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Akullian A, Akulu R, Aliyu G, Anam F, Guichard AC, Ayles H, Baggaley R, Bansi-Matharu L, Baptiste SL, Bershteyn A, Cambiano V, Carter A, Chotun N, Citron DT, Crowley S, Dalal S, Edun O, Fraser C, Galvani AP, Garnett GP, Glabius R, Godfrey-Faussett P, Grabowski MK, Gray GE, Hargreaves JR, Imai-Eaton JW, Johnson LF, Kaftan D, Kagaayi J, Kataika E, Kilonzo N, Kirungi WL, Korenromp EL, Kouton MH, Lucie Abeler-Dörner L, Mahy M, Mangal TD, Martin-Hughes R, Matsikure S, Meyer-Rath G, Mishra S, Mmelesi M, Mohammed A, Moolla H, Morrison MR, Moyo S, Mudimu E, Mugabe M, Murenga M, Ng'ang'a J, Olaifa Y, Phillips AN, Pickles MR, Probert WJ, Ramaabya D, Rautenbach SP, Revill P, Shakarishvili A, Sheneberger R, Smith J, Stegling C, Stover J, Tanser F, Taramusi I, ten Brink D, Whittles LK, Zaidi I. The HIV response beyond 2030: preparing for decades of sustained HIV epidemic control in eastern and southern Africa. Lancet 2024; 404:638-641. [PMID: 38782003 DOI: 10.1016/s0140-6736(24)00980-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
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2
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Sehurutshi A, Farooqui H, Chivese T. The Impact of COVID-19 on the HIV Cascade of Care in Botswana - An Interrupted Time Series. AIDS Behav 2024; 28:2630-2638. [PMID: 38856847 PMCID: PMC11286653 DOI: 10.1007/s10461-024-04388-x] [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] [Accepted: 05/22/2024] [Indexed: 06/11/2024]
Abstract
Globally, Botswana has one of the highest burdens of HIV. This study estimated the impact of the COVID-19 pandemic on the HIV cascade of care in Sub-Saharan Africa. We conducted an interrupted time series analysis on national-level data to estimate the effect of COVID-19 on the numbers of HIV tests, positive HIV tests and ART initiations from April 2019 until March 2021. In multivariable Poisson interrupted time series regression, the COVID-19 lockdown was associated with a 27% decrease in the monthly numbers of HIV tests (IRR 0.73, 95%CI 0.72-0.73), a 25% decrease in HIV positive tests (IRR 0.75, 95%CI 0.71-0.79), and a 43% reduction in ART initiations (IRR 0.57, 95%CI 0.55-0.60). The impact of the pandemic on all three outcomes was worse in males and those aged ≥ 50 years. In conclusion, COVID-19 had a strong negative impact on HIV screening, diagnosis and ART initiation in Botswana.
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Affiliation(s)
- Alice Sehurutshi
- Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town, South Africa
- Harvard AIDS Institute Partnership, Gaberone, Botswana
| | - Habib Farooqui
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar.
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3
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Knauss S, Andriamiadana G, Leitheiser R, Rampanjato Z, Bärnighausen T, Emmrich JV. Effect of the COVID-19 Lockdown on Mobile Payments for Maternal Health: Regression Discontinuity Analysis. JMIR Public Health Surveill 2024; 10:e49205. [PMID: 39078698 PMCID: PMC11322714 DOI: 10.2196/49205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 01/24/2024] [Accepted: 05/03/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in the unprecedented popularity of digital financial services for contactless payments and government cash transfer programs to mitigate the economic effects of the pandemic. The effect of the pandemic on the use of digital financial services for health in low- and middle-income countries, however, is poorly understood. OBJECTIVE This study aimed to assess the effect of the first COVID-19 lockdown on the use of a mobile maternal health wallet, with a particular focus on delineating the age-dependent differential effects, and draw conclusions on the effect of lockdown measures on the use of digital health services. METHODS We analyzed 819,840 person-days of health wallet use data from 3416 women who used health care at 25 public sector primary care facilities and 4 hospitals in Antananarivo, Madagascar, between January 1 and August 27, 2020. We collected data on savings, payments, and voucher use at the point of care. To estimate the effects of the first COVID-19 lockdown in Madagascar, we used regression discontinuity analysis around the starting day of the first COVID-19 lockdown on March 23, 2020. We determined the bandwidth using a data-driven method for unbiased bandwidth selection and used modified Poisson regression for binary variables to estimate risk ratios as lockdown effect sizes. RESULTS We recorded 3719 saving events, 1572 payment events, and 3144 use events of electronic vouchers. The first COVID-19 lockdown in Madagascar reduced mobile money savings by 58.5% (P<.001), payments by 45.8% (P<.001), and voucher use by 49.6% (P<.001). Voucher use recovered to the extrapolated prelockdown counterfactual after 214 days, while savings and payments did not cross the extrapolated prelockdown counterfactual. The recovery duration after the lockdown differed by age group. Women aged >30 years recovered substantially faster, returning to prelockdown rates after 34, 226, and 77 days for savings, payments, and voucher use, respectively. Younger women aged <25 years did not return to baseline values. The results remained robust in sensitivity analyses using ±20 days of the optimal bandwidth. CONCLUSIONS The COVID-19 lockdown greatly reduced the use of mobile money in the health sector, affecting savings, payments, and voucher use. Savings were the most significantly reduced, implying that the lockdown affected women's expectations of future health care use. Declines in payments and voucher use indicated decreased actual health care use caused by the lockdown. These effects are crucial since many maternal and child health care services cannot be delayed, as the potential benefits will be lost or diminished. To mitigate the adverse impacts of lockdowns on maternal health service use, digital health services could be leveraged to provide access to telemedicine and enhance user communication with clear information on available health care access options and adherence to safety protocols.
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Affiliation(s)
- Samuel Knauss
- Global Digital Last Mile Health Research Lab, Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Germany, Berlin, Germany
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Gracia Andriamiadana
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Roxane Leitheiser
- Global Digital Last Mile Health Research Lab, Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Germany, Berlin, Germany
| | | | - Till Bärnighausen
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, United States
- Africa Health Research Institute, Mtubatuba, South Africa
| | - Julius Valentin Emmrich
- Global Digital Last Mile Health Research Lab, Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Germany, Berlin, Germany
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
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Di Ciaccio M, Boulahdour N, Tadjeddine A, Brouk N, Ouchallal R, Hami N, Bourhaba O, Adami E, Lorente N, Delabre RM, Karkouri M, Rojas Castro D. Psychosocial experience of the Covid-19 crisis among people who use or inject drugs in Algeria: A community-based qualitative study. J Health Psychol 2024:13591053241259251. [PMID: 39045700 DOI: 10.1177/13591053241259251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024] Open
Abstract
The COVID-19 crisis had a global impact and many marginalised groups, such as people who use or inject drugs, are more vulnerable to the SARS-CoV-2 virus and its consequences due to their pre-existing health inequalities. Moreover, people who use/inject drugs are also criminalised in some countries such as Algeria. This analysis aimed to explore the psychosocial experience of the COVID-19 crisis among people who use/inject drugs in Algeria. Twenty-nine qualitative interviews were conducted in 2021 with a community-based approach. Results of the thematic content analysis showed the intersectional effects of the COVID-19 crisis among people who use or inject drugs through the experience of a double crisis: one related to COVID-19 and the second to their specific difficulties related to drug use. Addressing social inequalities in health of people who use or inject drugs, through better recognition of their rights and needs, is crucial to improving their health.
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Affiliation(s)
| | | | | | - Nafaa Brouk
- Association de Protection Contre le Sida (APCS), Oran, Algeria
- Unité de dépistage du cancer du sein, EPSP, Alger, Algeria
| | - Rachida Ouchallal
- Association de Protection Contre le Sida (APCS), Oran, Algeria
- EHS Frantz-Fanon, Blida, Algeria
| | - Noria Hami
- Association de Protection Contre le Sida (APCS), Oran, Algeria
- Etablissement Hospitalier Pédiatrique, Oran, Algeria
| | - Othmane Bourhaba
- Association de Lutte Contre le Sida (ALCS), Casablanca, Morocco
- Community-based research laboratory, Coalition PLUS, Dakar, Senegal
| | - Elisa Adami
- Community-based research laboratory, Pantin, France
| | - Nicolas Lorente
- Community-based research laboratory, Pantin, France
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, España
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | | | - Mehdi Karkouri
- Association de Lutte Contre le Sida (ALCS), Casablanca, Morocco
- Community-based research laboratory, Coalition PLUS, Dakar, Senegal
- Centre Hospitalier Universitaire, Casablanca, Morocco
| | - Daniela Rojas Castro
- Community-based research laboratory, Pantin, France
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
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5
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Zuniga JM, Prachniak C, Policek N, Magula N, Gandhi A, Anderson J, Diallo DD, Lima VD, Ravishankar S, Acharya S, Achrekar A, Adeleke M, Aïna É, Baptiste S, Barrow G, Begovac J, Bukusi E, Castel A, Castellanos E, Cestou J, Chirambo G, Crowley J, Dedes N, Ditiu L, Doherty M, Duncombe C, Durán A, Futterman D, Hader S, Kounkeu C, Lawless F, Lazarus JV, Lex S, Lobos C, Mayer K, Mejia M, Moheno HR, d'Arminio Monforte A, Morán-Arribas M, Nagel D, Ndugwa R, Ngunu C, Poonkasetwattana M, Prins M, Quesada A, Rudnieva O, Ruth S, Saavedra J, Toma L, Wanjiku Njenga L, Williams B. IAPAC-Lancet HIV Commission on the future of urban HIV responses. Lancet HIV 2024:S2352-3018(24)00124-3. [PMID: 39043198 DOI: 10.1016/s2352-3018(24)00124-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 07/25/2024]
Affiliation(s)
- José M Zuniga
- International Association of Providers of AIDS Care, Washington, DC, USA; Fast-Track Cities Institute, Washington, DC, USA.
