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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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Annor F, Nartey YA, Abbew ET, Cudjoe O, Ayisi-Addo S, Ashinyo A, Obiri-Yeboah D. Human immunodeficiency virus care and management in incarcerated populations in Sub-Saharan Africa between 2010 and 2022: A narrative review. Int J STD AIDS 2024; 35:80-95. [PMID: 37793133 DOI: 10.1177/09564624231205335] [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] [Indexed: 10/06/2023]
Abstract
BACKGROUND Different countries in sub-Saharan Africa (SSA) have established guidelines to reduce HIV transmission and improve its management in prisons. This narrative review aimed to examine established literature on HIV care and management among incarcerated persons in SSA to identify successful interventions that could inform improved guidelines, policies, and practices related to the clinical care of this population. METHODS We searched PubMed, Scopus, Web of Science, Embase, and TRIP Medical Databases in August 2022 for articles published between 1st January 2010 and 30th June 2022. We identified 27 eligible articles based on the Population/Concept/Context framework. RESULTS HIV screening primarily involved mass campaigns rather than formal prison programmes, with limited implementation of universal testing and treatment. Although a few studies reported on access to antiretrovirals (ARVs), prisoners in urban areas and females had disproportionate access. Barriers identified include poor living conditions, high levels of stigma, and resource constraints. Inter-prison transfers, release from prison, and lack of established programmes hindered follow-up and linkage to care. CONCLUSIONS The implementation of strategies such as universal testing and treatment, human resource strengthening, financing plans for testing, ARV care, and frequent assessment of risk could improve HIV care and management in prisons in SSA.
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Affiliation(s)
- Francis Annor
- Directorate of Research, Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana
| | - Yvonne Ayerki Nartey
- Department of Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Department of Internal Medicine and Therapeutics, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Elizabeth Tabitha Abbew
- Department of Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerpen, Belgium
| | - Obed Cudjoe
- Department of Medical Laboratory Science, University of Cape Coast, Cape Coast, Ghana
| | - Stephen Ayisi-Addo
- National AIDS/STI Control Program of the Ghana Health Service, Accra, Ghana
| | - Anthony Ashinyo
- National AIDS/STI Control Program of the Ghana Health Service, Accra, Ghana
| | - Dorcas Obiri-Yeboah
- Directorate of Research, Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
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Chen Y, Cao Z, Li J, Chen J, Zhu Q, Liang S, Lan G, Xing H, Liao L, Feng Y, Shao Y, Ruan Y, Chen H. HIV transmission and associated factors under the scale-up of HIV antiretroviral therapy: a population-based longitudinal molecular network study. Virol J 2023; 20:289. [PMID: 38049910 PMCID: PMC10696835 DOI: 10.1186/s12985-023-02246-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/19/2023] [Indexed: 12/06/2023] Open
Abstract
OBJECTIVES To evaluate the prevention efficacy of scaling up HIV/AIDS antiretroviral therapy (ART) on HIV transmission at the population level and determine associated factors of HIV secondary transmission. METHODS We used HIV longitudinal molecular networks to assess the genetic linkage between baseline and newly diagnosed cases. A generalized estimating equation was applied to determine the associations between demographic, clinical characteristics and HIV transmission. RESULTS Patients on ART had a 32% lower risk of HIV transmission than those not on ART. A 36% reduction in risk was also seen if ART-patients maintained their HIV viral load lower than 50 copies/mL. A 71% lower risk occurred when patients sustained ART for at least 3 years and kept HIV viral load less than 50 copies/mL. Patients who discontinued ART had a similar HIV transmission risk as those not on ART. Patients who were older, male, non-Han, not single, retired, infected via a heterosexual route of transmission and those who possessed higher CD4 counts had a higher risk of HIV transmission. HIV-1 subtype of CRF01_AE was less transmissible than other subtypes. CONCLUSIONS The efficacy of ART in a real-world setting was supported by this longitudinal molecular network study. Promoting adherence to ART is crucial to reduce HIV transmission.
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Affiliation(s)
- Yi Chen
- The People's Hospital of Guangxi Zhuang Autonomous Region and Guangxi Academy of Medical Sciences, Nanning, 530021, China
| | - Zhiqiang Cao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, 102206, China
| | - Jianjun Li
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Jin Chen
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, 102206, China
| | - Qiuying Zhu
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Shujia Liang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Guanghua Lan
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China
| | - Hui Xing
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, 102206, China
| | - Lingjie Liao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, 102206, China
| | - Yi Feng
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, 102206, China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, 102206, China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, 102206, China.
| | - Huanhuan Chen
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, 530028, China.
