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Kruger G, van der Borght EA, Teijema MT, van Furth MT. "I don't know if you have searched through the scriptures to find a reference on HIV/AIDS. I mean there isn't going to be one, right?": HIV stigma solutions from dialogues between faith leaders and health care workers. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:165-174. [PMID: 37905443 DOI: 10.2989/16085906.2023.2238687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/01/2023] [Indexed: 11/02/2023]
Abstract
In South African communities, both faith leaders and health care workers play a vital role in supporting the health of community members and people living with HIV in particular. This study describes HIV stigma when faith leaders and health care workers engaged in discourse. The study used a descriptive qualitative inquiry design. Data were gathered between 2015 and 2016 in the areas of Masiphumelele and Gugulethu in Cape Town, South Africa. Three themes emerged: (1) participants identified influences that can increase HIV stigma; (2) participants shared the challenges that they face to reduce HIV stigma; and (3) participants suggested solutions to reduce HIV stigma. Themes discussed include ground-level problems and practical solutions to address HIV stigma in faith communities. Collaboration between faith leaders and health care workers are vital resources in the fight against HIV stigma. Future research and interventions should aim to promote organised collaboration between faith communities and health care structures.
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Affiliation(s)
- Germari Kruger
- Faculty of Religion and Theology, Vrije Universiteit, Amsterdam, The Netherlands
- Unit for Reformational Theology and the Development of the South African Society, North-West University, Potchefstroom, South Africa
| | | | - Martha T Teijema
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marceline Tutu van Furth
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
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Ingabire C, Watnick D, Gasana J, Umwiza F, Munyaneza A, Kubwimana G, Murenzi G, Anastos K, Adedimeji A, Ross J. Experiences of stigma and HIV care engagement in the context of Treat All in Rwanda: a qualitative study. BMC Public Health 2023; 23:1817. [PMID: 37726734 PMCID: PMC10507909 DOI: 10.1186/s12889-023-16752-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 09/12/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND 'Treat All' policies recommending immediate antiretroviral therapy (ART) soon after HIV diagnosis for all people living with HIV (PLHIV) are now ubiquitous in sub-Saharan Africa. While early ART initiation and retention is effective at curtailing disease progression and transmission, evidence suggests that stigma may act as a barrier to engagement in care. This study sought to understand the relationships between HIV stigma and engagement in care for PLHIV in Rwanda in the context of Treat All. METHODS Between September 2018 and March 2019, we conducted semi-structured, qualitative interviews with adult PLHIV receiving care at two health centers in Kigali, Rwanda. We used a grounded theory approach to data analysis to develop conceptual framework describing how stigma influences HIV care engagement in the context of early Treat All policy implementation in Rwanda. RESULTS Among 37 participants, 27 (73%) were women and the median age was 31 years. Participants described how care engagement under Treat All, including taking medications and attending appointments, increased their visibility as PLHIV. This served to normalize HIV and use of ART but also led to high levels of anticipated stigma in the health center and community at early stages of treatment. Enacted stigma from family and community members and resultant internalized stigma acted as additional barriers to care engagement. Nonetheless, participants described how psychosocial support from care providers and family members helped them cope with stigma and promoted continued engagement in care. CONCLUSIONS Treat All policy in Rwanda has heightened the visibility of HIV at the individual and social levels, which has influenced HIV stigma, normalization, psychosocial support and care engagement in complex ways. Leveraging the individual and community support described by PLHIV to deliver evidence-based, peer or provider-delivered stigma reduction interventions may aid in attaining Treat All goals.
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Affiliation(s)
- Charles Ingabire
- Einstein-Rwanda Research and Capacity Building Program, Rwanda Military Hospital, Kigali, Rwanda.
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda.
| | - Dana Watnick
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Josephine Gasana
- Einstein-Rwanda Research and Capacity Building Program, Rwanda Military Hospital, Kigali, Rwanda
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Francine Umwiza
- Einstein-Rwanda Research and Capacity Building Program, Rwanda Military Hospital, Kigali, Rwanda
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Athanase Munyaneza
- Einstein-Rwanda Research and Capacity Building Program, Rwanda Military Hospital, Kigali, Rwanda
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Gallican Kubwimana
- Einstein-Rwanda Research and Capacity Building Program, Rwanda Military Hospital, Kigali, Rwanda
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Gad Murenzi
- Einstein-Rwanda Research and Capacity Building Program, Rwanda Military Hospital, Kigali, Rwanda
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jonathan Ross
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Sheinfil AZ, Foley JD, Moskal D, Dalton MR, Firkey M, Ramos J, Maisto SA, Woolf-King SE. Daily Associations Between Alcohol Consumption and Antiretroviral Therapy (ART) Adherence Among HIV-Positive Men Who Have Sex With Men. AIDS Behav 2022; 26:3153-3163. [PMID: 35362912 PMCID: PMC9474713 DOI: 10.1007/s10461-022-03657-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 01/02/2023]
Abstract
Alcohol consumption is one of the strongest predictors of suboptimal adherence to antiretroviral therapy (ART), however, there is little research that has investigated both within- and between-person associations of alcohol consumption and ART adherence at the event-level. In this secondary data-analysis, (N = 22) HIV-positive MSM prospectively reported daily alcohol consumption and ART adherence for 42-days. Multilevel models demonstrated (1) days in which participants reported consuming any alcohol was associated with 2.48 increased odds of ART non-adherence, compared to days in which participants reported no alcohol consumption, and (2) there was a non-significant trend indicating days in which participants reported consuming greater than their own average levels of alcohol was associated with increased odds of ART non-adherence. Findings highlight the importance of combining intervention efforts that address alcohol consumption and suboptimal ART adherence, and indicate a need for future research to investigate the mechanisms by which alcohol influences ART adherence.
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Affiliation(s)
- Alan Z Sheinfil
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244, Syracuse, NY, USA.
| | - Jacklyn D Foley
- Behavioral Medicine Program, Massachusetts General Hospital, Boston, USA
| | - Dezarie Moskal
- VA Center for Integrated Healthcare, VA WNY Healthcare System, New York, USA
| | - Michelle R Dalton
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244, Syracuse, NY, USA
| | - Madison Firkey
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244, Syracuse, NY, USA
| | - Jeremy Ramos
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244, Syracuse, NY, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244, Syracuse, NY, USA
| | - Sarah E Woolf-King
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244, Syracuse, NY, USA
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Ntombela NP, Kharsany ABM, Soogun A, Yende-Zuma N, Baxter C, Kohler HP, McKinnon LR. Viral suppression among pregnant adolescents and women living with HIV in rural KwaZulu-Natal, South Africa: a cross sectional study to assess progress towards UNAIDS indicators and Implications for HIV Epidemic Control. Reprod Health 2022; 19:116. [PMID: 35550580 PMCID: PMC9097174 DOI: 10.1186/s12978-022-01419-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/18/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND South Africa has made significant progress in scaling up antiretroviral therapy (ART) to achieve the aspirational goal of HIV epidemic control. The aim of this study was to determine the prevalence of HIV, assess progress towards each of the Joint United Nations Programme on HIV/AIDS (UNAIDS) indicators and determine factors associated with achieving viral suppression among pregnant adolescents and women living with HIV in rural KwaZulu-Natal, South Africa. METHODS Pregnant adolescents and women, 12 years and older seeking antenatal care at six primary health care clinics were enrolled in a cross-sectional study. Following written informed consent, structured questionnaires were administered, and finger-prick blood samples were collected for HIV antibody testing and viral load measurement. Viral suppression was defined as HIV viral load of < 400 copies per mL. RESULTS Between Dec 2016 and March 2017, among the 546 enrolled participants, data for 545 were analysed. The overall HIV prevalence was 40.2% [95% Confidence Interval (CI) 36.1-44.3]. Age-stratified prevalence increased from 22.1% (95% CI, 15.9-30.0) in the 14-19 year age group to 63.9% (95% CI, 55.1-71.9) among women ≥ 30 years (Χ2 trend P < 0.0001). Of the HIV positive participants, 84.5% (95% CI, 79.0-88.8) knew their HIV positive status, 98.3% (95% CI 95.1-99.4) who knew their status were on ART, and