PLoS One 2020; 15:e0239513. [PMID: 32970730 PMCID: PMC7514038 DOI: 10.1371/journal.pone.0239513] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/08/2020] [Indexed: 01/20/2023] Open
Abstract
Introduction Antiretroviral therapy (ART) has revolutionised the care of HIV-positive individuals resulting in marked decreases in morbidity and mortality, and markedly reduced transmission to sexual partners. However, these benefits can only be realised if individuals are aware of their HIV-positive status, initiated and retained on suppressive lifelong ART. Framed using the socio-ecological model, the present study explores factors contributing to poor ART uptake among community members despite high acceptance of HIV-testing within a Treatment as Prevention (TasP) trial. In this paper we identify barriers and facilitators to treatment across different levels of the socio-ecological framework covering individual, community and health system components. Methods This research was embedded within a cluster-randomised trial (ClinicalTrials.gov, number NCT01509508) of HIV treatment as Prevention in rural KwaZulu-Natal, South Africa. Data were collected between January 2013 and July 2014 from resident community members. Ten participants contributed to repeat in-depth interviews whilst 42 participants took part in repeat focus group discussions. Data from individual interviews and focus group discussions were triangulated using community walks to give insights into community members’ perception of the barriers and facilitators of ART uptake. We used thematic analysis guided by a socio-ecological framework to analyse participants’ narratives from both individual interviews and focus group discussions. Results Barriers and facilitators operating at the individual, community and health system levels influence ART uptake. Stigma was an over-arching barrier, across all three levels and expressed variably as fear of HIV disclosure, concerns about segregated HIV clinical services and negative community religious perceptions. Other barriers were individual (substance misuse, fear of ART side effects), community (alternative health beliefs). Facilitators cited by participants included individual (expectations of improved health and longer life expectancy following ART, single tablet regimens), community (availability of ART in the community through mobile trial facilities) and health system factors (fast and efficient service provided by friendly staff). Discussion We identified multiple barriers to achieving universal ART uptake. To enhance uptake in HIV care services, and achieve the full benefits of ART requires interventions that tackle persistent HIV stigma, and offer people with HIV respectful, convenient and efficient services. These interventions require evaluation in appropriately designed studies.
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Affiliation(s)
- Collins Iwuji
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, United Kingdom
- Africa Health Research Institute, Berea, KwaZulu-Natal, South Africa
- * E-mail:
| | | | - Thembelihle Zuma
- Africa Health Research Institute, Berea, KwaZulu-Natal, South Africa
| | - Melanie Plazy
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
| | - Joseph Larmarange
- Institut de Recherche pour le Développement(IRD), Centre Population et Développement (Ceped), Paris, France
| | - Joanna Orne-Gliemann
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
| | - Mark Siedner
- Africa Health Research Institute, Berea, KwaZulu-Natal, South Africa
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Maryam Shahmanesh
- Africa Health Research Institute, Berea, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, United Kingdom
| | - Janet Seeley
- Africa Health Research Institute, Berea, KwaZulu-Natal, South Africa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Opito R, Mpagi J, Bwayo D, Okello F, Mugisha K, Napyo A. Treatment outcome of the implementation of HIV test and treat policy at The AIDs Support Organization (TASO) Tororo clinic, Eastern Uganda: A retrospective cohort study. PLoS One 2020; 15:e0239087. [PMID: 32960927 PMCID: PMC7508381 DOI: 10.1371/journal.pone.0239087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/29/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Uganda has been making progress towards universal HIV test and treat since 2013 and the 2016 test and treat