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Levano SR, Epting ME, Pluznik JA, Philips V, Riback LR, Zhang C, Aseffa B, Kapadia AR, Bowden CJ, Jordan B, O’Donovan E, Spaulding AC, Akiyama MJ. HIV testing in jails: Comparing strategies to maximize engagement in HIV treatment and prevention. PLoS One 2023; 18:e0286805. [PMID: 37352306 PMCID: PMC10289455 DOI: 10.1371/journal.pone.0286805] [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: 07/19/2022] [Accepted: 05/23/2023] [Indexed: 06/25/2023] Open
Abstract
Despite 15,000 people enter US jails yearly with undiagnosed HIV infection, routine HIV testing is not standard. Maximizing the yield and speed of HIV testing in short-term detention facilities could promote rapid entry or re-entry of people living with HIV (PLWH) into care. The goal of this study was to evaluate the impact of third generation, rapid point-of-care (rPOC) vs. fourth generation, laboratory-based antigen/antibody (LBAg/Ab) testing on the HIV care cascade in a large urban jail during a planned transition. We used aggregate historical data to compare rPOC testing and LBAg/Ab testing in the D.C. Department of Corrections. We examined two time periods, January to August 2019 when rPOC testing was performed, and October 2019 to January 2020 after LBAg/Ab testing began. We calculated monthly rates of HIV tests performed, HIV test results received, HIV test results received among those tested, antiretroviral therapy (ART) initiation, and proportion of PLWH receiving discharge planning prior to release. We then conducted an interrupted time series analysis to assess the differences between testing periods. There were 14,237 entrants during the first time period and 7,569 entrants during the second. Transitioning from rPOC to LBAg/Ab testing increased the rate of test uptake by 38.5% (95% CI: 14.0, 68.3), decreased the rate of test results received among those tested by 13.1% (95% CI: -14.0, -12.1), and increased the combined rate of HIV tests performed and results received by 20.4% (95% CI: 1.5, 42.8). Although the rate of HIV testing was greater under LBAg/Ab, PLWH received results immediately through rPOC testing, which is critically important in short-stay enviroments. Increasing rPOC uptake would increase its value and combined testing may maximize the detection of HIV and receipt of results among persons passing through jails.
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Affiliation(s)
- Samantha R. Levano
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Mallory E. Epting
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Jacob A. Pluznik
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Victoria Philips
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Lindsey R. Riback
- Divisions of General Internal Medicine & Infectious Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Chenshu Zhang
- Divisions of General Internal Medicine & Infectious Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Binyam Aseffa
- D.C Department of Corrections, Washington, D.C., United States of America
| | - Aman R. Kapadia
- Unity Health Care, Washington, D.C., United States of America
| | - Chava J. Bowden
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Beth Jordan
- D.C Department of Corrections, Washington, D.C., United States of America
| | - Eleni O’Donovan
- Unity Health Care, Washington, D.C., United States of America
| | - Anne C. Spaulding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Matthew J. Akiyama
- Divisions of General Internal Medicine & Infectious Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
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Smith HJ, Herce ME, Mwila C, Chisenga P, Yenga C, Chibwe B, Mai V, Kashela L, Nanyagwe M, Hatwiinda S, Moonga CN, Musheke M, Lungu Y, Sikazwe I, Topp SM. Experiences of Justice-Involved People Transitioning to HIV Care in the Community After Prison Release in Lusaka, Zambia: A Qualitative Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00444. [PMID: 37116925 PMCID: PMC10141426 DOI: 10.9745/ghsp-d-22-00444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/15/2023] [Indexed: 04/30/2023]
Abstract
INTRODUCTION In sub-Saharan Africa (SSA), incarcerated people experience a higher HIV burden than the general population. While access to HIV care and treatment for incarcerated people living with HIV (PLHIV) in SSA has improved in some cases, little is known about their transition to and post-release experience with care in the community. To address this gap, we conducted a qualitative study to describe factors that may influence post-release HIV care continuity in Zambia. METHODS In March-December 2018, we recruited study participants from a larger prospective cohort study following incarcerated and newly released PLHIV at 5 correctional facilities in 2 provinces in Zambia. We interviewed 50 participants immediately before release; 27 (54%) participated in a second interview approximately 6 months post-release. Demographic and psychosocial data were collected through a structured survey. RESULTS The pre-release setting was strongly influenced by the highly structured prison environment and assumptions about life post-release. Participants reported accessible HIV services, a destigmatizing environment, and strong informal social supports built through comradery among people facing the same trying detention conditions. Contrary to their pre-release expectations, during the immediate post-release period, participants struggled to negotiate the health system while dealing with unexpected stressors. Long-term engagement in HIV care was possible for participants with strong family support and a high level of self-efficacy. CONCLUSION Our study highlights that recently released PLHIV in Zambia face acute challenges in meeting their basic subsistence needs, as well as social isolation, which can derail linkage to and retention in community HIV care. Releasees are unprepared to face these challenges due to a lack of community support services. To improve HIV care continuity in this population, new transitional care models are needed that develop client self-efficacy, facilitate health system navigation, and pragmatically address structural and psychosocial barriers like poverty, gender inequality, and substance use.