of those on ART, 95.9% (95% CI 91.8-98.0) were virally suppressed. Among all HIV-positives 90.8% (95% CI, 86.3-94.0) had achieved viral suppression, whilst those in the 14-19 year age group were least likely to be virally suppressed at 82.8% (95% CI 65.5-92.4) compared to those in the older age groups. Married women compared to those unmarried were more likely to have achieved viral suppression (PRR) of 1.11 (95% CI 1.05-1.18), P < 0.001. CONCLUSIONS The proportion of HIV positive pregnant women achieving viral suppression was encouraging though far short of the target towards achieving epidemic control. Importantly, adolescent pregnant women were less likely to know their HIV status and to achieve viral suppression, underscoring the public health implications of sustained risk of HIV transmission. Thus, greater effort and strong social support are essential to improve HIV knowledge of status and care continuum towards the goal to achieving HIV epidemic control. To "fast-track" the response to achieve HIV epidemic control and end the AIDS epidemic, the Joint United Nations Programme on HIV/AIDS (UNAIDS) set ambitious HIV testing and treatment targets for people living with HIV. Meeting these targets through scaling up testing for HIV, initiating and sustaining antiretroviral therapy (ART) to maintain viral suppression provides both therapeutic and preventive benefits with the potential to reduce HIV transmission. Viral suppression among pregnant adolescents and women living with HIV is crucial for the prevention of mother-to-child transmission of HIV including onward transmission to sexual partners. As a public health approach, in South Africa all pregnant women are offered routine HIV testing and immediate initiation of lifelong ART irrespective of CD4 cell count. It is, therefore, important to ascertain progress towards reaching the targets. The proportion of HIV positive pregnant adolescents and women achieving viral suppression was encouraging though far short of the target towards achieving epidemic control. Importantly, pregnant adolescents were less likely to know their HIV status and to achieve viral suppression, underscoring the public health implications of sustained risk of HIV transmission. Thus, greater effort and strong social support are essential to improve HIV knowledge of status and care continuum towards the goal to achieving HIV epidemic control.
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Affiliation(s)
- Nonzwakazi P Ntombela
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Congella, South Africa
| | - Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Congella, South Africa.
- 2nd Floor, Doris Duke Medical Research Institute, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, CAPRISA, University of KwaZulu-Natal, Private Bag 7, Congella, 4013, Durban, South Africa.
| | - Adenike Soogun
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Congella, South Africa
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Congella, South Africa
| | - Cheryl Baxter
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Congella, South Africa
- Current Affiliation for Dr Cheryl Baxter, Centre for Epidemic Response and Innovation (CERI), School for Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa
| | - Hans-Peter Kohler
- Population Studies Center, University of Pennsylvania, New York, USA
| | - Lyle R McKinnon
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Congella, South Africa
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
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Bogart LM, Shazi Z, MacCarthy S, Mendoza-Graf A, Wara NJ, Zionts D, Dube N, Govere S, Bassett IV. Implementation of South Africa's Central Chronic Medicine Dispensing and Distribution Program for HIV Treatment: A Qualitative Evaluation. AIDS Behav 2022; 26:2600-2612. [PMID: 35122215 PMCID: PMC8815398 DOI: 10.1007/s10461-022-03602-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 12/19/2022]
Abstract
We used the Practical, Robust Implementation and Sustainability Model to evaluate implementation of South Africa’s Central Chronic Medicine Dispensing and Distribution (CCMDD) program, a differentiated service delivery program which allows clinically stable HIV-positive patients to receive antiretroviral therapy refills at clinic- or community-based pick-up points. Across ten clinics, we conducted 109 semi-structured interviews with stakeholders (pick-up point staff, CCMDD service providers and administrators) and 16 focus groups with 138 patients. Participants had highly favorable attitudes and said CCMDD decreased stigma concerns. Patient-level barriers included inadequate education about CCMDD and inability to get refills on designated dates. Organizational-level barriers included challenges with communication and transportation, errors in medication packaging and tracking, rigid CCMDD rules, and inadequate infrastructure. Recommendations included: (1) provide patient education and improve communication around refills (at the patient level); (2) provide dedicated space and staff, and ongoing training (at the organizational/clinic level); and (3) allow for prescription renewal at pick-up points and less frequent refills, and provide feedback to clinics (at the CCMDD program level).
