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Meek CJ, Munkhondya TEM, Mphande M, Tembo TA, Chitani M, Jean-Baptiste M, Vansia D, Kumbuyo C, Wang J, Simon KR, Rutstein SE, Barrington C, Kim MH, Go VF, Rosenberg NE. Examining the feasibility of assisted index case testing for HIV case-finding: a qualitative analysis of barriers and facilitators to implementation in Malawi. BMC Health Serv Res 2024; 24:606. [PMID: 38720312 PMCID: PMC11080127 DOI: 10.1186/s12913-024-10988-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Assisted index case testing (ICT), in which health care workers take an active role in referring at-risk contacts of people living with HIV for HIV testing services, has been widely recognized as an evidence-based intervention with high potential to increase status awareness in people living with HIV. While the available evidence from eastern and southern Africa suggests that assisted ICT can be an effective, efficient, cost-effective, acceptable, and low-risk strategy to implement in the region, it reveals that feasibility barriers to implementation exist. This study aims to inform the design of implementation strategies to mitigate these feasibility barriers by examining "assisting" health care workers' experiences of how barriers manifest throughout the assisted ICT process, as well as their perceptions of potential opportunities to facilitate feasibility. METHODS In-depth interviews were conducted with 26 lay health care workers delivering assisted ICT in Malawian health facilities. Interviews explored health care workers' experiences counseling index clients and tracing these clients' contacts, aiming to inform development of a blended learning implementation package. Transcripts were inductively analyzed using Dedoose coding software to identify and describe key factors influencing feasibility of assisted ICT. Analysis included multiple rounds of coding and iteration with the data collection team. RESULTS Participants reported a variety of barriers to feasibility of assisted index case testing implementation, including sensitivities around discussing ICT with clients, privacy concerns, limited time for assisted index case testing amid high workloads, poor quality contact information, and logistical obstacles to tracing. Participants also reported several health care worker characteristics that facilitate feasibility (knowledge, interpersonal skills, non-stigmatizing attitudes and behaviors, and a sense of purpose), as well as identified process improvements with the potential to mitigate barriers. CONCLUSIONS Maximizing assisted ICT's potential to increase status awareness in people living with HIV requires equipping health care workers with effective training and support to address and overcome the many feasibility barriers that they face in implementation. Findings demonstrate the need for, as well as inform the development of, implementation strategies to mitigate barriers and promote facilitators to feasibility of assisted ICT. TRIAL REGISTRATION NCT05343390. Date of registration: April 25, 2022.
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Affiliation(s)
- Caroline J Meek
- RTI International, Research Triangle Park, NC, USA.
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Mtisunge Mphande
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Tapiwa A Tembo
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Mike Chitani
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Milenka Jean-Baptiste
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dhrutika Vansia
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Caroline Kumbuyo
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Jiayu Wang
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Sarah E Rutstein
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Clare Barrington
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maria H Kim
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Vivian F Go
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nora E Rosenberg
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Tavakoli F, Dehghan M, Haghdoost AA, Mirzazadeh A, Gouya MM, Sharifi H. A qualitative study exploring approaches, barriers, and facilitators of the HIV partner notification program in Kerman, Iran. BMC Health Serv Res 2024; 24:570. [PMID: 38698401 PMCID: PMC11067232 DOI: 10.1186/s12913-024-11049-1] [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: 11/08/2023] [Accepted: 04/26/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND HIV partner notification services can help people living with HIV (PLHIV) to identify, locate, and inform their sexual and injecting partners who are exposed to HIV and refer them for proper and timely counseling and testing. To what extent these services were used by PLHIV and what are the related barriers and facilitators in southeast Iran are not known. So, this study aimed to explore HIV notification and its barriers and facilitators among PLHIV in Iran. METHODS In this qualitative study, the number of 23 participants were recruited from November 2022 to February 2023 including PLHIV (N = 12), sexual partners of PLHIV (N = 5), and staff members (N = 6) of a Voluntary Counseling and Testing (VCT) center in Kerman located in the southeast of Iran. Our data collection included purposive sampling to increase variation. The content analysis was conducted using the Graneheim and Lundman approach. The analysis yielded 221 (out of 322) related codes related to HIV notification, its barriers, and its facilitators. These codes were further categorized into one main category with three categories and nine sub-categories. RESULTS The main category was HIV notification approaches, HIV notification barriers, and facilitators. HIV notification approaches were notification through clear, and direct conversation, notification through gradual preparation and reassurance, notification due to being with PLHIV, notification through suspicious talking of the physician, and notification due to the behavior of others. Also, the barriers were classified into individual, social, and environmental, and healthcare system barriers and the facilitators were at PLHIV, healthcare staff, and community levels. Stigma was a barrier mentioned by most participants. Also, the main facilitator of HIV notification was social support, especially from the family side. CONCLUSIONS The findings highlighted the multidimensionality of HIV notification emphasizing the importance of tailored support and education to enhance the notification process for PLHIV and their networks. Also, our results show that despite all the efforts to reduce stigma and discrimination in recent years, stigma still exists as a main obstacle to disclosing HIV status and other barriers are the product of stigma. It seems that all programs should be directed towards destigmatization.
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Affiliation(s)
- Fatemeh Tavakoli
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahlagha Dehghan
- Reproductive Health, Family and Population Research Center, Kerman University of Medical Sciences, Kerman, Iran.
| | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Mohammad Mehdi Gouya
- Department of Infectious Diseases and Tropical Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA.