| | | | | | | | - Anisha Gandhi
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | | | | | | | | | | | | | | | | | - Solange Baptiste
- International Treatment Preparedness Coalition, Johannesburg, South Africa
| | | | | | - Elizabeth Bukusi
- Kenya Medical Research Institute, Nairobi, Kenya; University of Nairobi, Nairobi, Kenya
| | | | | | - Jorge Cestou
- Chicago Department of Public Health, Chicago, IL, USA
| | | | | | | | | | - Meg Doherty
- World Health Organization, Geneva, Switzerland
| | - Chris Duncombe
- International Association of Providers of AIDS Care, Washington, DC, USA
| | - Adriana Durán
- Ministry of Health, City of Buenos Aires, Buenos Aires, Argentina
| | | | | | - Chyrol Kounkeu
- Cameroonian Association for the Development and Empowerment of Vulnerable People, Yaoundé, Cameroon
| | - Fran Lawless
- Mayor's Office of Health Policy, New Orleans, LA, USA
| | - Jeffrey V Lazarus
- University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Policy, New York, NY, USA
| | | | | | - Kenneth Mayer
- Fenway Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | - Carol Ngunu
- Nairobi City County Department of Health, Nairobi, Kenya
| | | | - Maria Prins
- Academic Medical Center, Amsterdam, Netherlands
| | - Amara Quesada
- Action for Health Initiatives, Quezon City, Philippines
| | | | - Simon Ruth
- Thorne Harbour Health, Melbourne, VIC, Australia
| | | | - Lance Toma
- San Francisco Community Health Center, San Francisco, CA, USA
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Morris R, Gregson S, Maswera R, Moorhouse L, Dadirai T, Mandizvidza P, Moyo B, Mugurungi O, Nyamukapa C. The impact of COVID-19 on sexual risk behaviour for HIV acquisition in east Zimbabwe: An observational study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003194. [PMID: 39018312 PMCID: PMC11253984 DOI: 10.1371/journal.pgph.0003194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/29/2024] [Indexed: 07/19/2024]
Abstract
The Covid-19 pandemic and associated restrictions have the potential to alter sexual risk behaviours for HIV acquisition with important implications for HIV prevention programmes in sub-Saharan Africa. To date, no large-scale data have been published to substantiate hypothesised changes in sexual risk behaviours. We used longitudinal survey data to assess the impact of Covid-19 on sexual risk behaviours in east Zimbabwe. Data on sexual behaviours in HIV-negative adults aged 15-54 years were collected in two rounds of a general population open-cohort survey conducted in Manicaland, Zimbabwe shortly before (July 2018 to December 2019; N = 7316) and several months into the Covid-19 epidemic (February to July 2021; N = 6356). Descriptive statistics and logistic regression models of serial cross-sectional and prospective cohort data were used to assess changes in sexual risk behaviours. The proportion of females aged 15-19 years reporting sexual debut declined from 29.7% before Covid-19 to 20.3% during Covid-19 (adjusted odds ratio (AOR) = 0.49, 95% confidence interval (95% CI), 0.38-0.63). Fewer sexually-active females reported multiple sexual partners during Covid-19 (3.35% versus 6.07%; AOR = 0.55, 95% CI, 0.43-0.72). No population-level changes in male behaviour between survey rounds were recorded but the cohort analysis revealed a complex pattern of behaviour change with HIV risk behaviours increasing for some individuals and decreasing for others. Overall HIV risk behaviours remained high in a sub-Saharan African population with a generalised HIV epidemic over a period of Covid-19 lockdowns when movements and social contacts were restricted.
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Affiliation(s)
- Rebekah Morris
- Department of Infectious Disease Epidemiology and MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Simon Gregson
- Department of Infectious Disease Epidemiology and MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rufurwokuda Maswera
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Louisa Moorhouse
- Department of Infectious Disease Epidemiology and MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Tawanda Dadirai
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Phyllis Mandizvidza
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Brian Moyo
- AIDS and TB programme, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | - Owen Mugurungi
- AIDS and TB programme, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | - Constance Nyamukapa
- Department of Infectious Disease Epidemiology and MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
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7
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Shaw SY, Biegun JCS, Leung S, Isac S, Musyoki HK, Mugambi M, Kioko J, Musimbi J, Olango K, Kuria S, Ongaro MK, Walimbwa J, Emmanuel F, Blanchard J, Pickles M, Mishra S, Becker ML, Lazarus L, Lorway R, Bhattacharjee P. Describing the effect of COVID-19 on sexual and healthcare-seeking behaviours of men who have sex with men in three counties in Kenya: a cross-sectional study. Sex Transm Infect 2024:sextrans-2024-056105. [PMID: 38964841 DOI: 10.1136/sextrans-2024-056105] [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: 01/03/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND While the COVID-19 pandemic disrupted HIV preventative services in sub-Saharan Africa, little is known about the specific impacts the pandemic has had on men who have sex with men (MSM) in Kenya. METHODS Data were from an HIV self-testing intervention implemented in Kisumu, Mombasa and Kiambu counties in Kenya. Baseline data collection took place from May to July 2019, and endline in August-October 2020, coinciding with the lifting of some COVID-19 mitigation measures. Using endline data, this study characterised the impact the pandemic had on participants' risk behaviours, experience of violence and behaviours related to HIV. Logistic regression was used to understand factors related to changes in risk behaviours and experiences of violence; adjusted AORs (AORs) and 95% CIs are reported. RESULTS Median age was 24 years (IQR: 21-27). Most respondents (93.9%) reported no change or a decrease in the number of sexual partners (median number of male sexual partners: 2, IQR: 2-4). Some participants reported an increase in alcohol (10%) and drug (16%) consumption, while 40% and 28% reported decreases in alcohol and drug consumption, respectively. Approximately 3% and 10% reported an increase in violence from intimate partners and police/authorities, respectively. Compared with those with primary education, those with post-secondary education were 60% less likely to report an increase in the number of male sexual partners per week (AOR: 0.4, 95% CI: 0.2 to 0.9), while those who were HIV positive were at twofold the odds of reporting an increase or sustained levels of violence from intimate partners (AOR: 2.0, 95% CI: 1.1 to 4.0). CONCLUSION The results of this study demonstrate heterogeneity in participants' access to preventative HIV and clinical care services in Kenya after the onset of the COVID-19 epidemic. These results indicate the importance of responding to specific needs of MSM and adapting programmes during times of crisis.
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Affiliation(s)
- Souradet Y Shaw
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Stella Leung
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Helgar K Musyoki
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Mary Mugambi
- National Syndemic Disease Control Council, Nairobi, Kenya
| | - Japheth Kioko
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Janet Musimbi
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | | | | | | | | | - James Blanchard
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | - Lisa Lazarus
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert Lorway
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Parinita Bhattacharjee
- Partners for Health and Development in Africa, Nairobi, Kenya
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Ojukwu E, Pashaei A, Maia JC, Omobhude OF, Tawfik A, Nguyen Y. Repercussions of the COVID-19 pandemic on the HIV care continuum and related factors in economically disadvantaged nations: an integrated analysis using mixed-methods systematic review. Eur J Med Res 2024; 29:346. [PMID: 38926792 PMCID: PMC11202375 DOI: 10.1186/s40001-024-01917-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 06/01/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic affected the self-management and care of people living with HIV, requiring adaptations in the way health services are provided. However, it is unclear how these changes impacted HIV care in low-income countries. METHODS A systematic review including the current evidence related to changes in HIV care continuum during COVID-19 was conducted through a systematic search in the online databases including CINAHL, OVID-Medline, CAB Direct, and OVID-Embase. A two-step screening process was carried out to include eligible papers and reports according to inclusion criteria. RESULTS From the searches we identified 21 total studies published between 2021 and 2024, the studies revealed mostly negative impacts on all stages of the HIV care continuum in low-income countries. There were impacts related to the blocking measures due to COVID-19, fear of contracting the disease, difficulties in providing resources such as income, food and transports, reductions in the provision of care from prevention to viral suppression. CONCLUSION Overall, researchers identified several negative impacts of COVID-19 restrictions on HIV care continuum during pandemic; however, some observations indicated indirect positive impacts on some aspects of HIV care. Decline in HIV care practices during pandemic compared to before pandemic were observed including using preventative methods, counseling and testing, receiving HIV healthcare services, HIV medical appointments, antiretroviral adherence, engagement with treatment, and poor viral suppression. However, in some evidence improvement in ART adherence and PrEP use were observed.
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Affiliation(s)
- Emmanuela Ojukwu
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Ava Pashaei
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.
| | | | | | - Abdulaziz Tawfik
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Yvonne Nguyen
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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9
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Farhat JB, Tiendrebeogo T, Malateste K, Poda A, Minga A, Messou E, Chenal H, Ezechi O, Ofotokun I, Ekouevi DK, Bonnet F, Barger D, Jaquet A. Effects of the COVID-19 Pandemic on ART Initiation and Access to HIV Viral Load Monitoring in Adults Living With HIV in West Africa: A Regression Discontinuity Analysis. J Acquir Immune Defic Syndr 2024; 96:114-120. [PMID: 38427928 PMCID: PMC11108739 DOI: 10.1097/qai.0000000000003404] [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: 08/07/2023] [Accepted: 12/18/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVES Efforts to control the COVID-19 pandemic have potentially compromised the availability and/or quality of HIV services. We aimed to assess the pandemic's impact on antiretroviral therapy (ART) initiation and HIV viral load (VL) monitoring in 3 West African countries. METHODS We used routinely collected data from 5 clinics contributing to the International epidemiologic Database to Evaluate AIDS collaboration in Burkina Faso, Côte d'Ivoire, and Nigeria. We included ART-naïve adults living with HIV initiating ART from January 1, 2018. We conducted regression discontinuity analysis to estimate changes in the number of ART initiations and VL measures per week, before and during the pandemic period in each country. RESULTS In clinics in Burkina Faso and Côte d'Ivoire, ART initiations per week remained constant throughout the studied periods (-0.24 points (p) of ART initiations/week 95% CI: -5.5 to 5.9, -0.9 p, 95% CI: -8.5 to 8.6, respectively), whereas in Nigeria's clinic, they decreased significantly (-6.3 p, 95% CI: -10.8 to -1.7) after the beginning of the pandemic. The volume of VL tests performed decreased significantly in all 3 countries (-17.0 p, 95% CI: -25.3 to -8.6 in Burkina Faso, -118.4 p, 95% CI: -171.1 to -65.8 in Côte d'Ivoire and -169.1 p, 95% CI: -282.6 to -55.6 in Nigeria). CONCLUSIONS HIV clinics in two out of three countries in West Africa demonstrated resilience as they successfully maintained access to ART for ALWH despite the challenges imposed by the pandemic. However, VL monitoring was severely disrupted and did not return to prepandemic levels approximately 1 year after the beginning of the pandemic. Continued monitoring of the HIV care continuum in the postpandemic period is essential to mitigate potential enduring effects on ALWH's virological and clinical outcomes.
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Affiliation(s)
- Jihane Ben Farhat
- Epicentre, Médecins Sans Frontières, Department of Epidemiology and Training, Paris, France
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
- Univ. Bordeaux, INSERM, BPH, U1219, Team PHARes, Bordeaux, France
| | - Thierry Tiendrebeogo
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
| | - Karen Malateste
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
| | - Armel Poda
- Department of Infectious Diseases, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - Albert Minga
- Centre médical de Suivi des Donneurs de Sang (CMSDS), Centre National de Transfusion Sanguine (CNTS), Abidjan, Côte d’Ivoire
| | - Eugène Messou
- Centre de Prise en charge de Recherche et de Formation (CePReF), Abidjan, Côte d’Ivoire; Programme PACCI/ANRS Research Center, Abidjan, Côte d’Ivoire; Département de Dermatologie et d’Infectiologie, Unité de Formation et de Recherche des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d’Ivoire
| | - Henri Chenal
- Virology Laboratory, Integrated Centre for Bioclinical Research in Abidjan (CIRBA), BP 2071 Abidjan 18-Côte d’Ivoire
| | - Oliver Ezechi
- Office of the Central Secretariat, Nigeria Institute for Medical Research, Yaba, Lagos, Nigeria
| | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Fabrice Bonnet
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
- CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, INSERM, U1219, Bordeaux, France
| | - Diana Barger
- Univ. Bordeaux, INSERM, BPH, U1219, Team PHARes, Bordeaux, France
| | - Antoine Jaquet
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
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10
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Caro-Vega Y, Guerrero-Torres L, Cárdenas-Ortega A, Martin-Onraët A, Rodríguez-Zulueta P, Romero-Mora K, Schjetnan MGP, Piñeirúa-Menéndez A. Characteristics and outcomes of people living with HIV hospitalised at tertiary healthcare institutions during the COVID-19 pandemic in Mexico City. BMC Infect Dis 2024; 24:524. [PMID: 38789972 PMCID: PMC11127384 DOI: 10.1186/s12879-024-09208-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/08/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND While existing research on people living with HIV (PWH) during the COVID-19 pandemic primarily focused on their clinical outcomes, a critical gap remains in understanding the implications of COVID-19 delivery of in-hospital care services to PWH. Our study aimed to describe the characteristics and outcomes of PWH hospitalised during 2020 in Mexico City, comparing patients admitted due to COVID-19 vs. patients admitted due to other causes. METHODS All PWH hospitalised for ≥ 24 h at four institutions in Mexico City from January 1st to December 31st, 2020 were included. Patients were classified into two groups according to the leading cause of their first hospitalisation: COVID-19 or non-COVID-19. Characteristics among groups were compared using chi-square and Kruskal tests. A Cox model was used to describe the risk of death after hospitalisation and the characteristics associated with this outcome. Mortality and hospitalisation events were compared to data from 2019. RESULTS Overall, we included 238 PWH hospitalised in 2020. Among them, 42 (18%) were hospitalised due to COVID-19 and 196 (82%) due to non-COVID-19 causes, mainly AIDS-defining events (ADE). PWH hospitalised due to COVID-19 had higher CD4 + cell counts (380 cells/mm3 [IQR: 184-580] vs. 97 cells/mm3 [IQR: 34-272], p < 0.01) and a higher proportion of virologic suppression (VS) compared to those hospitalised due to non-COVID-19 causes (92% vs. 55%, p < 0.01). The adjusted hazard ratio (aHR) for AIDS was 3.1 (95%CI: 1.3-7.2). COVID-19 was not associated with death (aHR 0.9 [95%CI: 0.3-2.9]). Compared to 2019, mortality was significantly higher in 2020 (19% vs. 9%, p < 0.01), while hospitalisations decreased by 57%. CONCLUSIONS PWH with COVID-19 had higher VS and CD4 + cell counts and lower mortality compared to those hospitalised due to non-COVID-19-related causes, who more often were recently diagnosed with HIV and had ADEs. Most hospitalisations and deaths in 2020 in PWH were related to advanced HIV disease. The increased mortality and decreased hospitalisations of PWH during 2020 evidence the impact of the interruption of health services delivery for PWH with advanced disease due to the pandemic. Our findings highlight the challenges faced by PWH during 2020 in a country where advanced HIV remains a concern.
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Affiliation(s)
- Yanink Caro-Vega
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Lorena Guerrero-Torres
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Andrea Cárdenas-Ortega
- Departamento de Infectología, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | | | - Karla Romero-Mora
- Departamento de Infectología, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | - Alicia Piñeirúa-Menéndez
- CISIDAT, Cuernavaca, Morelos, México.
- , Dwight Morrow, 8-7, Cuernavaca Centro, Cuernavaca Morelos, 62000, Mexico.
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11
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Cheng W, Xu Y, Jiang H, Li J, Hou Z, Meng H, Wang W, Chai C, Jiang J. SARS-CoV-2 Infection, Hospitalization, and Associated Factors Among People Living With HIV in Southeastern China From December 2022 to February 2023: Cross-Sectional Survey. JMIR Public Health Surveill 2024; 10:e51449. [PMID: 38630534 PMCID: PMC11025603 DOI: 10.2196/51449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/07/2024] [Accepted: 03/12/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Limited studies have explored the impact of the Omicron variant on SARS-CoV-2 infection, hospitalization, and associated factors among people living with HIV, particularly in China. The adjustment of preventive policies since December 2022 in China presents an opportunity to evaluate the real-world factors influencing SARS-CoV-2 infection and related hospitalization among people living with HIV. OBJECTIVE This study aimed to investigate SARS-CoV-2 infection, hospitalization rates, and associated factors among people living with HIV following the adjustment of preventive policies from December 2022 to February 2023 in southeastern China. METHODS A cross-sectional telephone or web-based survey was conducted among people living with HIV in 5 cities in southeastern China from December 2022 to February 2023. Demographic information, SARS-CoV-2 infection and related hospitalization, and HIV-specific characteristics were collected from existing databases and special investigations. Multivariate logistic regression analyses were conducted to determine the associated factors for infection and hospitalization rates of SARS-CoV-2. Additionally, subgroup analyses were conducted for the association between vaccination and infection across different vaccination statuses and time since the last vaccination. RESULTS Among people living with HIV with a COVID-19 testing history, the SARS-CoV-2 infection rate was 67.13% (95% CI 65.81%-68.13%), whereas the hospitalization rate was 0.71% (95% CI 0.46%-0.97%). Factors such as age, latest CD4 cell count, latest HIV viral load, and transmission route were found to be associated with SARS-CoV-2 infection, while age, cancer, latest CD4 cell count, and latest HIV viral load were associated with SARS-CoV-2 hospitalization. In terms of SARS-CoV-2 vaccination, compared to unvaccinated people living with HIV, there was a lower infection rate among those who had been vaccinated for <3 months in the booster vaccination group (adjusted odds ratio [aOR] 0.72, 95% CI 0.53-0.98; P=.04); and there was also a lower risk of hospitalization among people living with HIV who had received vaccination in the past 6-12 months (aOR 0.33, 95% CI 0.14-0.81; P=.02) and more than 12 months ago (aOR 0.22, 95% CI 0.07-0.72; P=.01). CONCLUSIONS After the ease of prevention and control measures in China, we observed a high SARS-CoV-2 infection rate but a low hospitalization rate. General risk factors, such as higher age and vaccination status, and HIV-related parameters, such as the latest CD4 cell count and HIV viral load, were associated with SARS-CoV-2 infection and hospitalization. A booster vaccination campaign for booster doses should be considered among people living with HIV in confronting possible COVID-19 epidemic emergencies in the near future.
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Affiliation(s)
- Wei Cheng
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Yun Xu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Haibo Jiang
- Ningbo Center for Disease Control and Prevention, Ningbo, China
| | - Jun Li
- Wenzhou Center for Disease Control and Prevention, Wenzhou, China
| | - Zhigang Hou
- Jiaxing Center for Disease Control and Prevention, Jiaxing, China
| | - Haibin Meng
- Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Wei Wang
- Quzhou Center for Disease Control and Prevention, Quzhou, China
| | - Chengliang Chai
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jianmin Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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12
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Mekonen ZT, Fenta TG, Nadeem SP, Cho DJ. Global Health Commodities Supply Chain in the Era of COVID-19 Pandemic: Challenges, Impacts, and Prospects: A Systematic Review. J Multidiscip Healthc 2024; 17:1523-1539. [PMID: 38623396 PMCID: PMC11018129 DOI: 10.2147/jmdh.s448654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/04/2024] [Indexed: 04/17/2024] Open
Abstract
Background The COVID-19 pandemic led to the most substantial health crisis in the 21st Century. This pandemic interrupted the supply of essential commodities for human beings. Among the essential commodities for human survival, disruption of the supply of essential health commodities has become a global concern. Objective The study aimed to systematically analyze published articles on the challenges, impacts, and prospects of the global health commodities' supply chain in the era of the COVID-19 pandemic. Methods A standard searching strategy was conducted in seven research databases to retrieve pertinent articles. Finally, 459 articles were retrieved for further screening, and only 13 articles were selected for final synthesis. Results Almost 38.5% of the studies targeted the supply chain of health commodities used to treat HIV, TB, and malaria. Lockdown policies, travel restrictions, lack of transportation, low manufacturing capacity, and rising costs were the significant challenges indicated for the supply interruption of essential health commodities and COVID-19 vaccines. Findings indicated that the supply interruption of essential health commodities leads to a devastating impact on global health. Conclusion Global medicine shortages due to the pandemic crisis can have a devastatingly harmful impact on patient outcomes and might result in a devastatingly long-lasting effect on the health of the world community. Supply-related challenges of the COVID-19 vaccine affect countries' ambitions for achieving herd immunity quickly. Monitoring the pandemic's effect on the health commodities' supply system and designing a short-term and long-term resilient health supply chain system that can cope with current and future health catastrophes is pivotal.
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Affiliation(s)
- Zelalem Tilahun Mekonen
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teferi Gedif Fenta
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Denny J Cho
- Logistics Department, Kyrgyz State Technical University, Bishkek, Kyrgyzstan
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13
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Spinelli MA, Christopoulos KA, Moreira CV, Jain JP, Lisha N, Glidden DV, Burkholder GA, Crane HM, Shapiro AE, Jacobson JM, Cachay ER, Mayer KH, Napravnik S, Moore RD, Gandhi M, Johnson MO. Viral Suppression Trajectories Destabilized After Coronavirus Disease 2019 Among US People With Human Immunodeficiency Virus: An Interrupted Time Series Analysis. Clin Infect Dis 2024; 78:991-994. [PMID: 37963086 PMCID: PMC11006098 DOI: 10.1093/cid/ciad657] [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: 07/26/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023] Open
Abstract
We examined changes in the proportion of people with human immunodeficiency virus (PWH) with virologic suppression (VS) in a multisite US cohort before and since the coronavirus disease 2019 (COVID-19) pandemic. Overall, prior gains in VS slowed during COVID-19, with disproportionate impacts on Black PWH and PWH who inject drugs.
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Affiliation(s)
- Matthew A Spinelli
- Division of HIV, ID, and Global Medicine, University of California, SanFrancisco, California, USA
| | - Katerina A Christopoulos
- Division of HIV, ID, and Global Medicine, University of California, SanFrancisco, California, USA
| | - Carlos V Moreira
- Division of HIV, ID, and Global Medicine, University of California, SanFrancisco, California, USA
| | - Jennifer P Jain
- Division of Prevention Science, University of California, SanFrancisco, California, USA
| | - Nadra Lisha
- Department of Epidemiology and Biostatistics, University of California, SanFrancisco, California, USA
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, SanFrancisco, California, USA
| | - Greer A Burkholder
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham,Alabama, USA
| | - Heidi M Crane
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Adrienne E Shapiro
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Jeffrey M Jacobson
- Divsion of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio, USA
| | - Edward R Cachay
- Division of Infectious Diseases, University of California, San Diego, California, USA
| | - Kenneth H Mayer
- Department of Medicine, Harvard University and the Fenway Institute/Fenway Health, Boston, Massachusetts, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Richard D Moore
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Monica Gandhi
- Division of HIV, ID, and Global Medicine, University of California, SanFrancisco, California, USA
| | - Mallory O Johnson
- Division of Prevention Science, University of California, SanFrancisco, California, USA
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14
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Abdalla SM, Koya SF, Rosenberg SB, Stovall IB, Biermann O, Zeinali Z, Cohen GH, Ettman CK, Galea S. Pandemic stressors and mental health indicators in eight countries. Soc Psychiatry Psychiatr Epidemiol 2024; 59:585-598. [PMID: 37587229 DOI: 10.1007/s00127-023-02541-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 07/30/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE The Covid-19 pandemic has exacted a significant physical, financial, social, and emotional toll on populations throughout the world. This study aimed to document the association between pandemic stressors and mental health during the pandemic across countries that differ in cultural, geographic, economic, and demographic factors. METHODS We administered an online survey randomly in Brazil, China, Germany, Egypt, India, Indonesia, Nigeria, and the United States from September 2020 to November 2020. This survey included questions on Covid-19-related stressors as well as the Patient Health Questionnaire-2 and the Primary Care PTSD Checklist to screen for depression and post-traumatic stress disorder (PTSD) symptoms, respectively. We performed bivariable and multivariable regression analyses to assess the prevalence and odds ratios of overall depression symptoms and probable PTSD and in relation to stressors across countries. RESULTS Among 8754 respondents, 28.9% (95% CI 27.5-30.0%) experienced depression symptoms, and 5.1% (95% CI 4.5-6.0%) experienced probable PTSD. The highest prevalence of depression symptoms was in Egypt (41.3%, 95% CI 37.6-45.0%) and lowest in the United States (24.9%, 95% CI 22.3-27.7%). The highest prevalence of probable PTSD was in Brazil (7.3%, 95% CI 5.6-9.4%) and the lowest in China (1.2%, 95% CI 0.7-2.0%). Overall, experiencing six or more Covid-19-related stressors was associated with both depression symptoms (OR 1.90, 95% CI 1.46-2.48) and probable PTSD (OR 13.8, 95% CI 9.66-19.6). CONCLUSION The association between pandemic related stressors and the burden of adverse mental health indicators early in the Covid-19 pandemic transcended geographic, economic, cultural, and demographic differences between countries. The short-term and long-term impacts of the pandemic on mental health should be incorporated in efforts to tackle the consequences of Covid-19.
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Affiliation(s)
- Salma M Abdalla
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02119, USA.
- Department of Global Health, School of Public Health, Boston University, Boston, MA, USA.
| | - Shaffi Fazaludeen Koya
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02119, USA
| | - Samuel B Rosenberg
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02119, USA
| | - Isaac B Stovall
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02119, USA
| | - Olivia Biermann
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Gregory H Cohen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02119, USA
| | | | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02119, USA
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15
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Gagliardini R, Giacomelli A, Bozzi G, D'Arminio Monforte A, Tavelli A, Mazzotta V, Bruzzesi E, Cervo A, Saracino A, Mussini C, Girardi E, Cozzi-Lepri A, Antinori A. Impact of COVID-19 pandemic on retention in care of native and migrant people with HIV in the ICONA cohort. Travel Med Infect Dis 2024; 58:102691. [PMID: 38336335 DOI: 10.1016/j.tmaid.2024.102691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/19/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND COVID-19 pandemic challenged the UNAIDS 90-90-90 targets. How the COVID-19 pandemic affected HIV retention in care and whether it has disproportionally affected migrant people with HIV (PWH) remained to be investigated. METHODS PWH in ICONA Cohort in follow-up in each of the study periods were included: 01/09/2019-29/02/2020 (pandemic period) and 01/03/2018-31/08/2018 (historical period, as a control). Risk of temporary loss to follow-up (LTFU, defined as no data recorded for a person for one year) was analyzed by logistic regression, with migrant status as the main exposure variable. Difference in difference (DID) analysis was applied to evaluate the effect of COVID-19 pandemic in the different risk of LTFU between natives and migrants. RESULTS 8864 (17.1% migrants) and 8071 (16.8% migrants) PWH constituted the pandemic and the historical period population, respectively. Proportion of PWH defined as LTFU in the pandemic period was 10.5% in native and 19.6% in migrant PWH. After controlling for age, sex and geographical location of enrolling site, risk of temporary LTFU was higher for migrants than native PWH [adjusted odds ratio 1.85 (95%CI 1.54-2.22)] in pandemic period. In PWH contributing to both periods, LTFU was 9.0% (95% CI 8.3-9.8) in natives vs 17.0% (95% CI 14.7-19.4) in migrants during the pandemic. Instead, LTFU was 1.2% (95%CI 0.9, 1.5) in natives vs 2.2% (95% CI 1.3-3.1) in migrants during the historical period, with a resulting DID of 7.0% (95% CI 4.4-9.6). CONCLUSIONS A greater proportion of LTFU in migrant PWH was observed in both periods, which remained unaltered over time. Interventions to reduce LTFU of migrants are necessary.
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Affiliation(s)
- Roberta Gagliardini
- Clinical and Research Infectious Diseases Department, National Institute of Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Giacomelli
- III Infectious Disease Unit, ASST-Fatebenefratelli Sacco, Milan, Italy
| | - Giorgio Bozzi
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | - Valentina Mazzotta
- Clinical and Research Infectious Diseases Department, National Institute of Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Elena Bruzzesi
- UO Malattie Infettive, IRCCS Ospedale San Raffaele, Italy
| | - Adriana Cervo
- Division of Infectious Diseases, University of Modena, Modena, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, University Hospital, University of Bari, Bari, Italy
| | - Cristina Mussini
- Division of Infectious Diseases, University of Modena, Modena, Italy
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Andrea Antinori
- Clinical and Research Infectious Diseases Department, National Institute of Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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16
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Wahome E, Otieno FO, Kimani J, Boyd A, Okall D, Nzioka J, Gichuru E, van der Elst E, Mehta SD, Bailey RC, Graham SM, Sanders EJ. Impact of coronavirus disease 2019-related clinic closures on HIV incidence in young adult MSM and transgender women in Kenya. AIDS 2024; 38:407-413. [PMID: 37939103 PMCID: PMC10842664 DOI: 10.1097/qad.0000000000003782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Little is known about the impact that the COVID-19 pandemic had on risk of HIV acquisition in sub-Saharan Africa. We assessed the impact of COVID-19-related clinic closures on HIV incidence in a cohort of gay, bisexual, and other men who have sex with men (MSM) and transgender women in Kenya. METHODS MSM and transgender women enrolled in a prospective, multicentre cohort study were followed quarterly for HIV testing, behaviour assessments, and risk. We estimated the HIV incidence rate and its 95% credible intervals (CrI) among participants who were HIV-negative before COVID-19-related clinic closure, comparing incidence rate and risk factors associated with HIV acquisition before vs. after clinic reopening, using a Bayesian Poisson model with weakly informative priors. RESULTS A total of 690 (87%) participants returned for follow-up after clinic reopening (total person-years 664.3 during clinic closure and 1013.3 after clinic reopening). HIV incidence rate declined from 2.05/100 person-years (95% CrI = 1.22-3.26, n = 14) during clinic closures to 0.96/100 person-years (95% CrI = 0.41-2.07, n = 10) after clinic reopening (IRR = 0.47, 95% CrI = 0.20-1.01). The proportion of participants reporting hazardous alcohol use and several sexual risk behaviours was higher during clinic closures than after clinic reopening. In multivariable analysis adjusting for study site and participant characteristics, HIV incidence was lower after clinic reopening (IRR 0.57, 95% CrI = 0.23-1.33). Independent risk factors for HIV acquisition included receptive anal intercourse (IRR 1.94, 95% CrI = 0.88-4.80) and perceived risk of HIV (IRR 3.03, 95% CRI = 1.40-6.24). CONCLUSION HIV incidence during COVID-19-related clinic closures was moderately increased and reduced after COVID-19 restrictions were eased. Ensuring access to services for key populations is important during public health emergencies.
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Affiliation(s)
| | | | - Joshua Kimani
- Sex Worker Outreach Program (SWOP), and Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Anders Boyd
- Public Health Service of Amsterdam, Department of Infectious Diseases
- Stichting HIV Monitoring
- Amsterdam UMC location University of Amsterdam, Infectious Diseases
| | - Duncan Okall
- Sex Worker Outreach Program (SWOP), and Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Joseph Nzioka
- Sex Worker Outreach Program (SWOP), and Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | | | - Elise van der Elst
- KEMRI/Wellcome Trust Research Programme, Kilifi
- Department of Global Health, University of Amsterdam, Amsterdam, Netherlands
| | | | - Robert C. Bailey
- Nyanza Reproductive Health Society, Kisumu
- University of Illinois at Chicago, IL
| | - Susan M. Graham
- KEMRI/Wellcome Trust Research Programme, Kilifi
- Nyanza Reproductive Health Society, Kisumu
- University of Washington, Seattle, WA, USA
| | - Eduard J. Sanders
- KEMRI/Wellcome Trust Research Programme, Kilifi
- Department of Global Health, University of Amsterdam, Amsterdam, Netherlands
- University of Oxford, Headington, UK
- The Aurum Institute, Johannesburg, South Africa
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Pantelic M, Coombes Z, Barnard P, Hartshorn J, Caswell G, Sharma A, Whitbread J, Nyikavaranda P, Llewellyn C. "HIV has taught us that you can survive anything": findings from auto-ethnographic video diaries exploring resilience among people living with HIV during the Covid pandemic in five countries. AIDS Care 2024; 36:351-357. [PMID: 37128186 DOI: 10.1080/09540121.2023.2206606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/18/2023] [Indexed: 05/03/2023]
Abstract
This study aimed to elucidate the intrinsic and extrinsic resilience resources among people living with HIV (PLWH) during the Covid pandemic. Autoethnographic video diaries from 29 PLWH from Argentina, UK, Philippines, Zimbabwe, and Trinidad and Tobago were included. Data were thematically analysed and validated with community partners and a video was co-produced. PLWH displayed a readiness to adopt healthy behaviours and engage in optimistic and constructive thinking about the future. Hobbies and daily activities, supportive relationships with peers living with HIV, family and friends, opportunities to mobilise and contribute to their communities in meaningful ways, supportive healthcare providers and reliable access to antiretroviral treatment helped foster psychological resilience among PLWH. The extrinsic resilience resources also supported positive physical health outcomes among PLWH through improved medication adherence.
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Affiliation(s)
- Marija Pantelic
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Zara Coombes
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Poppy Barnard
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | | | - Georgina Caswell
- Global Network of People Living with HIV, Cape Town, South Africa
| | - Aditi Sharma
- Global Network of People Living with HIV, Cape Town, South Africa
| | | | | | - Carrie Llewellyn
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK
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18
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Jung M. Physical Distancing for Gay Men from People Living with HIV During the COVID-19 Pandemic. JOURNAL OF HOMOSEXUALITY 2024:1-19. [PMID: 38319682 DOI: 10.1080/00918369.2024.2314031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
The fear of COVID-19 can exacerbate social stigma and prejudice against individuals living with HIV (PLWH). This research delved into the behaviors of MSM (men who have sex with men) who practice physical-distancing from PLWH. Data from 878 respondents were collected through a web survey conducted on Korea's largest LGBT portal site over one month in July 2022. The study examined various independent variables encompassing socioeconomic characteristics, health status, media consumption habits, and homosexual attributes of MSM. The dependent variable assessed was the extent of physical-distancing perceived by MSMs without HIV toward PLWH. The statistical analysis employed nested regression models. In Model I, it was observed that physical-distancing from PLWH decreased as the age and education level of the respondent increased. In Model II, a decrease in physical-distancing was noted among respondents with underlying health conditions. Model III indicated that increased use of traditional media corresponded to greater physical-distancing from PLWH. Lastly, Model IV revealed a reduction in physical-distancing when the respondent was themselves a person living with HIV. This study underscores the existence of physical-distancing toward PLWH within the gay community. Consequently, fostering solidarity and providing support becomes imperative to prevent the isolation of PLWH within this community.
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Affiliation(s)
- Minsoo Jung
- Department of Health Science, Dongduk Women's University, Seoul, South Korea
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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19
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She B, Mangal TD, Adjabeng AY, Colbourn T, Collins JH, Janoušková E, Li Lin I, Mnjowe E, Mohan S, Molaro M, Phillips AN, Revill P, Smith RM, Twea PD, Nkhoma D, Manthalu G, Hallett TB. The changes in health service utilisation in Malawi during the COVID-19 pandemic. PLoS One 2024; 19:e0290823. [PMID: 38232073 PMCID: PMC10793884 DOI: 10.1371/journal.pone.0290823] [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: 02/10/2023] [Accepted: 08/17/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic and the restriction policies implemented by the Government of Malawi may have disrupted routine health service utilisation. We aimed to find evidence for such disruptions and quantify any changes by service type and level of health care. METHODS We extracted nationwide routine health service usage data for 2015-2021 from the electronic health information management systems in Malawi. Two datasets were prepared: unadjusted and adjusted; for the latter, unreported monthly data entries for a facility were filled in through systematic rules based on reported mean values of that facility or facility type and considering both reporting rates and comparability with published data. Using statistical descriptive methods, we first described the patterns of service utilisation in pre-pandemic years (2015-2019). We then tested for evidence of departures from this routine pattern, i.e., service volume delivered being below recent average by more than two standard deviations was viewed as a substantial reduction, and calculated the cumulative net differences of service volume during the pandemic period (2020-2021), in aggregate and within each specific facility. RESULTS Evidence of disruptions were found: from April 2020 to December 2021, services delivered of several types were reduced across primary and secondary levels of care-including inpatient care (-20.03% less total interactions in that period compared to the recent average), immunisation (-17.61%), malnutrition treatment (-34.5%), accidents and emergency services (-16.03%), HIV (human immunodeficiency viruses) tests (-27.34%), antiretroviral therapy (ART) initiations for adults (-33.52%), and ART treatment for paediatrics (-41.32%). Reductions of service volume were greatest in the first wave of the pandemic during April-August 2020, and whereas some service types rebounded quickly (e.g., outpatient visits from -17.7% to +3.23%), many others persisted at lower level through 2021 (e.g., under-five malnutrition treatment from -15.24% to -42.23%). The total reduced service volume between April 2020 and December 2021 was 8 066 956 (-10.23%), equating to 444 units per 1000 persons. CONCLUSION We have found substantial evidence for reductions in health service delivered in Malawi during the COVID-19 pandemic which may have potential health consequences, the effect of which should inform how decisions are taken in the future to maximise the resilience of healthcare system during similar events.
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Affiliation(s)
- Bingling She
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Tara D. Mangal
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Anna Y. Adjabeng
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Tim Colbourn
- Institute for Global Health, University College London, London, United Kingdom
| | - Joseph H. Collins
- Institute for Global Health, University College London, London, United Kingdom
| | - Eva Janoušková
- Institute for Global Health, University College London, London, United Kingdom
| | - Ines Li Lin
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Sakshi Mohan
- Centre for Health Economics, University of York, York, United Kingdom
| | - Margherita Molaro
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Andrew N. Phillips
- Institute for Global Health, University College London, London, United Kingdom
| | - Paul Revill
- Centre for Health Economics, University of York, York, United Kingdom
| | - Robert Manning Smith
- Centre for Advanced Spatial Analysis (CASA), University College London, London, United Kingdom
| | - Pakwanja D. Twea
- Department of Planning and Policy Development, Ministry of Health and Population, Lilongwe, Malawi
| | - Dominic Nkhoma
- College of Medicine, University of Malawi, Lilongwe, Malawi
| | - Gerald Manthalu
- Department of Planning and Policy Development, Ministry of Health and Population, Lilongwe, Malawi
| | - Timothy B. Hallett
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
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Mupambireyi Z, Cowan FM, Chappell E, Chimwaza A, Manika N, Wedderburn CJ, Gannon H, Gibb T, Heys M, Fitzgerald F, Chimhuya S, Gibb D, Ford D, Mushavi A, Bwakura-Dangarembizi M. "Getting pregnant during COVID-19 was a big risk because getting help from the clinic was not easy": COVID-19 experiences of women and healthcare providers in Harare, Zimbabwe. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002317. [PMID: 38190418 PMCID: PMC10773929 DOI: 10.1371/journal.pgph.0002317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024]
Abstract
The COVID-19 pandemic and associated measures may have disrupted delivery of maternal and neonatal health services and reversed the progress made towards dual elimination of mother-to-child transmission of HIV and syphilis in Zimbabwe. This qualitative study explores the impact of the pandemic on the provision and uptake of prevention of mother-to-child transmission (PMTCT) services from the perspectives of women and maternal healthcare providers. Longitudinal in-depth interviews were conducted with 20 pregnant and breastfeeding women aged 20-39 years living with HIV and 20 healthcare workers in two maternity polyclinics in low-income suburbs of Harare, Zimbabwe. Semi-structured interviews were held after the second and third waves of COVID-19 in March and November 2021, respectively. Data were analysed using a modified grounded theory approach. While eight antenatal care contacts are recommended by Zimbabwe's Ministry of Health and Child Care, women reported only being able to access two contacts. Although HIV testing, antiretroviral therapy (ART) refills and syphilis screening services were accessible at first contact, other services such as HIV-viral load monitoring and enhanced adherence counselling were not available for those on ART. Closure of clinics and shortened operating hours during the second COVID-19 wave resulted in more antenatal bookings occurring later during pregnancy and more home deliveries. Six of the 20 (33%) interviewed women reported giving birth at home, assisted by untrained traditional midwives as clinics were closed. Babies delivered at home missed ART prophylaxis and HIV testing at birth despite being HIV-exposed. Although women faced multiple challenges, they continued to attempt to access services after delivery. These findings underline the importance of investing in robust health systems that can respond to emergency situations to ensure continuity of essential HIV prevention, treatment, and care services.
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Affiliation(s)
- Zivai Mupambireyi
- Department of Children and Adolescents Centre for Sexual Health HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Frances M. Cowan
- Department of Children and Adolescents Centre for Sexual Health HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elizabeth Chappell
- Medical Research Council (MRC) Clinical Trials Unit at University College London, London, United Kingdom
| | - Anesu Chimwaza
- Department of AIDS/Tuberculosis, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Ngoni Manika
- Department of AIDS/Tuberculosis, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Catherine J. Wedderburn
- Medical Research Council (MRC) Clinical Trials Unit at University College London, London, United Kingdom
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Hannah Gannon
- Institute of Child Health, University College London, London, United Kingdom
| | - Tom Gibb
- Picturing Health, London, United Kingdom
| | - Michelle Heys
- Institute of Child Health, University College London, London, United Kingdom
| | - Felicity Fitzgerald
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Simbarashe Chimhuya
- Department of Child and Adolescent Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Diana Gibb
- Medical Research Council (MRC) Clinical Trials Unit at University College London, London, United Kingdom
| | - Deborah Ford
- Medical Research Council (MRC) Clinical Trials Unit at University College London, London, United Kingdom
| | - Angela Mushavi
- Department of AIDS/Tuberculosis, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Mutsa Bwakura-Dangarembizi
- Department of Child and Adolescent Health, Faculty of Medicine and Health Sciences University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
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21
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Korenromp EL, Sabin K, Stover J, Brown T, Johnson LF, Martin-Hughes R, ten Brink D, Teng Y, Stevens O, Silhol R, Arias-Garcia S, Kimani J, Glaubius R, Vickerman P, Mahy M. New HIV Infections Among Key Populations and Their Partners in 2010 and 2022, by World Region: A Multisources Estimation. J Acquir Immune Defic Syndr 2024; 95:e34-e45. [PMID: 38180737 PMCID: PMC10769164 DOI: 10.1097/qai.0000000000003340] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Previously, The Joint United Nations Programme on HIV/AIDS estimated proportions of adult new HIV infections among key populations (KPs) in the last calendar year, globally and in 8 regions. We refined and updated these, for 2010 and 2022, using country-level trend models informed by national data. METHODS Infections among 15-49 year olds were estimated for sex workers (SWs), male clients of female SW, men who have sex with men (MSM), people who inject drugs (PWID), transgender women (TGW), and non-KP sex partners of these groups. Transmission models used were Goals (71 countries), AIDS Epidemic Model (13 Asian countries), Optima (9 European and Central Asian countries), and Thembisa (South Africa). Statistical Estimation and Projection Package fits were used for 15 countries. For 40 countries, new infections in 1 or more KPs were approximated from first-time diagnoses by the mode of transmission. Infection proportions among nonclient partners came from Goals, Optima, AIDS Epidemic Model, and Thembisa. For remaining countries and groups not represented in models, median proportions by KP were extrapolated from countries modeled within the same region. RESULTS Across 172 countries, estimated proportions of new adult infections in 2010 and 2022 were both 7.7% for SW, 11% and 20% for MSM, 0.72% and 1.1% for TGW, 6.8% and 8.0% for PWID, 12% and 10% for clients, and 5.3% and 8.2% for nonclient partners. In sub-Saharan Africa, proportions of new HIV infections decreased among SW, clients, and non-KP partners but increased for PWID; elsewhere these groups' 2010-to-2022 differences were opposite. For MSM and TGW, the proportions increased across all regions. CONCLUSIONS KPs continue to have disproportionately high HIV incidence.
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Affiliation(s)
- Eline L. Korenromp
- Data for Impact Department, The Joint United Nations Program on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Keith Sabin
- Data for Impact Department, The Joint United Nations Program on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - John Stover
- Center for Modeling, Planning and Policy Analysis, Avenir Health, Glastonbury, CT
| | - Tim Brown
- Research Program, East-West Center, Honolulu, HI
| | - Leigh F. Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Rowan Martin-Hughes
- Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia
| | - Debra ten Brink
- Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia
| | - Yu Teng
- Center for Modeling, Planning and Policy Analysis, Avenir Health, Glastonbury, CT
| | - Oliver Stevens
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Romain Silhol
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- HIV Prevention Trials Network Modelling Centre, Imperial College London, London, United Kingdom
| | - Sonia Arias-Garcia
- Data for Impact Department, The Joint United Nations Program on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
- University of Nairobi, Nairobi, Kenya; and
| | - Robert Glaubius
- Center for Modeling, Planning and Policy Analysis, Avenir Health, Glastonbury, CT
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Mary Mahy
- Data for Impact Department, The Joint United Nations Program on HIV/AIDS (UNAIDS), Geneva, Switzerland
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22
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Wang Y, Lai Y. The Interrelationship between HIV Infection and COVID-19: A Review of the Literature. Curr HIV Res 2024; 22:6-15. [PMID: 38151836 DOI: 10.2174/011570162x282739231222062830] [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: 10/15/2023] [Revised: 11/26/2023] [Accepted: 12/04/2023] [Indexed: 12/29/2023]
Abstract
The Corona Virus Disease 2019 (COVID-19) pandemic resulting from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to significant morbidity and mortality in patients and put a strain on healthcare systems worldwide. The clinical characteristics and results of COVID-19 in immunosuppressed patients, such as people living with human immunodeficiency virus (PLWH), considered at higher risk of severe disease, are not well-characterized. Accumulated evidence indicates that COVID-19 and the human immunodeficiency virus (HIV) can interact in various ways. This review explored the similarities and differences in virology between SARS-CoV-2 and HIV, the effect of the COVID-19 vaccine on PLWH, the impact of the COVID-19 pandemic on PLWH care and prevention, and the influence of HIV-related factors on COVID-19. Discovering the potential link between HIV and COVID-19 may provide a novel way to avoid the factors of HIV and SARS-CoV-2 co-infection and advance future research.
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Affiliation(s)
- Yiyu Wang
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Yu Lai
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
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23
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Mude W, Mwenyango H, Preston R, O'Mullan C, Vaughan G, Jones G. HIV Testing Disruptions and Service Adaptations During the COVID-19 Pandemic: A Systematic Literature Review. AIDS Behav 2024; 28:186-200. [PMID: 37548796 PMCID: PMC10803448 DOI: 10.1007/s10461-023-04139-4] [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] [Accepted: 07/12/2023] [Indexed: 08/08/2023]
Abstract
Access to treatment and care in safe clinical settings improves people's lives with HIV. The COVID-19 pandemic disrupted vital HIV programs and services, increasing the risk of adverse health outcomes for people with HIV and HIV transmission rates in the community. This systematic literature review provides a meta-analysis of HIV testing disruptions and a synthesis of HIV/AIDS services adapted during COVID-19. We searched scholarly databases from 01 January 2020 to 30 June 2022 using key terms on HIV testing rates and services during the COVID-19 pandemic. The process of how the included articles were identified, selected, appraised, and synthesised was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included 17 articles that reported changes in HIV testing during the COVID-19 pandemic and 22 that reported adaptations in HIV/AIDS services. We found that HIV testing decreased by 37% during the search period because of the COVID-19 pandemic. Service providers adopted novel strategies to support remote service delivery by expanding community antiretroviral therapy dispensing, setting up primary care outreach points, and instituting multi-month dispensing services to sustain client care. Therefore, service providers and policymakers should explore alternative strategies to increase HIV testing rates impacted by COVID-19 and leverage funding to continue providing the identified adapted services.
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Affiliation(s)
- William Mude
- School of Health Medical and Applied Sciences, Central Queensland University, Cairns Campus, 42-52 Abbott Street & Shields Street, Cairns, QLD, 4870, Australia.
| | - Hadijah Mwenyango
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4BN, UK
| | - Robyn Preston
- School of Health Medical and Applied Sciences, Central Queensland University, Townsville Campus, Townsville, Australia
| | - Catherine O'Mullan
- School of Health Medical and Applied Sciences, Central Queensland University, Bundaberg Campus, Bundaberg, Australia
| | - Geraldine Vaughan
- School of Health Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, Australia
| | - Gary Jones
- Cohort Doctoral Studies Program, James Cook University, Cairns, Australia
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24
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Skovdal M, Maunzagona T, Dzamatira F, Magoge-Mandizvidza P, Maswera R, Moyo BK, Nyamukapa C, Gregson S. 'Condoms are hard to get by': access to HIV prevention methods during lockdown of the COVID-19 epidemic in eastern Zimbabwe. Glob Health Action 2023; 16:2206207. [PMID: 37133235 PMCID: PMC10158550 DOI: 10.1080/16549716.2023.2206207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND In the early phase of the coronavirus disease 2019 (COVID-19) pandemic, health services were disrupted worldwide, including HIV prevention services. While some studies have begun to document the effects of COVID-19 on HIV prevention, little has been done to qualitatively examine how lockdown measures were experienced and perceived to affect access to HIV prevention methods in sub-Saharan Africa. OBJECTIVES To explore how the COVID-19 pandemic was perceived to affect access to HIV prevention methods in eastern Zimbabwe. METHOD This article draws on qualitative data from the first three data collection points (involving telephone interviews, group discussions, and photography) of a telephone and WhatsApp-enabled digital ethnography. Data were collected from 11 adolescent girls and young women and five men over a 5-month period (March-July 2021). The data were analysed thematically. RESULTS Participants reported widespread interruption to their condom supply when beerhalls were shut down as part of a nationwide lockdown. Restrictions in movement meant that participants who could afford to buy condoms from larger supermarkets or pharmacies were unable to. Additionally, the police reportedly refused to issue letters granting permission to travel for the purpose of accessing HIV prevention services. The COVID-19 pandemic was also described to obstruct the demand (fear of COVID-19, movement restrictions) and supply (de-prioritised, stock-outs) for HIV prevention services. Nonetheless, under certain formal and informal circumstances, such as accessing other and more prioritised health services, or 'knowing the right people', some participants were able to access HIV prevention methods. CONCLUSION People at risk of HIV experienced the COVID-19 epidemic in Zimbabwe as disruptive to access to HIV prevention methods. While the disruptions were temporary, they were long enough to catalyse local responses, and to highlight the need for future pandemic response capacities to circumvent a reversal of hard-won gains in HIV prevention.
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Affiliation(s)
- Morten Skovdal
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tanyaradzwa Maunzagona
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Freedom Dzamatira
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Phyllis Magoge-Mandizvidza
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rufurwokuda Maswera
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Constance Nyamukapa
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Simon Gregson
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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25
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Aluisio AR, Bergam SJ, Sugut J, Kinuthia J, Bosire R, Ochola E, Ngila B, Guthrie KM, Liu T, Mugambi M, Katz DA, Farquhar C, Mello MJ. HIV self-testing acceptability among injured persons seeking emergency care in Nairobi, Kenya. Glob Health Action 2023; 16:2157540. [PMID: 36628574 PMCID: PMC9848354 DOI: 10.1080/16549716.2022.2157540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/07/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Emergency department-based HIV self-testing (ED-HIVST) could increase HIV-testing services to high-risk, under-reached populations. OBJECTIVES This study sought to understand the injury patient acceptability of ED-HIVST. METHODS Injury patients presenting to the Kenyatta National Hospital Accident and Emergency Department were enrolled from March to May 2021. Likert item data on HIVST assessing domains of general acceptability, personal acceptability, and acceptability to distribute to social and/or sexual networks were collected. Ordinal regression was performed yielding adjusted odds ratios (aOR) to identify characteristics associated with high HIVST acceptability across domains. RESULTS Of 600 participants, 88.7% were male, and the median age was 29. Half reported having primary care providers (PCPs) and 86.2% reported prior HIV testing. For each Likert item, an average of 63.5% of the participants reported they 'Agree Completely' with positive statements about ED-HIVST in general, for themselves, and for others. In adjusted analysis for general acceptability, those <25 (aOR = 1.67, 95%CI:1.36-2.08) and with prior HIV testing (aOR = 1.68, 95%CI:1.27-2.21) had greater odds of agreeing completely. For personal acceptability, those with a PCP (aOR = 3.31, 95%CI:2.72-4.03) and prior HIV testing (aOR = 1.83, 95%CI:1.41-2.38) had greater odds of agreeing completely. For distribution acceptability, participants with a PCP (aOR = 2.42, 95%CI:2.01-2.92) and prior HIV testing (aOR = 1.79, 95%CI: 1.38-2.33) had greater odds of agreeing completely. CONCLUSIONS ED-HIVST is perceived as highly acceptable, and young people with prior testing and PCPs had significantly greater favourability. These data provide a foundation for ED-HIVST programme development in Kenya.
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Affiliation(s)
- Adam R. Aluisio
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Scarlett J. Bergam
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Janet Sugut
- Department of Accident and Emergency, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Rose Bosire
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Eric Ochola
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Beatrice Ngila
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Kate M. Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | | | - David A. Katz
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Michael J. Mello
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
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26
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Brault MA, Linnander EL, Ginindza TM, Mabuza K, Christie S, Canavan ME, Jones A, Desai MM. Assessing changes in adolescent girls' and young women's sexual and reproductive health service utilisation following a COVID-19 lockdown in eSwatini. Glob Health Action 2023; 16:2243760. [PMID: 37565704 PMCID: PMC10424588 DOI: 10.1080/16549716.2023.2243760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
The effects of COVID-19-associated restrictions on youth sexual and reproductive health (SRH) care during the pandemic remain unclear, particularly in sub-Saharan Africa. This study uses interrupted time series analyses to assess changes in SRH care utilisation (including visits for HIV testing and treatment, family planning, and antenatal care) adolescent girls' and young women's (AGYW; aged 15-24 years old) in eSwatini following COVID-19 lockdown beginning in March 2020. SRH utilisation data from 32 clinics in the Manzini region that remained open throughout the 2020 COVID-19 period were extracted from eSwatini's electronic health record system. We tabulated and graphed monthly visits (both overall and by visit type) by AGYW during the two-year period between January 2019 and December 2020. Despite the March to September 2020 lockdown, we did not detect significant changes in monthly visit trends from 2019 to 2020. Our findings suggest little change to AGYW's SRH utilisation in eSwatini during the 2020 COVID-19 lockdown period.
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Affiliation(s)
- Marie A. Brault
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, San Antonio, TX, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Erika L. Linnander
- Global Health Leadership Initiative, Yale School of Public Health, New Haven, CT, USA
- Department of Health Policy & Management, Yale School of Public Health, New Haven, CT, USA
| | - Thokozani M. Ginindza
- Health Management Information Systems (HMIS), eSwatini Ministry of Health, Mbabane, eSwatini
| | | | - Sarah Christie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- School of Public Health, University of the Western Cape, Bellville, Republic of South Africa
| | - Maureen E. Canavan
- Yale School of Medicine, Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT, USA
| | - Anastasia Jones
- Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, San Antonio, TX, USA
| | - Mayur M. Desai
- Global Health Leadership Initiative, Yale School of Public Health, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
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27
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Delabre RM, Di Ciaccio M, Lorente N, Villes V, Castro Avila J, Yattassaye A, Bonifaz C, Ben Moussa A, Sikitu IZ, Khodabocus N, Freitas R, Spire B, Veras MA, Sagaon-Teyssier L, Girard G, Roux P, Velter A, Delpech V, Ghosn J, Riegel L, Rojas Castro D. Impact of the COVID-19 Health Crisis on Key Populations at Higher Risk for, or Living With, HIV or Hepatitis C Virus and People Working With These Populations: Multicountry Community-Based Research Study Protocol (EPIC Program). JMIR Res Protoc 2023; 12:e45204. [PMID: 38096016 PMCID: PMC10755648 DOI: 10.2196/45204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/18/2023] [Accepted: 08/10/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Information concerning the impact of the COVID-19 health crisis on populations most affected by HIV and hepatitis C virus (HCV; or key populations [KP]), and those working with these populations in community settings, is limited. Community-based organizations working in the field of HIV and viral hepatitis are well placed to identify and meet the new needs of KP owing to the health crisis. OBJECTIVE This study aims to describe the development and implementation of an exploratory and descriptive multicountry, community-based research program, EPIC (Enquêtes Pour évaluer l'Impact de la crise sanitaire covid en milieu Communautaire), within an international network of community-based organizations involved in the response to HIV and viral hepatitis. The EPIC program aimed to study the impact of the COVID-19 health crisis on KP or people living with HIV or HCV and people working with these populations at the community level (community health workers [CHWs]) and to identify the key innovations and adaptations in HIV and HCV services. METHODS A general protocol and study documents were developed and shared within the Coalition PLUS network. The protocol had a built-in flexibility that allowed participating organizations to adapt the study to local needs in terms of the target population and specific themes of interest. Data were collected using surveys or interviews. RESULTS From July 2020 to May 2022, a total of 79 organizations participated in the EPIC program. Across 32 countries, 118 studies were conducted: 66 quantitative (n=12,060 among KP or people living with HIV or people living with HCV and n=811 among CHWs) and 52 qualitative (n=766 among KP or people living with HIV or people living with HCV and n=136 among CHWs). CONCLUSIONS The results of the EPIC program will provide data to describe the impact of the health crisis on KP and CHWs and identify their emerging needs. Documentation of innovative solutions that were put into place in this context may help improve the provision of services after COVID-19 and for future health crises. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45204.
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Affiliation(s)
| | | | - Nicolas Lorente
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Agència de Salut Pública de Catalunya, Badalona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Virginie Villes
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | | | - Adam Yattassaye
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Association pour la Résilience des Communautés pour l'Accès au Développement et à la Santé PLUS, Bamako, Mali
| | - César Bonifaz
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Corporación Kimirina, Quito, Ecuador
| | - Amal Ben Moussa
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Association de Lutte Contre le Sida, Casablanca, Morocco
| | - Ingrid-Zaïre Sikitu
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Association Nationale de Soutien aux Séropositifs et Malades du Sida, Bujumbura, Burundi
| | - Niloufer Khodabocus
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Prévention Information Lutte contre le SIDA, Port Louis, Mauritius
| | - Rosa Freitas
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Grupo de Ativistas em Tratamentos, Lisbon, Portugal
| | - Bruno Spire
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
| | | | - Luis Sagaon-Teyssier
- Association pour la Résilience des Communautés pour l'Accès au Développement et à la Santé PLUS, Bamako, Mali
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
| | - Gabriel Girard
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
| | - Perrine Roux
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
| | - Annie Velter
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
- Santé Publique France, Saint-Maurice, France
| | - Valérie Delpech
- Director of Population and Public Health Directorate, North Coast North South Wales, Australia
| | - Jade Ghosn
- Assistance Publique - Hôpitaux de Paris Nord, Service des Maladies Infectieuses, Center Hospitalier Universitaire Bichât - Claude Bernard, Paris, France
- Infection, Antimicrobials, Modelling, Evolution, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1137, Université Paris Cité, Paris, France
| | - Lucas Riegel
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | - Daniela Rojas Castro
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
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Alonso D, Vallès X. A potential transition from a concentrated to a generalized HIV epidemic: the case of Madagascar. Infect Dis Poverty 2023; 12:112. [PMID: 38057918 DOI: 10.1186/s40249-023-01164-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND HIV expansion is controlled by a range of interrelated factors, including the natural history of HIV infection and socio-economical and structural factors. However, how they dynamically interact in particular contexts to drive a transition from concentrated HIV epidemics in vulnerable groups to generalized epidemics is poorly understood. We aim to explore these mechanisms, using Madagascar as a case-study. METHODS We developed a compartmental dynamic model using available data from Madagascar, a country with a contrasting concentrated epidemic, to explore the interaction between these factors with special consideration of commercial and transactional sex as HIV-infection drivers. RESULTS The model predicts sigmoidal-like prevalence curves with turning points within years 2020-2022, and prevalence reaching stabilization by 2033 within 9 to 24% in the studied (10 out of 11) cities, similar to high-prevalence regions in Southern Africa. The late/slow introduction of HIV and circumcision, a widespread traditional practice in Madagascar, could have slowed down HIV propagation, but, given the key interplay between risky behaviors associated to young women and acute infections prevalence, mediated by transactional sex, the protective effect of circumcision is currently insufficient to contain the expansion of the disease in Madagascar. CONCLUSIONS These results suggest that Madagascar may be experiencing a silent transition from a concentrated to a generalized HIV epidemic. This case-study model could help to understand how this HIV epidemic transition occurs.
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Affiliation(s)
- David Alonso
- Computational and Theoretical Ecology, Spanish Council for Scientific Research (CEAB-CSI)C, C/Access Cala Francesc, 14, 17300, Blanes, Spain
| | - Xavier Vallès
- International Health Program (PROSICS), North Metropolitan Health Area From Barcelona, Hospital Universitari Germans Trias i Pujol, Passatge dels Encants, s/n, 08914, Badalona, Catalonia, Spain.
- Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, C/Canyet s/n, 08916, Badalona, Spain.
- Fundació Lluita contra les Infeccions, C/Canyet s/n, 08916, Badalona, Spain.
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Puryear SB, Mwangwa F, Opel F, Chamie G, Balzer LB, Kabami J, Ayieko J, Owaraganise A, Kakande E, Agengo G, Bukusi E, Kabageni S, Omoding D, Bacon M, Schrom J, Woolf‐King S, Petersen ML, Havlir DV, Kamya M, Hahn JA. Effect of a brief alcohol counselling intervention on HIV viral suppression and alcohol use among persons with HIV and unhealthy alcohol use in Uganda and Kenya: a randomized controlled trial. J Int AIDS Soc 2023; 26:e26187. [PMID: 38054564 PMCID: PMC10698822 DOI: 10.1002/jia2.26187] [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: 04/05/2023] [Revised: 09/25/2023] [Accepted: 10/09/2023] [Indexed: 12/07/2023] Open
Abstract
INTRODUCTION Unhealthy alcohol use significantly contributes to viral non-suppression among persons with HIV (PWH). It is unknown whether brief behavioural interventions to reduce alcohol use can improve viral suppression among PWH with unhealthy alcohol use in sub-Saharan Africa (SSA). METHODS As part of the SEARCH study (NCT04810650), we conducted an individually randomized trial in Kenya and Uganda of a brief, skills-based alcohol intervention among PWH with self-reported unhealthy alcohol use (Alcohol Use Disorders Identification Test-Consumption [AUDIT-C], prior 3 months, ≥3/female; ≥4/male) and at risk of viral non-suppression, defined as either recent HIV viral non-suppression (≥400 copies/ml), missed visits, out of care or new diagnosis. The intervention included baseline and 3-month in-person counselling sessions with interim booster phone calls every 3 weeks. The primary outcome was HIV viral suppression (<400 copies/ml) at 24 weeks, and the secondary outcome was unhealthy alcohol use, defined by AUDIT-C or phosphatidylethanol (PEth), an alcohol biomarker, ≥50 ng/ml at 24 weeks. RESULTS Between April and September 2021, 401 persons (198 intervention, 203 control) were enrolled from HIV clinics in Uganda (58%) and Kenya (27%) and alcohol-serving venues in Kenya (15%). At baseline, 60% were virally suppressed. Viral suppression did not differ between arms at 24 weeks: suppression was 83% in intervention and 82% in control arms (RR: 1.01, 95% CI: 0.93-1.1). Among PWH with baseline viral non-suppression, 24-week suppression was 73% in intervention and 64% in control arms (RR 1.15, 95% CI: 0.93-1.43). Unhealthy alcohol use declined from 98% at baseline to 73% in intervention and 84% in control arms at 24 weeks (RR: 0.86, 95% CI: 0.79-0.94). Effects on unhealthy alcohol use were stronger among women (RR 0.70, 95% CI: 0.56-0.88) than men (RR 0.93, 95% CI: 0.85-1.01) and among participants with a baseline PEth⩽200 ng/ml (RR 0.68, 95% CI: 0.53-0.87) versus >200 ng/ml (RR 0.97, 95% CI: 0.92-1.02). CONCLUSIONS In a randomized trial of 401 PWH with unhealthy alcohol use and risk for viral non-suppression, a brief alcohol intervention reduced unhealthy alcohol use but did not affect viral suppression at 24 weeks. Brief alcohol interventions have the potential to improve the health of PWH in SSA by reducing alcohol use, a significant driver of HIV-associated co-morbidities.
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Affiliation(s)
- Sarah B. Puryear
- Division of HIV, ID and Global MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Fred Opel
- Kenya Medical Research InstituteKisumuKenya
| | - Gabriel Chamie
- Division of HIV, ID and Global MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Laura B. Balzer
- Division of BiostatisticsSchool of Public HealthUniversity of California BerkeleyBerkeleyCaliforniaUSA
| | - Jane Kabami
- Infectious Diseases Research CollaborationMbararaUganda
| | | | | | | | | | | | | | | | - Melanie Bacon
- National Institute of Allergy and Infectious DiseasesBethesdaMarylandUSA
| | - John Schrom
- Division of HIV, ID and Global MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Maya L. Petersen
- Division of BiostatisticsSchool of Public HealthUniversity of California BerkeleyBerkeleyCaliforniaUSA
| | - Diane V. Havlir
- Division of HIV, ID and Global MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Moses Kamya
- Department of MedicineMakerere University College of Health SciencesKampalaUganda
| | - Judith A. Hahn
- Division of HIV, ID and Global MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Marcus ME, Mahlalela N, Drame ND, Rohr JK, Vollmer S, Tollman S, Berkman L, