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Hoffmann CJ, Herce ME, Chimoyi L, Smith HJ, Tlali M, Olivier CJ, Topp SM, Muyoyeta M, Reid SE, Hausler H, Charalambous S, Fielding K. Reaching for 90:90:90 in Correctional Facilities in South Africa and Zambia: Virtual Cross-Section of Coverage of HIV Testing and Antiretroviral Therapy During Universal Test and Treat Implementation. J Acquir Immune Defic Syndr 2024; 96:465-471. [PMID: 38985444 DOI: 10.1097/qai.0000000000003456] [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: 01/30/2024] [Accepted: 04/11/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND People in correctional settings are a key population for HIV epidemic control. We sought to demonstrate scale-up of universal test and treat in correctional facilities in South Africa and Zambia through a virtual cross-sectional analysis. METHODS We used routine data on 2 dates: At the start of universal test and treat implementation (time 1, T1) and 1 year later (time 2, T2). We obtained correctional facility census lists for the selected dates and matched HIV testing and treatment data to generate virtual cross-sections of HIV care continuum indicators. RESULTS In the South African site, there were 4193 and 3868 people in the facility at times T1 and T2; 43% and 36% were matched with HIV testing or treatment data, respectively. At T1 and T2, respectively, 1803 (43%) and 1386 (36%) had known HIV status, 804 (19%) and 845 (21%) were known to be living with HIV, and 60% and 56% of those with known HIV were receiving antiretroviral therapy (ART). In the Zambian site, there were 1467 and 1366 people in the facility at times T1 and T2; 58% and 92% were matched with HIV testing or treatment data, respectively. At T1 and T2, respectively, 857 (59%) and 1263 (92%) had known HIV status, 277 (19%) and 647 (47%) were known to be living with HIV, and 68% and 68% of those with known HIV were receiving ART. CONCLUSIONS This virtual cross-sectional analysis identified gaps in HIV testing coverage, and ART initiation that was not clearly demonstrated by prior cohort-based studies.
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Affiliation(s)
- Christopher J Hoffmann
- Department of Medicine, Johns Hopkins University, Baltimore, MD
- The Aurum Institute, Johannesburg, South Africa
| | - Michael E Herce
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC
| | | | - Helene J Smith
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Mpho Tlali
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Stephanie M Topp
- College of Public Health Medicine and Veterinary Sciences, James Cook University, Townsville, Australia
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Stewart E Reid
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Department of Family Medicine, School of Medicine, University of Pretoria, Pretoria, South Africa; and
| | - Harry Hausler
- TB HIV Care, Cape Town, South Africa
- Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Katherine Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Posner J, Ndhlovu AP, Musangulule JM, Duffy M, Casella A, Madevu-Matson C, Davis N, Sharer M. Evaluating the Preliminary Effectiveness of the Person-Centered Care Assessment Tool (PCC-AT) in Zambian Health Facilities: Protocol for a Mixed Methods Cross-Sectional Study. JMIR Res Protoc 2024; 13:e54129. [PMID: 39042423 PMCID: PMC11303880 DOI: 10.2196/54129] [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: 10/30/2023] [Revised: 05/16/2024] [Accepted: 06/10/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Person-centered care (PCC) within HIV treatment services has demonstrated potential to overcome inequities in HIV service access while improving treatment outcomes. Despite PCC being widely considered a best practice, no consensus exists on its assessment and measurement. This study in Zambia builds upon previous research that informed development of a framework for PCC and a PCC assessment tool (PCC-AT). OBJECTIVE This mixed methods study aims to examine the preliminary effectiveness of the PCC-AT through assessing the association between client HIV service delivery indicators and facility PCC-AT scores. We hypothesize that facilities with higher PCC-AT scores will demonstrate more favorable HIV treatment continuity, viral load (VL) coverage, and viral suppression in comparison to those of facilities with lower PCC-AT scores. METHODS We will implement the PCC-AT at 30 randomly selected health facilities in the Copperbelt and Central provinces of Zambia. For each study facility, data will be gathered from 3 sources: (1) PCC-AT scores, (2) PCC-AT action plans, and (3) facility characteristics, along with service delivery data. Quantitative analysis, using STATA, will include descriptive statistics on the PCC-AT results stratified by facility characteristics. Cross-tabulations and/or regression analysis will be used to determine associations between scores and treatment continuity, VL coverage, and/or viral suppression. Qualitative data will be collected via action planning, with detailed notes collected and recorded into an action plan template. Descriptive coding and emerging themes will be analyzed with NVivo software. RESULTS As of May 2024, we enrolled 29 facilities in the study and data analysis from the key informant interviews is currently underway. Results are expected to be published by September 2024. CONCLUSIONS Assessment and measurement of PCC within HIV treatment settings is a novel approach that offers HIV treatment practitioners the opportunity to examine their services and identify actions to improve PCC performance. Study results and the PCC-AT will be broadly disseminated for use among all project sites in Zambia as well as other HIV treatment programs, in addition to making the PCC-AT publicly available to global HIV practitioners. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54129.