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Oljira H, Rata A, Mulatu B, Abera T. Partner notification service utilization and associated factors among clients attending anti-retroviral therapy clinics of public health facilities in Gimbi Town, West Ethiopia, 2023: a facility-based mixed-method cross-sectional study. BMC Public Health 2024; 24:687. [PMID: 38438988 PMCID: PMC10913634 DOI: 10.1186/s12889-024-18196-4] [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: 09/05/2023] [Accepted: 02/23/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Partner Notification Service is among the strategies used to conduct targeted Human Immunodeficiency Virus Testing Service by obtaining information about sexual contacts of index clients to refer for testing. But most people living with Human Immunodeficiency Virus are still unaware of their status, including Ethiopia. Limited studies are available on the magnitude of partner notification service utilization and associated factors in Ethiopia. OBJECTIVE The aim of this study was to assess the magnitude of partner notification service utilization and associated factors among people living with Human Immunodeficiency Virus attending anti-retroviral therapy clinics of public health facilities in Gimbi town, West Ethiopia. METHODS A facility-based mixed-method cross-sectional study design was used. Total of 455 study participants were selected by systematic random sampling for quantitative data and health workers were purposively selected for qualitative data until saturation of ideas was reached. The study was conducted from December 1, 2022 to January 30, 2023. Structured questionnaires and key informant interview guides were used for data collection. Quantitative data were analyzed using Statistical Package for Social Science version 25. Open code 4.02 software was used for qualitative data analysis. Frequencies and proportions were used to summarize descriptive statistics. Bivariable and multivariable logistic regression was used to identify associated factors then variables with a p value < 0.05 were declared to have an association with the dependent variable. RESULT Exactly 298 (65.5%) of the study participants were notified their HIV status to their sexual partners. Factors associated with Partner Notification Service Utilization were depression AOR: 0.12 (95% CI: 0.07, 0.20), urban settlers AOR: 2.21 (95% CI: 1.2, 3.83), fear of support loss AOR: 0.24 (95% CI: 0.14, 0.40) and intimate partner violence AOR: 0.55 (95% CI: 0.31, 0.97). From qualitative part of this study, factors associated to Partner Notification service utilization were fear of stigma, discrimination and fear of divorce. CONCLUSION Two-third of the study participants were utilized partner notification service, and efforts are important to prevent depression and intimate partner violence. Local government bodies and stakeholders should implement economic strengthening and strategies to address the rural community for HIV/AIDS prevention. Promotion of supportive and inclusive environment for PLHIV should also considered as way to increase PNS utilization.
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Affiliation(s)
- Habtamu Oljira
- Department of Biomedical Science, School of Medicine, Wallaga University, Nekemte, Oromia, Ethiopia.
| | - Abiriham Rata
- Nekemte Blood Bank, Oromia Health Beuareu, Nekemte, Oromia, Ethiopia
| | - Befirdu Mulatu
- Department of Public Health, Institute of Health Science, Wallaga University, Nekemte, Oromia, Ethiopia
| | - Tesfaye Abera
- Department of Nursing, School of Nursing and Midwifery, Wallaga University, Nekemte, Oromia, Ethiopia
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McGowan M, Bärnighausen K, Berner-Rodoreda A, McMahon SA, Mtaita C, Mauti J, Neuhann F. "The targets…are driving the agenda and that probably needs to change": stakeholder perspectives on HIV partner notification in sub-Saharan Africa. BMC Public Health 2024; 24:521. [PMID: 38373972 PMCID: PMC10877856 DOI: 10.1186/s12889-023-17422-9] [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: 09/20/2023] [Accepted: 12/06/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Voluntary assisted partner notification (VAPN) in HIV contact tracing is a globally recommended strategy to identify persons who have been exposed to HIV and link them to HIV testing and follow-up. However, there is little understanding about how VAPN is experienced by stakeholders in sub-Saharan African (SSA) contexts. We conducted a multi-level and multi-national qualitative analysis evaluating stakeholder perspectives surrounding VAPN implementation to inform the development of future VAPN policies. METHOD We conducted in-depth interviews (IDIs) with VAPN stakeholders at global (n = 5), national (n = 6), and community level (n = 4) across a total of seven SSA countries. Eligible participants were ≥ 18 years old and had experience developing, implementing, or overseeing VAPN policies in SSA. We sought to understand stakeholder's perspectives on policy development, implementation, and perceived outcomes (barriers and facilitators). Interviews were audio recorded, transcribed, and analyzed thematically using a combination of inductive and deductive approaches. RESULTS Between December 2019 and October 2020 we conducted 15 IDIs. While participants agreed that VAPN resulted in a high yield of people newly diagnosed with HIV; they noted numerous barriers surrounding VAPN implementation across global, national, and community levels, the majority of which were identified at community level. Barriers at global and national level included high target setting, contradictory laws, and limited independent research disenfranchising the experiences of implementing partners. The barriers identified at community level included client-level challenges (e.g., access to healthcare facilities and fear of adverse events); healthcare worker challenges (e.g., high workloads); limited data infrastructure; and cultural/gender norms that hindered women from engaging in HIV testing and VAPN services. In response to these barriers, participants shared implementation facilitators to sustain ethical implementation of VAPN services (e.g., contact tracing methods) and increase its yield (e.g., HIV self-testing integrated with VAPN services). CONCLUSION Overall, stakeholders perceived VAPN implementation to encounter barriers across all implementation levels (global to community). Future VAPN policies should be designed around the barriers and facilitators identified by SSA stakeholders to maximize the implementation of (ethical) HIV VAPN services and increase its impact in sub-Saharan African settings.
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Affiliation(s)
- Maureen McGowan
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Kate Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Astrid Berner-Rodoreda
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Caroline Mtaita
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Joy Mauti
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Florian Neuhann
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
- School of Medicine and Clinical Sciences, Lewy Mwanawasa Medical University, Lusaka, Zambia
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Greensides D, Bishop K, Manfredini L, Wong V. Do No Harm: A Review of Social Harms Associated with HIV Partner Notification. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300189. [PMID: 38135515 PMCID: PMC10749648 DOI: 10.9745/ghsp-d-23-00189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/19/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION HIV partner notification services (PNS) are highly effective in identifying people living with HIV, but the complex risks and repercussions associated with HIV testing and disclosure must be examined. The benefits of assisting people to learn their HIV status and link with treatment or prevention based on their results must be considered alongside the risks of adverse events or social harms. METHODS The study team systematically searched the PubMed, EBSCO, and Web of Science electronic databases (2015-2021), as well as abstracts from the International AIDS Society Conference (2016-2020) and the Conference on Retroviruses and Opportunistic Infections (2015-2020). Fifteen studies and 1 conference abstract met the inclusion criteria for this narrative review. RESULTS AND DISCUSSION Incidence of social harms across studies ranged from 0%-6.3%, with the higher range occurring among women with a previous history of intimate partner violence (IPV). The majority of the studies (69%) reported that less than or equal to 1% of participants experienced social harms as a result of PNS. Social harms included relationship dissolution, IPV, and loss of financial support. CONCLUSIONS Evidence from a limited set of studies suggests that although social harms associated with HIV partner notification do occur, they are rare. Considering the rapid global scale-up of PNS, additional research and oversight are needed to provide countries with recommended minimum standards to support providers, clients, and their partners with safe partner notification.
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Affiliation(s)
- Dawn Greensides
- Global Health Technical Assistance and Mission Support Project, supporting the Office of HIV/AIDS, Prevention, Care, and Treatment Division, U.S. Agency for International Development, Washington, DC, USA
| | - Kristina Bishop
- U.S. Agency for International Development, Washington, DC, USA
| | - Liz Manfredini
- Global Health Training, Advisory, and Support Contract, Credence Management Solutions, LLC, supporting the Office of HIV/AIDS, Prevention Care and Treatment Division, U.S. Agency for International Development, Washington, DC, USA.
| | - Vincent Wong
- U.S. Agency for International Development, Washington, DC, USA
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Naughton B, Owuor M, Wamuti B, Katz DA, Sharma M, Liu W, Lagat H, Kariithi E, Mugambi M, Bosire R, Masyuko S, Farquhar C, Weiner BJ. "I feel good because I have saved their lives": Acceptability of assisted partner services among female index clients and male sexual partners in Kenya. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001842. [PMID: 37224122 DOI: 10.1371/journal.pgph.0001842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 03/28/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Assisted partner services (APS), or notification for sexual partners of people diagnosed with HIV, is an efficient, effective, and high yield strategy to identify people living with HIV and is recommended by the World Health Organization (WHO). However, there remains a need to further understand the acceptability of APS qualitatively from a client lens, particularly when APS is integrated into the national health system. We investigated acceptability of APS when integrated into HIV services in Kenya. METHODS Starting in May 2018, APS was implemented in 31 health facilities in Kisumu and Homa Bay counties in western Kenya. From January to December 2019, we conducted in-depth interviews (IDIs) with female index clients (n = 16) and male sexual partners (n = 17) in 10 facilities participating in an APS scale up study. Interviews assessed APS satisfaction, perceived benefits of the intervention, and challenges that may affect delivery or uptake. We applied the Theoretical Framework of Acceptability by Sekhon et al. (2017) as a guide to organize our findings. RESULTS We find that views of APS are often guided by an individual's trust in the intervention's design and implementation, and an interest to preserve one's health and that of one's family and children. There were strong and consistent acceptable views of APS as "doing good" and "saving a life" and as a means of showing love towards one's partner(s). The initial acceptability framing of individuals engaging with APS was predicated either on a feeling of comfort with the intervention, or a wariness of divulging sex partner personal information. Health care workers (HCWs) were seen to play an important role in mitigating participant fears linked with the intervention, particularly around the sensitive nature of HIV disclosure and sexual partners. Clients noted considerable challenges that affected acceptability, including the risk to the relationship of disclosing one's HIV status, and the risk of intimate partner violence. DISCUSSION We found that APS is acceptable as a strategy to reach male sexual partners of females diagnosed with HIV, and these findings provide opportunities to inform recommendations for further scale-up. Opportunities such as focusing on intervention confidentiality and appropriate counseling, excluding female clients at risk of IPV from this intervention, and highlighting the altruistic benefits of APS to potential clients. Understanding the perspectives of clients receiving APS in a real-world setting may be valuable to policy-makers and stakeholders interested in scaling up or enhancing APS within health systems.
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Affiliation(s)
- Brienna Naughton
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | - Beatrice Wamuti
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - David A Katz
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Wenjia Liu
- Department of Child, Family & Population Health Nursing, University of Washington, Seattle, Washington, United States of America
| | | | | | | | - Rose Bosire
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Sarah Masyuko
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Ministry of Health, Nairobi, Kenya
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
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Wamuti B, Owuor M, Liu W, Katz D, Lagat H, Otieno G, Kariithi E, Macharia P, Masyuko S, Mugambi M, Farquhar C, Weiner B. Implementation fidelity to HIV assisted partner services (aPS) during scale-up in western Kenya: a convergent mixed methods study. BMC Health Serv Res 2023; 23:511. [PMID: 37208724 DOI: 10.1186/s12913-023-09541-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 05/10/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND HIV assisted partner services (aPS) is an intervention to improve HIV status awareness among sex and drug-injecting partners of people newly diagnosed with HIV (index clients). Implementation fidelity-the degree to which an intervention is conducted as intended - is critical to effectiveness, but there are limited data about aPS fidelity when delivered by HIV testing service (HTS) providers. We explored factors affecting implementation fidelity to aPS in two high-HIV prevalence counties in western Kenya. METHODS We used convergent mixed methods adapting the conceptual framework for implementation fidelity within the aPS scale-up project. This was an implementation study examining scale-up of APS within HTS programs in Kisumu and Homa Bay counties that recruited male sex partners (MSPs) of female index clients. We defined implementation fidelity as the extent to which HTS providers followed the protocol for phone and in-person participant tracing at six expected tracing attempts. Quantitative data were collected from tracing reports in 31 facilities between November 2018 and December 2020, and in-depth interviews (IDIs) were conducted with HTS providers. Descriptive statistics were used to describe tracing attempts. IDIs were analyzed using thematic content analysis. RESULTS Overall, 3017 MSPs were mentioned of whom 98% (2969/3017) were traced, with most tracing attempts being successful (2831/2969, 95%). Fourteen HTS providers participated in the IDIs-mostly females (10/14, 71%) with a median age of 35 years (range 25-52), who all had post-secondary education (14/14, 100%). The proportion of tracing attempts occurring by phone ranged from 47 to 66%, with the highest proportion occurring on the first attempt and lowest on the sixth attempt. Contextual factors either enhanced or impeded implementation fidelity to aPS. Positive provider attitudes towards aPS and conducive work environment factors promoted implementation fidelity, while negative MSP responses and challenging tracing conditions impeded it. CONCLUSION Interactions at the individual (provider), interpersonal (client-provider), and health systems (facility) levels affected implementation fidelity to aPS. As policymakers prioritize strategies to reduce new HIV infections, our findings highlight the importance of conducting fidelity assessments to better anticipate and mitigate the impact of contextual factors during the scale-up of interventions.
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Affiliation(s)
- Beatrice Wamuti
- Department of Global Health and Population, Harvard University, Boston, USA.
| | | | - Wenjia Liu
- School of Nursing, University of Washington, Seattle, USA
| | - David Katz
- Department of Global Health, University of Washington, Seattle, USA
| | | | | | | | - Paul Macharia
- Department of Global Health, University of Washington, Seattle, USA
| | - Sarah Masyuko
- Department of Global Health, University of Washington, Seattle, USA
- Ministry of Health, Nairobi, Kenya
| | | | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
- Department of Medicine, University of Washington, Seattle, USA
| | - Bryan Weiner
- Department of Global Health, University of Washington, Seattle, USA
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Joel JN, Awuor P, Blanco N, Lavoie MCC, Lascko T, Ngunu C, Mwangi J, Mutisya I, Ng'eno C, Wangusi R, Koech E. Scale-up of HIV index testing in an urban population: Experiences and achievements from Nairobi County, Kenya. Trop Med Int Health 2023; 28:116-125. [PMID: 36538038 DOI: 10.1111/tmi.13843] [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: 12/24/2022]
Abstract
OBJECTIVE To describe the implementation strategies of the index testing program across Nairobi County in Kenya, assess outcomes along the HIV index testing cascade (acceptance, elicitation ratio, HIV positivity and linkage to treatment), and assess annual changes along the HIV index testing cascade during the first 2 years of implementation. METHODS Retrospective analysis of programmatic aggregate data collected from October 2017 to September 2019 after the roll-out of index testing services in 48 health facilities in Nairobi County. Proportions and ratios were calculated for acceptance, elicitation ratio, testing uptake and HIV positivity. We compared these outcomes between years using a chi-squared test, Fisher's exact test or Wilcoxon sign test, and we assessed trends using the Mann-Kendall test. RESULTS Testing among eligible partners increased from 42.4% (1471/3470) to 74.9% (6114/8159) in the general population, and the positivity yield remained high across both years (25.2% in year 1 and 24.1% in year 2). Index testing positivity yield remained significantly higher than other testing modalities (24.3% vs. 1.3%, p < 0.001). The contribution of index testing services to the total number of HIV-positive individuals identified increased from 7.5% in the first year to 28.6% in the second year (p < 0.001). More men were tested, but the positivity yield was higher among women (30.0%) and those aged 50 years or older (32.4%). Testing eligible partners in key populations (KPs) decreased from 52.4% (183/349) to 40.7% (109/268) (p = 0.674); however, the HIV positivity yield increased from 8.6% to 23.9% (p < 0.001) by the second year of implementation. The HIV positivity yield from index testing remained higher than other testing modalities (14% vs. 0.9%, p < 0.001) for KPs. CONCLUSION Index testing was well-accepted and effective in identifying individuals living with HIV in a Kenyan urban setting across both general populations and KPs. Ongoing adaptations to the strategies deployed as part of index testing services helped improve most of the outcomes along the index testing cascade.
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Affiliation(s)
- Javies Ngui Joel
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation, Nairobi, Kenya
| | - Patrick Awuor
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation, Nairobi, Kenya
| | - Natalia Blanco
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Marie-Claude C Lavoie
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Taylor Lascko
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Carol Ngunu
- Department of Health, Nairobi Metropolitan Services, Nairobi, Kenya
| | - Jonathan Mwangi
- Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control & Prevention, Nairobi, Kenya
| | - Immaculate Mutisya
- Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control & Prevention, Nairobi, Kenya
| | - Caroline Ng'eno
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation, Nairobi, Kenya
| | - Rebecca Wangusi
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation, Nairobi, Kenya
| | - Emily Koech
- Chief Executive Officer, Center for International Health, Education, and Biosecurity-Kenya, Nairobi, Kenya
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Chen Q, Liu J, Fu X, Yang F, Liu Q, Li J, Tan Z, Li J, Lin K, Yan Y, Yang Y, Li Y, Jiang H. Effect of Late Testing and Antiretroviral Treatment on Mortality Among People Living With HIV in the Era of Treat-All in Guangdong Province, China, 1992–2018: A Cohort Study. Front Public Health 2022; 10:851117. [PMID: 35875008 PMCID: PMC9304903 DOI: 10.3389/fpubh.2022.851117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/09/2022] [Indexed: 11/20/2022] Open
Abstract
Late testing and antiretroviral therapy (ART) prevailed among people living with HIV (PLHIV) and impacted the benefit of immediate ART. This study aimed to identify the benefit of the test-and-immediate-treat policy in China, the effect of immediate ART, and the influence of late testing and ART on the whole PLHIV in Guangdong Province, China. We designed two tendency analyses in aggregative form and two cohorts (surveillance and ART cohort) in individuals' perspectives based on the HIV/AIDS Comprehensive Response Information Management System. Two interrupted time series models were conducted for tendency analysis from 2009 to 2018 to explore the all-cause and short-term mortality decrease after the test-and-immediate-treat policy. A time-dependent Cox model was performed for the surveillance cohort from 1992 to 2018 and a joint model was utilized for the ART cohort to identify the effect of immediate ART and the influence of late testing and ART on death. The tendency analysis included 324,914 and 68,679 person-year for all-cause/short-term mortality. A total of 49,289 and 26,287 PLHIV were recruited in the surveillance and ART cohort with 5,557 and 459 deaths, respectively. The short-term mortality dropped from 4.69 cases/100 person-year in January 2009 to 0.35 cases/100 person-year in December 2018 (standardized rate). The all-cause mortality saw a decreasing trend from 1.46 cases/100 person-year in January 2009 to 0.14 cases/100 person-year in December 2018 (standardized rate). The tendency analysis showed a significant short-term mortality slope decrease after the test-and-immediate-treat policy (P = 0.024). From the surveillance cohort, late testing, in general, was a risk factor for all-cause mortality [hazard ratio (HR) = 1.330, 95% CI, 1.250, 1.416]. ART cohort showed higher hazards of all-cause mortality among PLHIV with no late testing, but late ART (HR = 1.690, 95% CI, 1.166, 2.451) and both the late testing and late ART (HR = 1.335, 95% CI, 1.042, 1.710). Immediate ART might decrease the hazard of all-cause death though it is insignificant (HR = 0.923, 95% CI: 0.755, 1.129) in the ART cohort. The test-and-immediate-test policy brought benefit to PLHIV. We should enlarge HIV testing using comprehensive approaches to decrease late testing and ART and increase the benefit of immediate ART.
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Affiliation(s)
- Qiaosen Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jun Liu
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Xiaobing Fu
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Fang Yang
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Qicai Liu
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Junbin Li
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhimin Tan
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Kaihao Lin
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yao Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yan Li
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- *Correspondence: Hongbo Jiang
| | - Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
- Yan Li
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Untapped Potential for Safer Conception Messaging to Transform PrEP Rollout and Promote Service Engagement Among Serodiscordant Couples. AIDS Behav 2022; 26:2397-2408. [PMID: 35064850 DOI: 10.1007/s10461-022-03584-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 11/01/2022]
Abstract
Uptake of pre-exposure prophylaxis (PrEP) fell short of targets for Sub-Saharan Africa's initial rollout, revealing the need for more effective promotion strategies. In Uganda, we explored potential benefits and challenges of integrating safer conception messaging to promote PrEP among serodiscordant couples. In-depth interviews were conducted with clients and personnel at three clinics and analyzed thematically. Participants (n = 58) valued PrEP as a safer conception method (SCM) but described lack of integration of safer conception and PrEP services as well as inconsistent practices in prescribing PrEP to couples pursuing conception. Participants reported that the wider population remains largely unaware of PrEP and SCM or harbors misconceptions that PrEP is primarily for highly stigmatized groups like sex workers. Participants further described how heterosexual couples can still be reluctant to test for HIV, unaware of tools like PrEP and SCM that would allow them to continue their relationship and/or pursuit of childbearing. Overall, findings suggest that integrating PrEP and SCM in messaging and services targeting serodiscordant couples holds untapped benefits throughout the HIV prevention cascade.
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Liu W, Wamuti BM, Owuor M, Lagat H, Kariithi E, Obong'o C, Mugambi M, Sharma M, Bosire R, Masyuko S, Katz DA, Farquhar C, Weiner BJ. "It is a process" - a qualitative evaluation of provider acceptability of HIV assisted partner services in western Kenya: experiences, challenges, and facilitators. BMC Health Serv Res 2022; 22:616. [PMID: 35525931 PMCID: PMC9078086 DOI: 10.1186/s12913-022-08024-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Assisted partner service (APS) is effective for increasing HIV testing services (HTS) uptake among sexual partners of people diagnosed with HIV with rare social harm. The acceptability of APS to HTS providers is important for the quality and effectiveness of APS delivery. Within a larger ongoing implementation science study of APS in western Kenya, we qualitatively evaluated the provider acceptability of APS. Methods From May–June 2020, we conducted virtual, semi-structured in-depth interviews with 14 HTS providers recruited from 8 of 31 study health facilities in Homa Bay and Kisumu counties. Participants were selected using criteria-based purposive sampling to maximize variation on patient volume (assessed by the number of index clients tested for HIV) and APS performance (assessed by sexual partners elicitation and enrollment). Interviews inquired providers’ experiences providing APS including challenges and facilitators and the impact of contextual factors. Data were analyzed using an inductive approach. Results Overall, HTS providers found APS acceptable. It was consistently reported that doing APS was a continuous process rather than a one-day job, which required building rapport and persistent efforts. Benefits of APS including efficiency in HIV case finding, expanded testing coverage in men, and increased HIV status awareness and linkage to care motivated the providers. Provider referral was perceived advantageous in terms of independent contact with partners on behalf of index clients and efficiency in partner tracing. Challenges of providing APS included protecting clients’ confidentiality, difficulty obtaining partners’ accurate contact information, logistic barriers of tracing, and clients’ refusal due to fear of being judged for multiple sexual partners, fear of breach of confidentiality, and HIV stigma. Building rapport with clients, communicating with patience and nonjudgmental attitude and assuring confidentiality were examples of facilitators. Working in rural areas and bigger facilities, training, supportive supervision, and community awareness of APS promoted APS delivery while low salaries, lack of equipment, and high workload undermined it. Conclusions HTS providers found APS acceptable. Delivering APS as a process was the key to success. Future scale-up of APS could consider encouraging provider referral instead of the other APS methods to improve efficiency and reduce potential harm to clients.
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Affiliation(s)
- Wenjia Liu
- School of Nursing, University of Washington, Seattle, USA.
| | | | | | | | | | | | - Mary Mugambi
- National AIDS and STI Control Programme, Kenya Ministry of Health, Nairobi, Kenya
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, USA
| | - Rose Bosire
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Sarah Masyuko
- Department of Global Health, University of Washington, Seattle, USA.,National AIDS and STI Control Programme, Kenya Ministry of Health, Nairobi, Kenya
| | - David A Katz
- Department of Global Health, University of Washington, Seattle, USA
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, USA.,Department of Medicine, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, USA
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Rahmalia A, Wisaksana R, Laga M, van Crevel R, Peeters Grietens K. Facilitators and barriers to status disclosure and partner testing of women living with HIV in Indonesia: a mixed methods study. Sex Reprod Health Matters 2022; 30:2028971. [PMID: 35167424 PMCID: PMC8856062 DOI: 10.1080/26410397.2022.2028971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This mixed-methods study investigated HIV status disclosure and partner testing of women living with HIV (WLWH) in a concentrated epidemic setting in Bandung, Indonesia. The qualitative exploratory strand used theoretical sampling to carry out semi-structured interviews with 47 HIV-infected women with varying anti-retroviral therapy status. The quantitative strand included 122 female patients receiving HIV care at a referral clinic. HIV diagnosis made women reassess their sexual partnerships. Some lost their partner due to death or divorce. Women with a longstanding HIV infection often formed new partnerships. They disclosed their status to new partners without assistance from health providers; the type and stability of the partnership influenced decision to disclose. Fear of rejection prevented initial disclosure prior to bringing the new partners to a health provider. Disclosure did not always result in partner testing because of low risk-awareness or denial of the partner. Despite a similar proportion of status disclosure to partner (92.8%), only 53.7% of new partners of WLWH were tested in contrast to 89.7% of partners tested among WLWH who stayed with the same partner. In antenatal care, where same-day testing was often done for pregnant couples, more partners were tested. Overall, consistent condom use was low and HIV status forced WLWH who continued sex work to work at settings where condom use was not enforced. WLWH face barriers to HIV status disclosure and partner testing and would benefit from partnership counselling. Guidelines for partner notification and testing should include specific strategies for women with longstanding HIV infection.
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Affiliation(s)
- Annisa Rahmalia
- Researcher, Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia; Infectious Diseases and Global Health, Radboud University Medical Centre, Nijmegen, The Netherlands. Correspondence:
| | - Rudi Wisaksana
- Head of HIV Research Group, Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Marie Laga
- Professor, Sexual Health and HIV, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Reinout van Crevel
- Professor, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Koen Peeters Grietens
- Professor, Head of Socio-Ecological Health Research (SEHR) Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Testing for saturation in qualitative evidence syntheses: An update of HIV adherence in Africa. PLoS One 2021; 16:e0258352. [PMID: 34665831 PMCID: PMC8525762 DOI: 10.1371/journal.pone.0258352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 09/24/2021] [Indexed: 11/22/2022] Open
Abstract
Background A systematic review of randomised trials may be conclusive signalling no further research is needed; or identify gaps requiring further research that may then be included in review updates. In qualitative evidence synthesis (QES), the rationale, triggers, and methods for updating are less clear cut. We updated a QES on adherence to anti-retroviral treatment to examine if thematic saturation renders additional research redundant. Methods We adopted the original review search strategy and eligibility criteria to identify studies in the subsequent three years. We assessed studies for conceptual detail, categorised as ‘rich’ or ‘sparse’, coding the rich studies. We sought new codes, and appraised whether findings confirmed, extended, enriched, or refuted existing themes. Finally, we examined if the analysis impacted on the original conceptual model. Results After screening 3895 articles, 301 studies met the inclusion criteria. Rich findings from Africa were available in 82 studies; 146 studies were sparse, contained no additional information on specific populations, and did not contribute to the analysis. New studies enriched our understanding on the relationship between external and internal factors influencing adherence, confirming, extending and enriching the existing themes. Despite careful evaluation of the new literature, we did not identify any new themes, and found no studies that refuted our theory. Conclusions Updating an existing QES using the original question confirmed and sometimes enriched evidence within themes but made little or no substantive difference to the theory and overall findings of the original review. We propose this illustrates thematic saturation. We propose a thoughtful approach before embarking on a QES update, and our work underlines the importance of QES priority areas where further primary research may help, and areas where further studies may be redundant.
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14
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Monroe-Wise A, Mbogo L, Guthrie B, Bukusi D, Sambai B, Chohan B, Scott J, Cherutich P, Musyoki H, Bosire R, Dunbar M, Macharia P, Masyuko S, Wilkinson E, De Oliveira T, Ludwig-Barron N, Sinkele B, Herbeck J, Farquhar C. Peer-mediated HIV assisted partner services to identify and link to care HIV-positive and HCV-positive people who inject drugs: a cohort study protocol. BMJ Open 2021; 11:e041083. [PMID: 33895711 PMCID: PMC8074565 DOI: 10.1136/bmjopen-2020-041083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Targeted, tailored interventions to test high-risk individuals for HIV and hepatitis C virus (HCV) are vital to achieving HIV control and HCV microelimination in Africa. Compared with the general population, people who inject drugs (PWID) are at increased risk of HIV and HCV and are less likely to be tested or successfully treated. Assisted partner services (APS) increases HIV testing among partners of people living with HIV and improves case finding and linkage to care. We describe a study in Kenya examining whether APS can be adapted to find, test and link to HIV care the partners of HIV-positive PWID using a network of community-embedded peer educators (PEs). Our study also identifies HCV-positive partners and uses phylogenetic analysis to determine risk factors for onward transmission of both viruses. METHODS This prospective cohort study leverages a network of PEs to identify 1000 HIV-positive PWID for enrolment as index participants. Each index completes a questionnaire and provides names and contact information of all sexual and injecting partners during the previous 3 years. PEs then use a stepwise locator protocol to engage partners in the community and bring them to study sites for enrolment, questionnaire completion and rapid HIV and HCV testing. Outcomes include number and type of partners per index who are mentioned, enrolled, tested, diagnosed with HIV and HCV and linked to care. ETHICS AND DISSEMINATION Potential index participants are screened for intimate partner violence (IPV) and those at high risk are not eligible to enrol. Those at medium risk are monitored for IPV following enrolment. A community advisory board engages in feedback and discussion between the community and the research team. A safety monitoring board discusses study progress and reviews data, including IPV monitoring data. Dissemination plans include presentations at quarterly Ministry of Health meetings, local and international conferences and publications. TRIAL REGISTRATION NUMBER NCT03447210, Pre-results stage.
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Affiliation(s)
- Aliza Monroe-Wise
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Loice Mbogo
- HIV Testing and Counseling and HIV Prevention, Kenyatta National Hospital, Nairobi, Kenya
| | - Brandon Guthrie
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - David Bukusi
- HIV Testing and Counseling and HIV Prevention, Kenyatta National Hospital, Nairobi, Kenya
| | - Betsy Sambai
- HIV Testing and Counseling and HIV Prevention, Kenyatta National Hospital, Nairobi, Kenya
| | - Bhavna Chohan
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Kenya Medical Research Institute, Nairobi, Kenya
| | - John Scott
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | | | - Rose Bosire
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Matthew Dunbar
- Center for Studies in Demography and Ecology, University of Washinigton, Seattle, Washington, USA
| | | | - Sarah Masyuko
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Kenya's Ministry of Health, Nairobi, Kenya
| | - Eduan Wilkinson
- KwaZulu-Natal Research and Innovation Sequencing Platform, University of KwaZulu-Natal, Durban, South Africa
| | - Tulio De Oliveira
- KwaZulu-Natal Research and Innovation Sequencing Platform, University of KwaZulu-Natal, Durban, South Africa
| | | | - Bill Sinkele
- Support for Addiction Prevention and Treatment in Africa, Nairobi, Kenya
| | - Joshua Herbeck
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
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Chen JS, Matoga M, Pence BW, Powers KA, Maierhofer CN, Jere E, Massa C, Khan S, Rutstein SE, Phiri S, Hosseinipour MC, Cohen MS, Hoffman IF, Miller WC, Lancaster KE. A randomized controlled trial evaluating combination detection of HIV in Malawian sexually transmitted infections clinics. J Int AIDS Soc 2021; 24:e25701. [PMID: 33929094 PMCID: PMC8085969 DOI: 10.1002/jia2.25701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/10/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION HIV diagnosis is the necessary first step towards HIV care initiation, yet many persons living with HIV (PLWH) remain undiagnosed. Employing multiple HIV testing strategies in tandem could increase HIV detection and promote linkage to care. We aimed to assess an intervention to improve HIV detection within socio-sexual networks of PLWH in two sexually transmitted infections (STI) clinics in Lilongwe, Malawi. METHODS We conducted a randomized controlled trial to evaluate an intervention combining acute HIV infection (AHI) screening, contract partner notification and social contact referral versus the Malawian standard of care: serial rapid serological HIV tests and passive partner referral. Enrolment occurred between 2015 and 2019. HIV-seropositive persons (two positive rapid tests) were randomized to the trial arms and HIV-seronegative (one negative rapid test) and -serodiscordant (one positive test followed by a negative confirmatory test) persons were screened for AHI with HIV RNA testing. Those found to have AHI were offered enrolment into the intervention arm. Our primary outcome of interest was the number of new HIV diagnoses made per index participant within participants' sexual and social networks. We also calculated total persons, sexual partners and PLWH (including those previously diagnosed) referred per index participant. RESULTS A total of 1230 HIV-seropositive persons were randomized to the control arm, and 561 to the intervention arm. Another 12,713 HIV-seronegative or -serodiscordant persons underwent AHI screening, resulting in 136 AHI cases, of whom 94 enrolled into the intervention arm. The intervention increased the number of new HIV diagnoses made per index participant versus the control (ratio: 1.9; 95% confidence interval (CI): 1.2 to 3.1). The intervention also increased the numbers of persons (ratio: 2.5; 95% CI: 2.0 to 3.2), sexual partners (ratio: 1.7; 95% CI: 1.4 to 2.0) and PLWH (ratio: 2.3; 95% CI: 1.7 to 3.2) referred per index participant. CONCLUSIONS Combining three distinct HIV testing and referral strategies increased the detection of previously undiagnosed HIV infections within the socio-sexual networks of PLWH seeking STI care. Combination HIV detection strategies that leverage AHI screening and socio-sexual contact networks offer a novel and efficacious approach to increasing HIV status awareness.
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Affiliation(s)
- Jane S Chen
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Brian W Pence
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kimberly A Powers
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Courtney N Maierhofer
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | | | | | | | - Sarah E Rutstein
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Mina C Hosseinipour
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Myron S Cohen
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Irving F Hoffman
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - William C Miller
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Division of EpidemiologyCollege of Public HealthThe Ohio State UniversityColumbusOHUSA
| | - Kathryn E Lancaster
- Division of EpidemiologyCollege of Public HealthThe Ohio State UniversityColumbusOHUSA
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Wirawan GBS, Januraga PP, Mahendra IGAA, Harjana NPA, Mahatmi T, Luhukay L, Rewari BB, Johnson C, Katz DA. Perspectives on voluntary assisted partner notification among providers, people with HIV and the general population in Indonesia: a formative qualitative study. BMC Public Health 2021; 21:254. [PMID: 33516201 PMCID: PMC7847236 DOI: 10.1186/s12889-021-10332-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Voluntary assisted partner notification (aPN) services are effective in increasing access to and uptake of HIV testing among partners of people with HIV. Following recommendations by the World Health Organization in 2016, Indonesia evaluated various approaches to aPN. We present the lessons learned from formative operational research undertaken to understand provider and patient perspectives on aPN from three demonstration sites in cities with a high HIV burden. METHODS We conducted a formative qualitative study in three cities: Jakarta, Semarang, and Denpasar between September and October 2019. We conducted six focus group discussions (FGDs) (n = 44 participants) among health-care providers, people living with HIV and the general population. We explored participant preferences and concerns about how aPN should be delivered, including the methods of and messaging for contacting partners. All FGDs were conducted in the Indonesian language. Qualitative data were analysed using thematic analysis. RESULTS aPN was acceptable across different participant populations, although with caveats. Some differences were observed between the general population, providers and people living with HIV. People living with HIV were mainly concerned with confidentiality of the procedure and preferred the use of telecommunication and messages that avoid explicit mention of HIV exposure. Providers preferred similar approaches but for different reasons, being concerned mainly with self-efficacy and security. There was consensus regarding dual referral models. The use of phone calls and short messages were preferred as these are perceived to minimize negative reactions and stigma, protect client confidentiality and are suitable in the current legal situation. The general population was mainly concerned with effectiveness and prefer direct provider-led approaches, such as preferring in-person meeting with explicit notification of potential HIV exposure. CONCLUSIONS We found consensus among stakeholders on acceptance of aPN, especially dual referral methods. Development and implementation of aPN protocols should also consider clients' individual situations and concerns regarding safeguarding of confidentiality, and offer a range of options to accommodate all stakeholders involved.
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Affiliation(s)
- Gede Benny Setia Wirawan
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bali, Denpasar, Indonesia
| | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bali, Denpasar, Indonesia.
| | | | - Ngakan Putu Anom Harjana
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bali, Denpasar, Indonesia
| | - Tiara Mahatmi
- World Health Organization Indonesia, Jakarta, Indonesia
| | | | | | - Cheryl Johnson
- Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, Switzerland
| | - David A Katz
- Department of Global Health, University of Washington, Seattle, USA
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Klabbers RE, Muwonge TR, Ayikobua E, Izizinga D, Bassett IV, Kambugu A, Tsai AC, Ravicz M, Klabbers G, O'Laughlin KN. Understanding the role of interpersonal violence in assisted partner notification for HIV: a mixed-methods study in refugee settlements in West Nile Uganda. J Glob Health 2020; 10:020440. [PMID: 33312504 PMCID: PMC7719270 DOI: 10.7189/jogh.10.020440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Assisted partner notification (APN) for HIV was introduced in refugee settlements in West Nile Uganda in 2018 to facilitate testing of sexual partners. While APN is an effective strategy recommended by the World Health Organization, its safety has not been evaluated in a refugee settlement context in which participants have high prior exposure to interpersonal violence. The extent to which interpersonal violence influences APN utilization and the frequency with which post-APN interpersonal violence occurs remains unknown. METHODS To explore the relationship between APN and interpersonal violence, a cross-sectional mixed-methods study was conducted at 11 health centers in refugee settlements in West Nile Uganda. Routinely collected index client and sexual partner data were extracted from APN registers and semi-structured interviews were conducted with health workers. RESULTS Through APN, 1126 partners of 882 distinct index clients were identified. For 8% (75/958) of partners, index clients reported a history of intimate partner violence (IPV). For 20% (226/1126) of partners, index clients were screened for post-APN IPV; 8 cases were reported of which 88% (7/8) concerned partners with whom index clients reported prior history of IPV. In qualitative interviews (N = 32), health workers reported HIV disclosure-related physical, sexual and psychological violence and deprivation or neglect. Incidents of disclosure-related violence against health workers and dependents of index clients were also reported. Fear of disclosure-related violence was identified as a major barrier to APN that prevents index clients from listing sexual partners. CONCLUSIONS Incidents of interpersonal violence have been reported following HIV-disclosure and fear of interpersonal violence strongly influences APN participation. Addressing HIV perception and stigma may contribute to APN uptake and program safety. Prospective research on interpersonal violence involving index clients and sexual partners in refugee settlements is needed to facilitate safe engagement in APN for this vulnerable population.
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Affiliation(s)
- Robin E Klabbers
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Timothy R Muwonge
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Emmanuel Ayikobua
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Diego Izizinga
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ingrid V Bassett
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew Kambugu
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Miranda Ravicz
- Department of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gonnie Klabbers
- Department of Health, Ethics and Society, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Kelli N O'Laughlin
- Departments of Emergency Medicine and Global Health, University of Washington, Seattle, Washington, USA
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Kariuki RM, Rithaa GK, Oyugi EO, Gachathi DM. What is the level of uptake of partner notification services in HIV testing in selected health facilities in Gatanga Sub County, Muranga County - Kenya; a retrospective study. BMC Infect Dis 2020; 20:432. [PMID: 32571230 PMCID: PMC7310157 DOI: 10.1186/s12879-020-05146-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 06/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identification of people living with HIV is key in HIV prevention and control. Partner Notification service is a World Health Organization backed strategy of reaching out to sexual partners of people diagnosed with HIV for HIV testing. However, its adoption and success rate in Kenya remains unknown. METHODS A cross sectional facility based study was undertaken in five purposely selected health facilities in Gatanga Sub county, Muranga County, Kenya. A retrospective review of patient medical records data for HIV positive index clients and their Sexual Partners conducted. Census approach was applied to extract data for study subjects from Partner Notification Services registers for the period covering January 2017 to August 2018. Epi Info software was used for data analysis. RESULTS A total of 183 index clients were offered Partner notification services. The mean age of the indexed clients studied was 39(SD ±13.1). Females comprised 64% of clients studied. Of the 183 indexed clients, 89% accepted the services and elicited 216 sexual partners for tracing. The ratio of elicited sexual partners to index client was 1.3:1. Out of the 216 sexual partners, 77% were reached and tested. A total of 46 [32%] of the sexual partners elicited and traced, tested HIV positive. The most preferred approaches were provider referral (51%) and contract referral (45%). Dual referral (4%) was the least preferred approach. CONCLUSIONS Assisted Partner notification services is acceptable and an effective strategy of increasing HIV case identification and raising awareness to exposed sexual partners in low resource countries.
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Affiliation(s)
- Rewel Mwangi Kariuki
- Department of Health, Murang'a County Government, P O Box 69, Muranga, 10200, Kenya.
| | - Gilbert Koome Rithaa
- College of Health Sciences, Mount Kenya University, P O Box 342, Thika, 01000, Kenya
| | - Elvis Omondi Oyugi
- Field Epidemiology & Laboratory Training Program (FELTP)-Kenya, P. O Box 30016, Nairobi, Kenya
| | - Daniel Muya Gachathi
- Department of Health, Murang'a County Government, P O Box 69, Muranga, 10200, Kenya
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Katz DA, Wong VJ, Medley AM, Johnson CC, Cherutich PK, Green KE, Huong P, Baggaley RC. The power of partners: positively engaging networks of people with HIV in testing, treatment and prevention. J Int AIDS Soc 2019; 22 Suppl 3:e25314. [PMID: 31321909 PMCID: PMC6639670 DOI: 10.1002/jia2.25314] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/15/2019] [Indexed: 01/09/2023] Open
Affiliation(s)
- David A Katz
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Vincent J Wong
- Global Health BureauOffice of HIV/AIDSUnited States Agency for International Development (USAID)WashingtonDCUSA
| | - Amy M Medley
- Division of Global HIV and TBCenter for Global HealthU.S. Centers for Disease Control and Prevention (CDC)AtlantaGAUSA
| | | | - Peter K Cherutich
- National AIDS/Sexually Transmitted Diseases Control ProgrammeMinistry of HealthNairobiKenya
| | | | - Phan Huong
- Vietnam Authority of HIV/AIDS Control, Ministry of HealthHanoiVietnam
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