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Mubiana-Mbewe M, Bosomprah S, Saroj RK, Kadota J, Koyuncu A, Thankian K, Vinikoor MJ. Development and validation of a novel scale for antiretroviral therapy readiness among pregnant women in urban Zambia with newly diagnosed HIV infection. AIDS Res Ther 2023; 20:21. [PMID: 37024961 PMCID: PMC10080880 DOI: 10.1186/s12981-023-00509-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: 06/03/2022] [Accepted: 02/28/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Women who are newly diagnosed with HIV infection during pregnancy may not be ready to immediately initiate lifelong antiretroviral therapy (ART; called Option B +) as is recommended. Lack of "readiness" drives early disengagement from care and undermines prevention of HIV transmission to infants. Several studies have shown high early attrition of women initiating ART in pregnancy. Although poor ART uptake and adherence have been attributed to various factors including stigma, disclosure issues and structural issues, there is no standard way of determining which pregnant woman will face challenges and therefore need additional support. We developed and validated a novel ART readiness tool in Lusaka, Zambia. METHODS The aim of this study was to develop and validate a tool that could be used to assess how ready a newly diagnosed pregnant woman living with HIV would be to initiate ART on the day of diagnosis. Using a mixed method design, we conducted this study in three public-setting health facilities in Lusaka, Zambia. Informed by qualitative research and literature review, we identified 27 candidate items. We assessed content validity using expert and target population judgment approaches. We administered the 27-item questionnaire to 454 newly diagnosed pregnant women living with HIV, who were enrolled into a randomized trial (trials number NCT02459678). We performed item reduction analysis and used Cronbach's alpha coefficient of 0.70 as threshold for reliability. RESULTS A total of 454 pregnant women living with HIV enrolled in the study between March 2017 and December 2017; 452 had complete data for analysis. The correlation coefficient between the 27 items on the completed ART readiness scale ranged from 0.31 to 0.70 while item discrimination index ranged from -0.01 to 2.38. Sixteen items were selected for the final scale, representing three domains, which we classified as "internalized and anticipated HIV stigma", "partner support" and "anticipated structural barriers". CONCLUSION We developed and validated a tool that could be used to assess readiness of newly diagnosed women living with HIV to initiate ART. This ART readiness tool could allow clinics to tailor limited resources to pregnant women living with HIV needing additional support to initiate and remain on ART.
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Affiliation(s)
- Mwangelwa Mubiana-Mbewe
- Centre for Infectious Diseases Research in Zambia, Plot 34620 Off Alick Nkhata Road, P.O. Box 34681, Lusaka, Zambia.
| | - Samuel Bosomprah
- Centre for Infectious Diseases Research in Zambia, Plot 34620 Off Alick Nkhata Road, P.O. Box 34681, Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Rakesh Kumar Saroj
- School of Computational and Integrative Sciences, Jawaharlal Nehru University, New Delhi, 110067, India
| | - Jillian Kadota
- UCSF Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Aybuke Koyuncu
- Department of Epidemiology, Johns Hopkins University, Maryland, USA
| | | | - Michael J Vinikoor
- Centre for Infectious Diseases Research in Zambia, Plot 34620 Off Alick Nkhata Road, P.O. Box 34681, Lusaka, Zambia
- Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
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Mutambanengwe-Jacob MT, Maponga CC, Amico KR, Ngara B, Yende-Zuma N, Chawana TD, Nematadzira T, Gumbo JF, Goverayi T, Matibe P, Malunda BV, Aizire J, Taha TE, Fowler MG, Stranix-Chibanda L. Impact of Motivational Enhanced Adherence Counseling and Point-of-Care Viral Load Monitoring on Viral Load Outcome in Women on Life-Long ART: A Randomized Pilot Study. AIDS Res Treat 2022; 2022:4887202. [PMID: 36105074 PMCID: PMC9467808 DOI: 10.1155/2022/4887202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/13/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