policy was expanded from the 2013 guidelines. The expanded policy was rolled out in 2017 across the country. The treatment outcomes of this new policy have not yet been assessed at program level. The objective of this study was to determine the treatment outcome of the HIV test and treat policy in TASO Tororo Clinic, Eastern Uganda. METHODOLOGY This was a retrospective cohort study using secondary data. The study involved 580 clients who were newly diagnosed HIV positive in TASO Tororo clinic between June 2017 and May 2018, who were then followed up for ART initiation, retention in care, viral load monitoring and viral load suppression. The data was analyzed using Stat 14.0 version statistical software application. RESULTS Of the 580 clients, 93.1%(540) were adults aged ≥20 years. The uptake of test and treat was at 92.4%(536) and 12 months retention was at 78.7% (422). The factors associated with retention in care were a) being counselled before ART initiation, AOR 2.41 (95%CI, 1.56-3.71), b) having a treatment supporter, AOR 1.57 (95%CI, 1.02-2.43) and having an opportunistic infection, AOR 2.99 (95%CI:1.21-7.41). The viral load coverage was 52.4% (221) and viral load suppression rate was 89.1% (197) of clients monitored. Age <20 years was the only identified factor associated with vial load non suppression, AOR 7.35 (95% CI = 2.23-24.24). CONCLUSION This study found high uptake of ART under test and treat policy, with very low viral load coverage, and a high viral load suppression rate among those monitored. The study therefore highlights a need to differentiate viral load testing based on the population needs and ensure each client testing positive receives pre-ART initiation counselling so as to improve retention in care.
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Affiliation(s)
- Ronald Opito
- Department of Public Health, Busitema University, Mbale, Uganda
- Directorate of Program Management and Capacity Development, The AIDs Support Organization (TASO), Kampala, Uganda
- * E-mail:
| | - Joseph Mpagi
- Department of Microbiology, Busitema University, Mbale, Uganda
| | - Denis Bwayo
- Department of Internal Medicine, Busitema University, Mbale, Uganda
| | - Francis Okello
- Department of Public Health, Busitema University, Mbale, Uganda
| | - Kenneth Mugisha
- Directorate of Program Management and Capacity Development, The AIDs Support Organization (TASO), Kampala, Uganda
| | - Agnes Napyo
- Department of Public Health, Busitema University, Mbale, Uganda
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Steiner C, MacKellar D, Cham HJ, Rwabiyago OE, Maruyama H, Msumi O, Pals S, Weber R, Kundi G, Byrd J, Kazaura K, Madevu-Matson C, Morales F, Justman J, Rutachunzibwa T, Rwebembera A. Community-wide HIV testing, linkage case management, and defaulter tracing in Bukoba, Tanzania: pre-intervention and post-intervention, population-based survey evaluation. Lancet HIV 2020; 7:e699-e710. [PMID: 32888413 DOI: 10.1016/s2352-3018(20)30199-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/03/2020] [Accepted: 05/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Community randomised trials have had mixed success in implementing combination prevention strategies that diagnose 90% of people living with HIV, initiate and retain on antiretroviral therapy (ART) 90% of those diagnosed, and achieve viral load suppression in 90% of those on ART (90-90-90). The Bukoba Combination Prevention Evaluation (BCPE) aimed to achieve 90-90-90 in Bukoba Municipal Council, Tanzania, by scaling up new HIV testing, linkage, and retention interventions. METHOD We did population-based, cross-sectional surveys before and after our community-wide intervention in Bukoba-a mixed urban and rural council of approximately 150 000 residents located on the western shore of Lake Victoria in Tanzania. BCPE interventions were implemented in 11 government-supported health-care facilities throughout Bukoba from Oct 1, 2014, to March 31, 2017, when national ART-eligibility guidelines expanded from CD4 counts of less than 350 cells per μL (Oct 1, 2014-Dec 31, 2015) and 500 or less cells per μL (Jan 1, 2016-Sept 30, 2016) to any CD4 cell count (test and treat, Oct 1, 2016-March 31, 2017). We used pre-intervention (Nov 4, 2013-Jan 25, 2014) and post-intervention (June 21, 2017-Sept 20, 2017) population-based household surveys to assess population prevalence of