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Affiliation(s)
- Laura M Bogart
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - Zinhle Shazi
- AIDS Healthcare Foundation, Durban, South Africa
| | - Sarah MacCarthy
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
- Department of Health Behavior, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Nafisa J Wara
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Dani Zionts
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Nduduzo Dube
- AIDS Healthcare Foundation, Durban, South Africa
| | | | - Ingrid V Bassett
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Center for AIDS Research (CFAR), Harvard University, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Steward WT, Agnew E, de Kadt J, Ratlhagana MJ, Sumitani J, Gilmore HJ, Grignon J, Shade SB, Tumbo J, Barnhart S, Lippman SA. Impact of SMS and peer navigation on retention in HIV care among adults in South Africa: results of a three-arm cluster randomized controlled trial. J Int AIDS Soc 2021; 24:e25774. [PMID: 34435440 PMCID: PMC8387209 DOI: 10.1002/jia2.25774] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/10/2021] [Accepted: 07/08/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Few interventions have demonstrated improved retention in care for people living with HIV (PLHIV) in sub-Saharan Africa. We tested the efficacy of two personal support interventions - one using text messaging (SMS-only) and the second pairing SMS with peer navigation (SMS+PN) - to improve HIV care retention over one year. METHODS In a cluster randomized control trial (NCT# 02417233) in North West Province, South Africa, we randomized 17 government clinics to three conditions: SMS-only (6), SMS+PN (7) or standard of care (SOC; 4). Participants at SMS-only clinics received appointment reminders, biweekly healthy living messages and twice monthly SMS check-ins. Participants at SMS+PN clinics received SMS appointment reminders and healthy living messages and spoke at least twice monthly with peer navigators (PLHIV receiving care) to address barriers to care. Outcomes were collected through biweekly clinical record extraction and surveys at baseline, six and 12 months. Retention in HIV care over one year was defined as clinic visits every three months for participants on antiretroviral therapy (ART) and CD4 screening every six months for pre-ART participants. We used generalized estimating equations, adjusting for clustering by clinic, to test for differences across conditions. RESULTS Between October 2014 and April 2015, we enrolled 752 adult clients recently diagnosed with HIV (SOC: 167; SMS-only: 289; SMS+PN: 296). Individuals in the SMS+PN arm had approximately two more clinic visits over a year than those in other arms (p < 0.01) and were more likely to be retained in care over one year than those in SOC clinics (54% vs. 38%; OR: 1.77, CI: 1.02, 3.10). Differences between SMS+PN and SOC conditions remained significant when restricting analyses to the 628 participants on ART (61% vs. 45% retained; OR: 1.78, CI: 1.08, 2.93). The SMS-only intervention did not improve retention relative to SOC (40% vs. 38%, OR: 1.12, CI: 0.63, 1.98). CONCLUSIONS A combination of SMS appointment reminders with personalized, peer-delivered support proved effective at enhancing retention in HIV care over one year. While some clients may only require appointment reminders, the SMS+PN approach offers increased flexibility and tailored, one-on-one support for patients struggling with more substantive challenges.
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Affiliation(s)
- Wayne T Steward
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Emily Agnew
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Julia de Kadt
- International Training and Education Center for Health (I‐TECH)PretoriaRepublic of South Africa
| | - Mary Jane Ratlhagana
- International Training and Education Center for Health (I‐TECH)PretoriaRepublic of South Africa
| | - Jeri Sumitani
- International Training and Education Center for Health (I‐TECH)PretoriaRepublic of South Africa
| | - Hailey J Gilmore
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Jessica Grignon
- International Training and Education Center for Health (I‐TECH)PretoriaRepublic of South Africa
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- International Training and Education Center for Health (I‐TECH) South AfricaPretoriaRepublic of South Africa
| | - Starley B Shade
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCAUSA
- Institute for Global Health SciencesDepartment of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCAUSA
| | - John Tumbo
- Department of Family Medicine and Primary Health CareSefako Makgatho Health Sciences UniversityPretoriaRepublic of South Africa
| | - Scott Barnhart
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- International Training and Education Center for Health (I‐TECH) South AfricaPretoriaRepublic of South Africa
| | - Sheri A Lippman
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCAUSA
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