We piloted the combined effectiveness of point-of-care viral load monitoring plus motivational enhanced adherence counseling (intervention) compared with routine care (control) in women identified at risk of virologic failure in the PROMOTE study in Zimbabwe. In an unblinded randomized study, consenting women with last viral load ≥200 copies/ml and/or pill count outside 90-110% range were randomized 1 : 1 to receive the intervention or continue routine care, comprising laboratory-based VL monitoring and standard EAC, from trained nurses and counsellors. Viral load was measured 0, 3, 6, and 12 months after enrolment. We compared viral suppression <200 copies/ml at 6 and 12 months between the arms through Fisher's exact test and sought associated factors by logistic regression with a 95% confidence interval (CI). Between December 2018 and July 2019, 50 women were enrolled (25 intervention and 25 controls) and followed until November 2020. At entry, 60% of the women were virally suppressed, 52% intervention vs. 68% control arm. Viral suppression was balanced between the two arms (p value = 0.248). At month 6 post study entry (primary endpont), 64% of the women retained in care were virally suppressed, 54% intervention vs. 76% control arm (p value = 0.124). At month12 post study entry (secondary endpoint), 69% of the women retained in care were virally suppressed, 67% intervention vs. 71% control arm women (p value = 0.739). More intervention women completed all scheduled sessions by month 6. Control group women were more likely to be virally suppressed at both timepoints. Only 25% had treatment switch by 12 months. Despite intense adherence support and viral load monitoring, sustained viral suppression remained elusive in women identified at risk of viral failure. These findings highlight the continued need for effective adherence intervention for women with unsuppressed HIV viral loads, efficient treatment switch strategies, as well as drug level monitoring.
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Affiliation(s)
- Mercy T. Mutambanengwe-Jacob
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Charles C. Maponga
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Bernard Ngara
- Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Program of Research in South Africa (CAPRISA), Durban, South Africa
| | - Tariro D. Chawana
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | | | - Justice F. Gumbo
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Tendayi Goverayi
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Petronella Matibe
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | | | - Jim Aizire
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Taha E. Taha
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary G. Fowler
- Department of Pathology, The Johns Hopkins Medicine, Baltimore, MD, USA
| | - Lynda Stranix-Chibanda
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
- Child and Adolescent Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Williams V, Edem B, Calnan M, Otwombe K, Okeahalam C. Considerations for Establishing Successful Coronavirus Disease Vaccination Programs in Africa. Emerg Infect Dis 2021; 27:2009-2016. [PMID: 34138694 PMCID: PMC8314831 DOI: 10.3201/eid2708.203870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The accelerated development of coronavirus disease (COVID-19) candidate vaccines is intended to achieve worldwide immunity. Ensuring COVID-19 vaccination is crucial to stemming the pandemic, reclaiming everyday life, and helping restore economies. However, challenges exist to deploying these vaccines, especially in resource-limited sub-Saharan Africa. In this article, we highlight lessons learned from previous efforts to scale up vaccine distribution and offer considerations for policymakers and key stakeholders to use for successful COVID-19 vaccination rollout in Africa. These considerations range from improving weak infrastructure for managing data and identifying adverse events after immunization to considering financing options for overcoming the logistical challenges of vaccination campaigns and generating demand for vaccine uptake. In addition, providing COVID-19 vaccination can be used to promote the adoption of universal healthcare, especially in sub-Saharan Africa countries.
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Mukose AD, Bastiaens H, Makumbi F, Buregyeya E, Naigino R, Musinguzi J, Van Geertruyden JP, Wanyenze RK. What influences uptake and early adherence to Option B+ (lifelong antiretroviral therapy among HIV positive pregnant and breastfeeding women) in Central Uganda? A mixed methods study. PLoS One 2021; 16:e0251181. [PMID: 33951109 PMCID: PMC8099116 DOI: 10.1371/journal.pone.0251181] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 04/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background High uptake and optimal adherence to Option B+ antiretroviral therapy (ART) increase effectiveness in averting mother-to-child transmission of HIV. Option B+ ART uptake, early adherence, and associated factors need to be evaluated in Central Uganda. Methods A mixed approaches study was carried out in six health facilities in Masaka, Mityana, and Luwero districts from October 2013 to February 2016. Questionnaires were administered to 507 HIV positive pregnant females seeking antenatal care services. Key informant interviews were conducted with 54 health providers, and in-depth interviews (IDIs) with 57 HIV positive women on Option B+ ART. Quantitative data were analyzed using log-binomial regression model to determine factors associated with optimal adherence (taking at least 95% of the prescribed ART), while thematic analysis was used on qualitative data. Results Ninety one percent of women (463/507) received a prescription of life long ART. Of these, 93.3% (432/463) started swallowing their medicines. Overall, 83% of women who received ART prescriptions (310/374) felt they were ready to initiate ART immediately. Main motivating factors to swallow ART among those who received a prescription were women’s personal desire to be healthy (92.3%) and desire to protect their babies (90.6%). Optimal adherence to ART was achieved by 76.8% (315/410). Adherence was higher among females who were ready to start ART (adj. PR = 3.20; 95% CI: 1.15–8.79) and those who had revealed their HIV positive result to someone (adj. PR = 1.23; 95% CI: 1.04–1.46). Facilitators of ART uptake from qualitative findings included adequate counseling, willingness to start, and knowing the benefits of ART. Reasons for refusal to start ART included being unready to start ART, fear to take ART for life, doubt of HIV positive results, and preference for local herbs. Reasons for non-adherence were travelling far away from health facilities, fear of side effects, non-disclosure of HIV results to anyone, and perception that the baby is safe from HIV infection post-delivery. Conclusions Uptake of Option B+ ART was very high. However, failure to start swallowing ART and sub-optimal adherence are a major public health concern. Enhancing women’s readiness to start ART and encouraging HIV result revelation could improve ART uptake and adherence.
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Affiliation(s)
- Aggrey David Mukose
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Global Health Institute, Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Hilde Bastiaens
- Global Health Institute, Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Esther Buregyeya
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rose Naigino
- Makerere University School of Public Health, Kampala, Uganda
| | | | - Jean-Pierre Van Geertruyden
- Global Health Institute, Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Enríquez Canto Y, Díaz Gervasi GM, Menacho Alvirio LA. Impacto del Programa TARGA en la disminución de casos de sida en el sistema de salud peruano, 1983-2018. Rev Panam Salud Publica 2020; 44:e27. [PMID: 32341690 PMCID: PMC7178554 DOI: 10.26633/rpsp.2020.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Evaluar el impacto del programa de terapia antirretroviral de gran actividad (TARGA) en la disminución de casos estadio sida en Perú en el período 1983-2018. Métodos. Experimento natural con diseño de series de tiempo interrumpidas durante un período de 36 años. Se analizaron los casos de sida según el año de diagnóstico y la política de acceso universal a la terapia con antirretrovirales del año 2004. Se emplearon datos agregados del Centro Nacional de Epidemiología, Prevención y Control de Enfermedades de 1983 al 2018. Se utilizó la regresión logarítmica lineal y se evaluó el Programa TARGA con un modelo autorregresivo integrado de media móvil (ARIMA, por sus siglas en inglés), a fin de realizar un pronóstico del número esperado de casos anuales de sida, y mediante series de tiempo interrumpidas. Resultados. Entre 2004 y 2018 hubo un decremento anual de 2,60% de casos (intervalo de confianza del 95% [IC95%]: -3,9 - 1,2). El mejor modelo ARIMA identificado tuvo los componentes: (8, 3, 1). El pronóstico arrojó un total de 32 709 nuevos casos de sida para este período, con una prevención estimada de 10 280 casos. El análisis de series de tiempo arrojó una disminución anual de 134,21 (IC 95%: -160 - -108,60) casos. Conclusiones. Los hallazgos evidenciaron un aumento sustancial en los casos de sida durante el período 1983-2004, con una reducción significativa posterior a la implementación del Programa TARGA. El programa se confirma como una intervención efectiva para la prevención del número de casos de sida, permite el acceso universal a la terapia con antirretrovirales y otorga otros servicios como pruebas de monitoreo, consejería psicológica y el fomento de la adherencia al tratamiento en las personas que viven con VIH-sida.
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