undiagnosed HIV infection and ART coverage, and progress towards 90-90-90, among residents aged 18-49 years. FINDINGS During the 2·5-year intervention, BCPE did 133 695 HIV tests, diagnosed and linked 3918 people living with HIV to HIV care at 11 Bukoba facilities, and returned to HIV care 604 patients who had stopped care. 4795 and 5067 residents aged 18-49 years participated in pre-intervention and post-intervention surveys. HIV prevalence before and after the intervention was similar: pre-intervention 8·9% (95% CI 7·5-10·4); post-intervention 8·4% (6·9-9·9). Prevalence of undiagnosed HIV infection decreased from 4·7% to 2·0% (prevalence ratio 0·42, 95% CI 0·31-0·57), and current ART use among all people living with HIV increased from 32·2% to 70·9% (2·20, 1·82-2·66) overall, 23·0% to 62·1% among men (2·70, 1·84-3·96), and 16·7% to 64·4% among people aged 18-29 years (3·87, 2·54-5·89). Of 436 and 435 people living with HIV aged 18-49 years who participated in pre-intervention and post-intervention surveys, previous HIV diagnosis increased from 47·4% (41·3-53·4) to 76·2% (71·8-80·6), ART use among diagnosed people living with HIV increased from 68·0% (60·9-75·2) to 93·1% (90·2-96·0), and viral load suppression of those on ART increased from 88·7% (83·6-93·8) to 91·3% (88·6-94·1). INTERPRETATION BCPE findings suggest scaling up recommended HIV testing, linkage, and retention interventions can help reduce prevalence of undiagnosed HIV infection, increase ART use among all people living with HIV, and make substantial progress towards achieving 90-90-90 in a relatively short period. BCPE facility-based testing and linkage interventions are undergoing national scale up to help achieve 90-90-90 in Tanzania. FUNDING US Presidents' Emergency Plan for AIDS Relief.
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Affiliation(s)
| | - Duncan MacKellar
- Division of Global HIV and TB, National Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Haddi Jatou Cham
- Division of Global HIV and TB, National Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Omari Msumi
- ICAP at Columbia University, Maseru, Lesotho
| | - Sherri Pals
- Division of Global HIV and TB, National Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel Weber
- US Centers for Disease Control and Prevention, Harare, Zimbabwe
| | | | | | | | | | | | | | - Thomas Rutachunzibwa
- Ministry of Health, Community Development, Gender, Elderly and Children, Bukoba, Tanzania
| | - Anath Rwebembera
- National AIDS Control Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
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Comprehensive HIV risk reduction interventions for 2020 and beyond: product choices and effective service-delivery platforms for individual needs and population-level impact. Curr Opin HIV AIDS 2020; 14:423-432. [PMID: 31261158 DOI: 10.1097/coh.0000000000000567] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW This review summarizes key HIV prevention strategies in the 2020 toolkit and discusses opportunities to maximize the public health impact of these prevention interventions at a population level. RECENT FINDINGS HIV prevention has relied on counseling, HIV testing, and condom distribution for the past three decades. Recent exciting work has provided evidence on effective HIV prevention interventions, including antiretroviral therapy for HIV prevention, expanding preexposure prophylaxis modalities, and voluntary medical male circumcision which all reduce individual-level HIV risk. Efficient service-delivery approaches are necessary to deliver these products at scale while addressing population-specific needs. These approaches include: making it easier to get individuals HIV tested and linked to prevention services; de-medicalization to increase access to prevention products; creating welcoming clinic service-delivery environments; and integrating HIV prevention products into existing clinical platforms to support ongoing care engagement. SUMMARY The 2020 HIV prevention toolkit includes powerful HIV prevention options, and product choice will be increasingly imperative. Meeting ambitious global HIV reduction targets in the next decade will require improved service-delivery platforms to get prevention choices to persons at risk while layering prevention coverage to achieve population-level impact.
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