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Affiliation(s)
- Jessica Posner
- International Division, JSI, Arlington, VA, United States
| | | | | | - Malia Duffy
- Health Across Humanity, LLC, Boston, MA, United States
- Department of Public Health, St. Ambrose University, Davenport, IA, United States
| | - Amy Casella
- International Division, JSI, Arlington, VA, United States
| | | | - Nicole Davis
- International Division, JSI, Arlington, VA, United States
| | - Melissa Sharer
- International Division, JSI, Arlington, VA, United States
- Department of Public Health, St. Ambrose University, Davenport, IA, United States
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Zulu JM, Budhwani H, Wang B, Menon A, Kim D, Zulu M, Nyamaruze P, Govender K, Armstrong R. Living a private lie: intersectional stigma, depression and suicidal thoughts for selected young key populations living with HIV in Zambia. BMC Public Health 2024; 24:1937. [PMID: 39030515 PMCID: PMC11264630 DOI: 10.1186/s12889-024-19278-z] [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: 02/17/2024] [Accepted: 06/26/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Limited research has been conducted on the forms, manifestations and effects of intersectional stigma among young HIV-positive men who have sex with men (MSM) and transgender women (TGW) in Zambia. In this study, we aimed to address this gap by elucidating the experiences of these in a small group of young, HIV + MSM and TGW in Zambia. METHODS We applied a mixed-methods design. Data were collected from January 2022 to May 2022. Qualitative data were collected using in-depth interviews while quantitative data were collected using a questionnaire. Qualitative transcripts were coded using thematic analysis while paper-based questionnaire data were entered into Kobo Connect. Descriptive statistics, using chi-squared tests were calculated using Excel. In this paper, we provide a descriptive profile of the sample and then focus on the qualitative findings on intersectional stigma, depression, and contemplation of suicide. RESULTS We recruited 56 participants from three sites: Lusaka, Chipata, and Solwezi districts. Participants' mean age was 23 years. The study found that 36% of all participants had moderate to significant symptoms of depression, 7% had major depression, 30% had moderate signs of anxiety, 11% had high signs of anxiety, 4% had very high signs of anxiety and 36% had contemplated suicide at least once. A greater proportion of TGW had moderate to significant symptoms of depression (40%) or major depression (10%) compared to MSM, at 33% and 6%, respectively (X2 = 0.65; p = 0.42). Similarly, more TGW (55%) had contemplated suicide than MSM peers (36%, X2=1.87; p = 0.17). In the qualitative data, four emergent themes about the forms, manifestations, and effects of intersectional stigma were (1) HIV, sexual orientation, and gender identity disclosure; (2) Dual identity; (3) Challenges of finding and maintaining sexual partners; (4) Coping and resilience. Overall, having to hide both one's sexuality and HIV status had a compounding effect and was described as living "a private lie." CONCLUSION Effectively addressing stigmas and poor mental health outcomes among young HIV-positive MSM and TGW will require adopting a socio-ecological approach that focuses on structural interventions, more trauma-informed and identity-supportive care for young people with HIV, as well as strengthening of authentic community-informed public health efforts.
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Affiliation(s)
- Joseph Mumba Zulu
- Department of Health Policy and Management, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
- Center for Community Health Systems and Implementation Research, Lusaka, Zambia.
| | - Henna Budhwani
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, UMass Chan Medical, School 368 Plantation Street, Worcester, MA, 01605, US
| | - Anitha Menon
- Department of Psychology, School of Humanities and Social Sciences, University of Zambia, Box 32379, Lusaka, Zambia
- Psychology Program, School of Liberal Studies, University of Petroleum and Energy Sciences, Dehradun, India
- Liberal Arts Department, Rochester Institute of Technology, Dubai, UAE
| | - Deogwoon Kim
- Department of Population and Quantitative Health Sciences, UMass Chan Medical, School 368 Plantation Street, Worcester, MA, 01605, US
| | - Mirriam Zulu
- Department of Health Policy and Management, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia
| | - Patrick Nyamaruze
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Kaymarlin Govender
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Russell Armstrong
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
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Scaramutti C, Hervera B, Rivera Y, Chueng TA, Forrest DW, Suarez E, Serota DP, Alkamli H, Ciraldo K, Bartholomew TS, Tookes HE. Improving access to HIV care among people who inject drugs through tele-harm reduction: a qualitative analysis of perceived discrimination and stigma. Harm Reduct J 2024; 21:50. [PMID: 38396017 PMCID: PMC10893685 DOI: 10.1186/s12954-024-00961-8] [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: 05/04/2023] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Tele-harm reduction (THR) is a telehealth-enhanced, peer-led, harm reduction intervention delivered within a trusted syringe services program (SSP) venue. The primary goal of THR is to facilitate linkage to care and rapid, enduring virologic suppression among people who inject drugs (PWID) with HIV. An SSP in Miami, Florida, developed THR to circumvent pervasive stigma within the traditional healthcare system. METHODS During intervention development, we conducted in-depth interviews with PWID with HIV (n = 25) to identify barriers and facilitators to care via THR. We employed a general inductive approach to transcripts guided by iterative readings of the raw data to derive the concepts, themes, and interpretations of the THR intervention. RESULTS Of the 25 PWID interviewed, 15 were in HIV care and adherent to medication; 4 were in HIV care but non-adherent; and 6 were not in care. Themes that emerged from the qualitative analysis included the trust and confidence PWID have with SSP clinicians as opposed to professionals within the traditional healthcare system. Several barriers to treatment were reported among PWID, including perceived and actual discrimination by friends and family, negative internalized behaviors, denial of HIV status, and fear of engaging in care. Facilitators to HIV care included empathy and respect by SSP staff, flexibility of telehealth location, and an overall destigmatizing approach. CONCLUSION PWID identified barriers and facilitators to receipt of HIV care through the THR intervention. Interviews helped inform THR intervention development, centered on PWID in the destigmatizing environment of an SSP.
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Affiliation(s)
- Carolina Scaramutti
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Belén Hervera
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yanexy Rivera
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Teresa A Chueng
- 2Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David W Forrest
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Edward Suarez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David P Serota
- 2Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hatoun Alkamli
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katrina Ciraldo
- Department of Family and Community Medicine & Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hansel E Tookes
- 2Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Li C, Zhao P, Tan RKJ, Wu D. Community engagement tools in HIV/STI prevention research. Curr Opin Infect Dis 2024; 37:53-62. [PMID: 38050762 DOI: 10.1097/qco.0000000000000993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
PURPOSE OF REVIEW Community engagement is key to the success of sustainable public health interventions. This review highlights recent published studies that describe the use of community-engaged methods in sexually transmitted infection (STI) prevention research. RECENT FINDINGS We organized the findings using a socio-ecological model. At the individual level, communities were engaged through participation in formative research, short-term consultations and community advisory board participation, as well as co-creation activities. At the interpersonal level, studies reviewed described peer-led interventions that leverage the influence and guidance of peers, patient-led interventions in the form of patient navigation and notification, as well as those that mobilize social networks and the power of social relationships to promote health. At the organizational and community level, multisectoral, multifacility collaborations between community, government, and academic stakeholders were highlighted. At the policy and population level, communities were engaged through community dialogues to disseminate research findings, as well as in developing strategic frameworks and clinical guidelines. Digital tools have also been leveraged for effective community engagement. SUMMARY Communities have an effective role to play in STI prevention and can be engaged at multiple levels. Future efforts may consider the use of community engagement tools highlighted in this review, including digital technologies that have the potential to reach more diverse end-users.
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Affiliation(s)
- Chunyan Li
- Tokyo College, The University of Tokyo, Tokyo, Japan
- The University of North Carolina Project China, Guangzhou, China
| | - Peipei Zhao
- Jane Addams College of Social Work, University of Illinois, Chicago, Illinois, USA
| | - Rayner K J Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Dan Wu
- Department of Social Medicine and Health Education, School of Public Health of Nanjing Medical University, Nanjing, China
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Ossomba JPBE, Ngangue P, Ekani ASO, Kamgain ET. De-medicalized and decentralized HIV testing: a strategy to test hard-to-reach men who have sex with men in Cameroon. Front Public Health 2023; 11:1180813. [PMID: 37564422 PMCID: PMC10410143 DOI: 10.3389/fpubh.2023.1180813] [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: 03/13/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Conventional HIV testing performed by a health professional has shown its limitations in targeting marginalized and vulnerable populations. Indeed, men who have sex with men (MSM) due to social discrimination are often uncomfortable using this service at the health facilities level. In this perspective, new differentiated approaches have been thought through de-medicalized and decentralized HIV testing (DDHT). This HIV testing strategy enables overcoming the structural, legal, and social barriers that prevent these populations from quickly accessing HIV services. This article discusses the prerequisites and added value of implementing this strategy for MSM living in a criminalized context and its implication in decentralizing health services toward the community level.
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Bolo A, Ochira P, Hakim AJ, Katoro J, Bunga S, Lako R, Anib V, Arkangelo GC, Lobojo BN, Okiria AG. Limited awareness of HIV Status hinders uptake of treatment among female sex workers and sexually exploited adolescents in Wau and Yambio, South Sudan. BMC Public Health 2023; 23:692. [PMID: 37059971 PMCID: PMC10103365 DOI: 10.1186/s12889-023-15593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 04/03/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Several factors determine uptake of HIV testing services (HTS) by female sex workers (FSW), including their knowledge of HIV and their awareness of services supporting people who are HIV-positive. HTS provided entry into the UNAIDS 90-90-90 cascade of care. We conducted a cross-sectional biobehavioural survey (BBS) to determine HIV prevalence and progress towards UNAIDS 90-90-90 cascade targets among this population in South Sudan. METHODS Respondent-driven sampling (RDS) was used to recruit women and sexually exploited girls aged 13-18 years who exchanged sex for goods or money in the past 6 months and resided in the town for at least 1 month. Consenting participants were interviewed and tested for HIV and, if positive, they were also tested for their viral load (VL). Data were weighted in RDS Analyst and analyzed with Stata 13. RESULTS A total of 1,284 participants were recruited. The overall HIV cascade coverages were 64.8% aware of their HIV-positive status; 91.0% of those aware of their positive status were on ART; and VL suppression among those on ART was 93.0%. CONCLUSION Being unaware of their HIV-positive status limits, the uptake of HIV treatment among FSW in South Sudan. This underscores the importance of optimized case-finding approaches to increase HTS among FSW and sexually exploited minors.
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Affiliation(s)
- Alex Bolo
- Division of Global HIV and TB (DGHT), United States Centers for Disease Control and Prevention, Juba, South Sudan.
| | | | - Avi J Hakim
- United States Centers for Disease Control and Prevention, DGHT, Atlanta, GA, USA
| | - Joel Katoro
- Division of Global HIV and TB (DGHT), United States Centers for Disease Control and Prevention, Juba, South Sudan
| | - Sudhir Bunga
- Division of Global HIV and TB (DGHT), United States Centers for Disease Control and Prevention, Juba, South Sudan
| | - Richard Lako
- South Sudan Ministry of Health, Juba, South Sudan
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