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Affiliation(s)
- Helene J Smith
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Michael E Herce
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Chilambwe Mwila
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Peter Chisenga
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Chisenga Yenga
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Besa Chibwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Vivien Mai
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Lillian Kashela
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Mirriam Nanyagwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sisa Hatwiinda
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Clement N Moonga
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Maurice Musheke
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Yotam Lungu
- Zambia Correctional Service, Government of the Republic of Zambia, Lusaka, Zambia
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
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Lindsay B, Nyirongo N, Mwango L, Toeque MG, Masumba C, Litongola JP, Sikanyika J, Kabombo H, Moyo M, Siachibila S, Mudenda J, Tembo K, Olowski P, Olufunso A, Muchinda E, Musonda B, Okuku J, Mwila A, Moonga CN, Herce ME, Claassen CW. Initial implementation of HIV pre-exposure prophylaxis for people who are incarcerated in Zambia: a cross-sectional observational study. Lancet HIV 2023; 10:e24-e32. [PMID: 36243018 DOI: 10.1016/s2352-3018(22)00220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND There are over 23 000 incarcerated people in Zambia, a population which has higher HIV prevalence than the general population yet has no access to HIV prevention. To evaluate the feasibility of HIV pre-exposure prophylaxis (PrEP) implementation in Zambian criminal justice facilities, we offered PrEP services to incarcerated people and aimed to describe early implementation outcomes. METHODS In this cross-sectional observational study, we implemented a PrEP programme between Oct 1, 2020, and March 31, 2021, supporting 16 criminal justice facilities in four Zambian provinces. Before implementation, we held stakeholder engagement meetings with Zambia Correctional Service officials to discuss PrEP benefits, and trained Zambia Correctional Service health-care workers in PrEP management using the national PrEP training package. People who were incarcerated and screened positive for substantial HIV risk by use of a standardised HIV risk assessment tool were offered voluntary HIV testing and counselling. Those who tested positive were linked to antiretroviral therapy, and those who tested negative and met national HIV prevention eligibility criteria were offered PrEP. We assessed PrEP uptake and used descriptive statistics to characterise programme beneficiaries and the cascade of PrEP services. FINDINGS During the study period, we reached 12 367 people older than 15 years with HIV risk assessment and counselling, including 11 794 (95·4%) men and 573 (4·6%) women. Of these, 2610 people received HIV testing, with 357 (13·7%) testing HIV positive; positivity was significantly higher in women (20·6%) than men (13·2%, p=0·011). 1276 people were identified as HIV negative and PrEP eligible. Of these, 1190 (93·3%) initiated PrEP. The age group with the highest proportion reached and initiated on PrEP was those aged 25-29 years, representing 19·2% (2377 of 12 367) of all people reached and 24·1% (287 of 1190) of those who initiated PrEP. INTERPRETATION Delivery of PrEP to people who are incarcerated is feasible with adequate resourcing and support to the criminal justice health system, and can result in high uptake among eligible individuals. Further assessment is needed of PrEP persistence and adherence, and the perceptions of people who are incarcerated regarding their HIV risk and preferences for combination HIV prevention services. FUNDING US President's Emergency Plan for AIDS Relief through the US Centers for Disease Control and Prevention.
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Affiliation(s)
- Brianna Lindsay
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia; Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Nasho Nyirongo
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | | | - Mona Gekanju Toeque
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia; Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | | | | | - Kalima Tembo
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | - Pawel Olowski
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | | | | | - Bupe Musonda
- Department of Public Health, Ministry of Health, Lusaka, Zambia
| | - Jackson Okuku
- US Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Annie Mwila
- US Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Clement N Moonga
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Michael E Herce
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia; Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Cassidy W Claassen
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia; Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
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7
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Chimoyi L, Charalambous S. The case for pre-exposure prophylaxis in prison settings. Lancet HIV 2023; 10:e3-e4. [PMID: 36243017 DOI: 10.1016/s2352-3018(22)00258-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/06/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Lucy Chimoyi
- The Aurum Institute, Parktown, Johannesburg, South Africa 2193; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Salome Charalambous
- The Aurum Institute, Parktown, Johannesburg, South Africa 2193; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Yale School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA.
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8
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Lindsay BR, Mwango L, Toeque M, Malupande SL, Nkhuwa E, Moonga CN, Chilambe A, Sakala H, Kafunda I, Olowski P, Olufunso A, Okuku J, Kancheya N, Mumba D, Hachaambwa L, Sheneberger R, Blanco N, Lavoie M, Claassen CW. Peer community health workers improve HIV testing and ART linkage among key populations in Zambia: retrospective observational results from the Z-CHECK project, 2019-2020. J Int AIDS Soc 2022; 25:e26030. [PMID: 36317821 PMCID: PMC9624072 DOI: 10.1002/jia2.26030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Zambia has made tremendous progress towards HIV epidemic control; however, gaps remain among key populations (KPs), such as female sex workers (FSWs), men who have sex with men (MSM), people who inject drugs (PWID) and people in prisons and enclosed settings due to cultural, social and legal barriers. The University of Maryland, Baltimore Zambia Community HIV Epidemic Control for Key Populations (Z-CHECK) project aimed to improve HIV case-finding, linkage and treatment adherence at the community level for KPs in Zambia. We describe Z-CHECK strategies and examine HIV positivity yield and antiretroviral therapy (ART) linkage among KPs to inform ongoing programme improvement. METHODS Z-CHECK recruited, trained and deployed peer community health workers (CHWs) for KP groups, with ongoing mentorship in community engagement. CHWs offered HIV testing in safe spaces and escorted newly HIV-diagnosed clients for same-day ART initiation. Z-CHECK also reached out to KP community leaders and gatekeepers for KP mobilization and trained healthcare workers (HCWs) on KP services and sensitivity. We conducted a retrospective observational review of routinely collected aggregate data for KPs aged ≥15 years at high risk for HIV transmission across five districts in Zambia from January 2019 to December 2020. RESULTS Z-CHECK provided HIV testing for 9211 KPs, of whom 2227 were HIV positive (positivity yield, 24%). Among these, 1901 (85%) were linked to ART; linkage for MSM, FSW, PWID and people in prisons and enclosed settings was 95%, 89%, 86% and 65%, respectively. Programme strategies that contributed to high positivity yield and linkage included the use of peer KP CHWs, social network testing strategies and opportunities for same-day ART initiation. Challenges to programme implementation included stigma and discrimination among HCWs, as well as KP CHW attrition, which may be explained by high mobility. CONCLUSIONS Peer CHWs were highly effective at reaching KP communities, identifying persons living with HIV and linking them to care. Engaging KP community gatekeepers resulted in high diffusion of health messages and increased access to health resources. The mobility of CHWs and HCWs is a challenge for programme implementation. Innovative interventions are needed to support PWID and people in prisons and enclosed settings.
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Affiliation(s)
- Brianna R. Lindsay
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia,Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | | | - Mona‐Gekanju Toeque
- Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | | | | | | | | | - Henry Sakala
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia
| | - Ina Kafunda
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia
| | - Pawel Olowski
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia
| | - Adebayo Olufunso
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia
| | - Jackson Okuku
- U.S. Centers for Disease Control and Prevention ZambiaLusakaZambia
| | - Nzali Kancheya
- U.S. Centers for Disease Control and Prevention ZambiaLusakaZambia
| | | | - Lottie Hachaambwa
- Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA,Ciheb ZambiaLusakaZambia
| | - Robb Sheneberger
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia,Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Natalia Blanco
- Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Marie‐Claude Lavoie
- Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Cassidy W. Claassen
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia,Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
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9
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Rabinovich R, Owczarzak J, Mabuto T, Ntombela N, Woznica D, Hoffmann CJ. Social support needs of HIV-positive individuals reentering community settings from correctional facilities in Johannesburg, South Africa. AIDS Care 2022; 34:1347-1354. [PMID: 34668791 PMCID: PMC9018888 DOI: 10.1080/09540121.2021.1990200] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 10/04/2021] [Indexed: 01/26/2023]
Abstract
Social networks and social support are important factors in medication adherence among people living with HIV (PLWH). Social networks can provide emotional, logistic, and material support leading to increased overall engagement in care. Certain populations of PLWH may have more limited access to social support, including those reentering community settings from correctional facilities. During periods of incarceration, social connections with family and friends may be frayed, reduced, or lost. This study, conducted in South Africa, explored the role of social support during community reentry among PLWH being released from correctional facilities. We conducted in-depth interviews with 41 community reentrants living with HIV. Qualitative analysis identified the challenges with establishing social support during reentry and the greater need for social support to remain engaged in HIV care in the community compared to in the correctional facility. These findings highlight challenges during community reentry and the importance of social support for these individuals.
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Affiliation(s)
| | - Jill Owczarzak
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD USA
| | - Tonderai Mabuto
- Aurum Institute, Johannesburg, South Africa
- School of Public Health, the University of the Witwatersrand, South Africa
| | | | - Daniel Woznica
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD USA
| | - Christopher J. Hoffmann
- School of Public Health, the University of the Witwatersrand, South Africa
- Johns Hopkins University School of Medicine, Baltimore MD USA
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10
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An Y, Ntombela N, Hoffmann CJ, Fashina T, Mabuto T, Owczarzak J. "That makes me feel human": a qualitative evaluation of the acceptability of an HIV differentiated care intervention for formerly incarcerated people re-entering community settings in South Africa. BMC Health Serv Res 2022; 22:1092. [PMID: 36028825 PMCID: PMC9415240 DOI: 10.1186/s12913-022-08469-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Correctional settings in South Africa have disproportionately high rates of HIV infection; a large number of inmates living with HIV return to the community each year. The transition community adherence club (TCAC) intervention was a differentiated care delivery approach with structural and peer components designed to increase antiretroviral therapy (ART) adherence and HIV care engagement following release from incarceration. The objective of this study was to assess the acceptability of the TCAC intervention among HIV-infected community re-entrants to inform program revisions and future intervention designs. Methods This was a qualitative study set within a randomized controlled trial (RCT) of the TCAC intervention in South Africa. We conducted semi-structured, in-depth interviews with 16 re-entrants living with HIV and assigned to the intervention arm. All interviews were audio-recorded, transcribed, translated, and de-identified. Transcripts were coded and analyzed using content analysis, and acceptability was assessed using the Theoretical Framework of Acceptability (TFA). Results Overall, study participants reported that the TCAC intervention was acceptable. Development of supportive relationships between participants, non-judgmental attitudes from peer-facilitators, and perceived effectiveness of the intervention to support ART adherence and HIV care were noted as the most valued components. An altruistic desire to help other participants facing similar post-incarceration and HIV-related challenges was a key motivator for TCAC attendance. A lack of access to reliable transportation to intervention sites and clinic-based medication collection were described as burdens to program participation. Illicit drug use by other group members and negative social influences were also identified as potential barriers to optimal program engagement. Conclusion The TCAC was a well-accepted model of differentiated care delivery among re-entrants living with HIV in South Africa. To further enhance intervention acceptability for future scale-ups, program revisions should address logistical barriers related to reaching TCAC sites and implementing ART distribution at TCAC group sessions.
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Affiliation(s)
- Yangxi An
- Johns Hopkins University, 1550 Orleans St, CRB II - 1M11, Baltimore, MD, 21205, USA
| | | | - Christopher J Hoffmann
- Johns Hopkins University, 1550 Orleans St, CRB II - 1M11, Baltimore, MD, 21205, USA. .,Aurum Institute, Johannesburg, South Africa. .,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA. .,Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA.
| | - Tolulope Fashina
- Johns Hopkins University, 1550 Orleans St, CRB II - 1M11, Baltimore, MD, 21205, USA
| | | | - Jill Owczarzak
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
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11
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Mukora R, Smith HJ, Herce ME, Chimoyi L, Hausler H, Fielding KL, Charalambous S, Hoffmann CJ. Costs of implementing universal test and treat in three correctional facilities in South Africa and Zambia. PLoS One 2022; 17:e0272595. [PMID: 36006967 PMCID: PMC9409581 DOI: 10.1371/journal.pone.0272595] [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: 11/19/2021] [Accepted: 07/21/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Universal test and treat (UTT) is a population-based strategy that aims to ensure widespread HIV testing and rapid antiretroviral therapy (ART) for all who have tested positive regardless of CD4 count to decrease HIV incidence and improve health outcomes. Little is known about the specific resources required to implement UTT in correctional facilities for incarcerated people. The primary aim of this study was to describe the resources used to implement UTT and to provide detailed costing to inform UTT scale-up in similar settings.
Methods
The costing study was a cross-sectional descriptive study conducted in three correctional complexes, Johannesburg Correctional Facility in Johannesburg (>4000 inmates) South Africa, and Brandvlei (~3000 inmates), South Africa and Lusaka Central (~1400 inmates), Zambia. Costing was determined through a survey conducted between September and December 2017 that identified materials and labour used for three separate components of UTT: HIV testing services (HTS), ART initiation, and ART maintenance. Our study participants were staff working in the correctional facilities involved in any activity related to UTT implementation. Unit costs were reported as cost per client served while total costs were reported for all clients seen over a 12-month period.
Results
The cost of HIV testing services (HTS) per client was $ 92.12 at Brandvlei, $ 73.82 at Johannesburg, and $ 65.15 at Lusaka. The largest cost driver for HIV testing at Brandvlei were staff costs at 55.6% of the total cost, while at Johannesburg (56.5%) and Lusaka (86.6%) supplies were the largest contributor. The cost per client initiated on ART was $917 for Brandvlei, $421.8 for Johannesburg, and $252.1 for Lusaka. The activity cost drivers were adherence counselling at Brandvlei (59%), and at Johannesburg and Lusaka it was the actual ART initiation at 75.6% and 75.8%, respectively. The annual unit cost for ART maintenance was $2,640.6 for Brandvlei, $710 for Johannesburg, and $385.5 for Lusaka. The activity cost drivers for all three facilities were side effect monitoring, and initiation of isoniazid preventive treatment (IPT), cotrimoxazole, and fluconazole, with this comprising 44.7% of the total cost at Brandvlei, 88.9% at Johannesburg, and 50.5% at Lusaka.
Conclusion
Given the needs of this population, the opportunity to reach inmates at high risk for HIV, and overall national and global 95-95-95 goals, the UTT policies for incarcerated individuals are of vital importance. Our findings provide comparator costing data and highlight key drivers of UTT cost by facility.
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Affiliation(s)
- Rachel Mukora
- The Aurum Institute, Aurum House, The Ridge, Johannesburg, South Africa
- * E-mail:
| | - Helene J. Smith
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | - Michael E. Herce
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Lucy Chimoyi
- The Aurum Institute, Aurum House, The Ridge, Johannesburg, South Africa
| | | | - Katherine L. Fielding
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Salome Charalambous
- The Aurum Institute, Aurum House, The Ridge, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Christopher J. Hoffmann
- The Aurum Institute, Aurum House, The Ridge, Johannesburg, South Africa
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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12
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Pham MD, Nguyen HV, Anderson D, Crowe S, Luchters S. Viral load monitoring for people living with HIV in the era of test and treat: progress made and challenges ahead - a systematic review. BMC Public Health 2022; 22:1203. [PMID: 35710413 PMCID: PMC9202111 DOI: 10.1186/s12889-022-13504-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background In 2016, we conducted a systematic review to assess the feasibility of treatment monitoring for people living with HIV (PLHIV) receiving antiretroviral therapy (ART) in low and middle-income countries (LMICs), in line with the 90-90-90 treatment target. By 2020, global estimates suggest the 90-90-90 target, particularly the last 90, remains unattainable in many LMICs. This study aims to review the progress and identify needs for public health interventions to improve viral load monitoring and viral suppression for PLHIV in LMICs. Methods A literature search was conducted using an update of the initial search strategy developed for the 2016 review. Electronic databases (Medline and PubMed) were searched to identify relevant literature published in English between Dec 2015 and August 2021. The primary outcome was initial viral load (VL) monitoring (the proportion of PLHIV on ART and eligible for VL monitoring who received a VL test). Secondary outcomes included follow-up VL monitoring (the proportion of PLHIV who received a follow-up VL after an initial elevated VL test), confirmation of treatment failure (the proportion of PLHIV who had two consecutive elevated VL results) and switching treatment regimen rates (the proportion of PLHIV who switched treatment regimen after confirmation of treatment failure). Results The search strategy identified 1984 non-duplicate records, of which 34 studies were included in the review. Marked variations in initial VL monitoring coverage were reported across study settings/countries (range: 12–93% median: 74% IQR: 46–82%) and study populations (adults (range: 25–96%, median: 67% IQR: 50–84%), children, adolescents/young people (range: 2–94%, median: 72% IQR: 47–85%), and pregnant women (range: 32–82%, median: 57% IQR: 43–71%)). Community-based models reported higher VL monitoring (median: 85%, IQR: 82-88%) compared to decentralised care at primary health facility (median: 64%, IRQ: 48-82%). Suboptimal uptake of follow-up VL monitoring and low regimen switching rates were observed. Conclusions Substantial gaps in VL coverage across study settings and study populations were evident, with limited data availability outside of sub-Saharan Africa. Further research is needed to fill the data gaps. Development and implementation of innovative, community-based interventions are required to improve VL monitoring and address the “failure cascade” in PLHIV on ART who fail to achieve viral suppression.
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Affiliation(s)
- Minh D Pham
- Burnet Institute, Melbourne, Australia. .,Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia.
| | - Huy V Nguyen
- Health Innovation and Transformation Centre, Federation University, Victoria, Australia.,School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - David Anderson
- Burnet Institute, Melbourne, Australia.,Department of Microbiology, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Suzanne Crowe
- Burnet Institute, Melbourne, Australia.,Central Clinical School, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Stanley Luchters
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia.,Centre for Sexual Health and HIV & AIDS Research, Harare, Zimbabwe.,Department of Public health and Primary care, Ghent University, Ghent, Belgium
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13
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Interventions to improve early retention of patients in antiretroviral therapy programmes in sub-Saharan Africa: A systematic review. PLoS One 2022; 17:e0263663. [PMID: 35139118 PMCID: PMC8827476 DOI: 10.1371/journal.pone.0263663] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/24/2022] [Indexed: 11/24/2022] Open
Abstract
Background Several interventions to improve long term retention (12 months and above) on treatment have been rigorously evaluated in Sub-Saharan Africa (SSA). However, research on interventions to improve retention of patients in the early stages of treatment (6 months) during this era of Universal Test and Treat has only recently emerged. The aim of this study is to systematically map evidence of interventions used to improve early retention of patients in antiretroviral therapy (ART) programmes in SSA. Methods We searched PubMed, EMBASE and Cochrane electronic databases to identify studies describing interventions aimed at improving early retention in ART treatment. We applied the methodological frameworks by Arksey and O’Malley (2005) and Levac et al. (2010). We also followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Interventions were categorized according to key broad areas in the existing literature. Results A total of 2,241 articles were identified of which 19 met the inclusion criteria and were eligible for this review, with the majority either being randomized control trials 32% (n = 6) or cohort studies 32% (n = 6). The studies reviewed were conducted in 11 SSA countries. The most common interventions described under key broad areas included: Health system interventions such as Universal Test-and-Treat, integration of ART initiation, HIV Testing and Counselling and Antenatal Care services and reduction of ART drug costs; Patient centered approaches such as fast track ART initiation, Differentiated Drug Delivery models and point of care HIV birth testing; Behavioral interventions and support through lay counselors, mentor mothers, nurse counselors and application of quality improvement interventions and financial incentives. Majority of the studies targeted the HIV positive adults and pregnant women. Conclusion With the introduction of Universal Test-and-Treat and same-day initiation of ART, findings suggest that adoption of policies that expand ART uptake with the goal of reducing HIV transmission at the population level, promoting patient centered approaches such as fast track ART initiation, Differentiated Service Delivery models and providing adequate support through Mentor Mothers, lay and nurse counselors may improve early retention in HIV care in SSA. However, these interventions have only been tested in few countries in the region which points to how hard evidence based HIV programming is. Further research investigating the impact of individual and a combination of interventions to improve early retention in HIV care, including for various groups at high risk of attrition, is warranted across SSA countries to fast track the achievement of 95-95-95 Joint United Nations Programme on HIV/AIDS (UNAIDS) targets by 2030.
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14
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Fernando NB, Woznica DM, Mabuto T, Hoffmann CJ. In-facility HIV peer-based rehabilitation programs' role in linkage to care among persons transitioning from correctional to community-based HIV care in South Africa. Int J Prison Health 2022; 18:473-482. [PMID: 35076191 DOI: 10.1108/ijph-05-2021-0044] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE This analysis aims to examine the role of pre-release, HIV-related, peer-based rehabilitation program attendance on post-release linkage to community-based HIV care in South Africa. DESIGN/METHODOLOGY/APPROACH During a post-release linkage-to-care prospective study, participants from six correctional facilities who had an HIV-positive diagnosis and were taking anti-retroviral medications at release (N = 351) self-reported rehabilitation program participation. Linkage-to-care status 90 days post-release was verified by medical chart review. FINDINGS In a binomial regression model, HIV-related, peer-based rehabilitation program attendance was insignificant (relative risk [RR] 1.1, 95% confidence interval [CI] [0.8, 1.4], p-value = 0.7), but short-/long-term incarceration site (RR 1.5, 95% CI [1.0, 2.1], p-value = 0.04) and relationship status pre-incarceration (RR 1.9, 95% CI [1.0, 3.6], p-value = 0.05) were significantly associated with linkage to HIV care post-release. ORIGINALITY/VALUE Rehabilitation and peer-based HIV programs have had demonstrated benefit in other settings. Assessment of current programs may identify opportunities for improvement.
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Affiliation(s)
- Nimasha B Fernando
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel M Woznica
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Christopher J Hoffmann
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA, and Aurum Institute, Johannesburg, South Africa
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15
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Chimoyi L, Smith H, Hausler H, Fielding K, Hoffmann CJ, Herce ME, Charalambous S. Delivery of TB preventive therapy to incarcerated people living with HIV in southern African correctional facilities. Public Health Action 2021; 11:171-173. [PMID: 34956843 DOI: 10.5588/pha.21.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 11/06/2021] [Indexed: 11/10/2022] Open
Abstract
TB preventive treatment (TPT) is recommended for high-risk and hard-to-reach populations such as incarcerated people living with HIV (PLHIV). To assess implementation of TPT delivery in correctional settings, we conducted an exploratory analysis of data from a multisite cohort study in South Africa and Zambia. From 975 participants, 648 were screened for TB, and 409 initiated TPT mostly within a month after initiation of antiretroviral therapy (190/409, 46.5%). We observed a median gap of one month (IQR 0.6-4.7) in TPT delivery to incarcerated PLHIV. Future research should examine standardised quality improvement tools and new strategies such as short-course regimens to improve TPT initiation in this population.
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Affiliation(s)
- L Chimoyi
- The Aurum Institute, Parktown, Johannesburg, South Africa
| | - H Smith
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - H Hausler
- TB HIV Care, Cape Town, South Africa
| | - K Fielding
- London School of Tropical Hygiene & Medicine, London, UK
| | - C J Hoffmann
- The Aurum Institute, Parktown, Johannesburg, South Africa.,Johns Hopkins University, Baltimore, MD, USA
| | - M E Herce
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - S Charalambous
- The Aurum Institute, Parktown, Johannesburg, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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16
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Ostermann J, Yelverton V, Smith HJ, Nanyangwe M, Kashela L, Chisenga P, Mai V, Mwila C, Herce ME. Preferences for transitional HIV care among people living with HIV recently released from prison in Zambia: a discrete choice experiment. J Int AIDS Soc 2021; 24:e25805. [PMID: 34648690 PMCID: PMC8516367 DOI: 10.1002/jia2.25805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction No studies from sub‐Saharan Africa have attempted to assess HIV service delivery preferences among incarcerated people living with HIV as they transition from prisons to the community (“releasees”). We conducted a discrete choice experiment (DCE) to characterize releasee preferences for transitional HIV care services in Zambia to inform the development of a differentiated service delivery model to promote HIV care continuity for releasees. Methods Between January and October 2019, we enrolled a consecutive sample of 101 releasees from a larger cohort prospectively following 296 releasees from five prisons in Zambia. We administered a DCE eliciting preferences for 12 systematically designed choice scenarios, each presenting three hypothetical transitional care options. Options combined six attributes: (1) clinic type for post‐release HIV care; (2) client focus of healthcare workers; (3) transitional care model type; (4) characteristics of transitional care provider; (5) type of transitional care support; and (6) HIV status disclosure support. We analysed DCE choice data using a mixed logit model, with coefficients describing participants’ average (“mean”) preferences for each option compared to the standard of care and their distributions describing preference variation across participants. Results Most DCE participants were male (n = 84, 83.2%) and had completed primary school (n = 54, 53.5%), with 29 (28.7%) unemployed at follow‐up. Participants had spent an average of 8.2 months in the community prior to the DCE, with 18 (17.8%) reporting an intervening episode of re‐incarceration. While we observed significant preference variation across participants (p < 0.001 for most characteristics), releasees were generally averse to clinics run by community‐based organizations versus government antiretroviral therapy clinics providing post‐release HIV care (mean preference = –0.78, p < 0.001). On average, releasees most preferred livelihood support (mean preference = 1.19, p < 0.001) and HIV care support (mean preference = 1.00, p < 0.001) delivered by support groups involving people living with HIV (mean preference = 1.24, p < 0.001). Conclusions We identified preferred characteristics of transitional HIV care that can form the basis for differentiated service delivery models for prison releasees. Such models should offer client‐centred care in trusted clinics, provide individualized HIV care support delivered by support groups and/or peer navigators, and strengthen linkages to programs providing livelihood support.
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Affiliation(s)
- Jan Ostermann
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, South Carolina, USA.,Center for Health Policy & Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Valerie Yelverton
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Helene J Smith
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.,School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mirriam Nanyangwe
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Lillian Kashela
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Peter Chisenga
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Vivien Mai
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Chilambwe Mwila
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Michael E Herce
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.,Institute for Global Health & Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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17
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Kagujje M, Somwe P, Hatwiinda S, Bwalya J, Zgambo T, Thornicroft M, Bozzani FM, Moonga C, Muyoyeta M. Cross-sectional assessment of tuberculosis and HIV prevalence in 13 correctional facilities in Zambia. BMJ Open 2021; 11:e052221. [PMID: 34580101 PMCID: PMC8477336 DOI: 10.1136/bmjopen-2021-052221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine the prevalence of tuberculosis (TB) and HIV in 13 Zambian correctional facilities. METHODS Cross-sectional study. SETTING 13 correctional facilities in seven of the 10 provinces in Zambia. PARTICIPANTS All incarcerated individuals were eligible for TB and HIV screening and testing. Of the total study population of 9695 individuals, which represent 46.2% of total correctional population at the beginning of the study, 8267 and 8160 were screened for TB and HIV, respectively. INTERVENTIONS TB and HIV screening and testing was done between July 2018 and February 2019. PRIMARY OUTCOME MEASURES All forms of TB, bacteriologically confirmed TB, drug-resistant TB, HIV. RESULTS Prevalence of all forms of TB and bacteriologically confirmed TB was 1599 (1340-1894) per 100 000 population and 1056 (847-1301) per 100 000 population, respectively. Among those with bacteriologically confirmed TB, 4.6% (1.3%-11.4%) had drug-resistant TB.There was no statistically significant difference in the prevalence of all forms of TB, bacteriologically confirmed TB and drug resistant TB between adults and juveniles: (p=0.82), (p=0.23), (p=0.68) respectively. Of the bacteriologically confirmed TB cases, 28.7% were asymptomatic. The prevalence of HIV was 14.3% (13.6%-15.1%). The prevalence of HIV among females was 1.8 times the prevalence of HIV among males (p=0.01). CONCLUSION Compared with the study in 2011 which screened inmates representing 30% of the country's inmate population, then the prevalence of all forms of TB and HIV in correctional facilities has reduced by about 75% and 37.6%, respectively. However, compared with the general population, the prevalence of all forms of TB and HIV was 3.5 and 1.3 times higher, respectively. TB/HIV programmes in correctional facilities need further strengthening to include aspects of juvenile-specific TB programming and gender responsive HIV programming.
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Affiliation(s)
- Mary Kagujje
- Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Paul Somwe
- Strategic Information Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sisa Hatwiinda
- Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Joel Bwalya
- Strategic Information Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Tamala Zgambo
- Health directorate, Zambia Correctional Service, Lusaka, Zambia
| | - Moomba Thornicroft
- Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Fiammetta Maria Bozzani
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Clement Moonga
- Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Monde Muyoyeta
- Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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18
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Tang J. Immunogenetic determinants of heterosexual HIV-1 transmission: key findings and lessons from two distinct African cohorts. Genes Immun 2021; 22:65-74. [PMID: 33934119 PMCID: PMC8225584 DOI: 10.1038/s41435-021-00130-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/05/2021] [Accepted: 04/15/2021] [Indexed: 02/03/2023]
Abstract
Immunogenetic studies in the past three decades have uncovered a broad range of human genetic factors that seem to influence heterosexual HIV-1 transmission in one way or another. In our own work that jointly evaluated both genetic and nongenetic factors in two African cohorts of cohabiting, HIV-1-discordant couples (donor and recipient pairs) at risk of transmission during quarterly follow-up intervals, relatively consistent findings have been seen with three loci (IL19, HLA-A, and HLA-B), although the effect size (i.e., odds ratio or hazards ratio) of each specific variant was quite modest. These studies offered two critical lessons that should benefit future research on sexually transmitted infections. First, in donor partners, immunogenetic factors (e.g., HLA-B*57 and HLA-A*36:01) that operate directly through HIV-1 viral load or indirectly through genital coinfections are equally important. Second, thousands of single-nucleotide polymorphisms previously recognized as "causal" factors for human autoimmune disorders did not appear to make much difference, which is somewhat puzzling as these variants are predicted or known to influence the expression of many immune response genes. Replicating these observations in additional cohorts is no longer feasible as the field has shifted its focus to early diagnosis, universal treatment, and active management of comorbidities.
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Affiliation(s)
- Jianming Tang
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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19
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Velen K, Charalambous S. Tuberculosis in prisons: an unintended sentence? LANCET PUBLIC HEALTH 2021; 6:e263-e264. [PMID: 33765454 DOI: 10.1016/s2468-2667(21)00049-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa; School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
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20
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Ohuabunwa T, Spaulding AC. Control of epidemics by jails: lessons for COVID-19 from HIV. Lancet HIV 2020; 7:e798-e799. [PMID: 32763151 PMCID: PMC7402651 DOI: 10.1016/s2352-3018(20)30195-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Tochi Ohuabunwa
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Anne C Spaulding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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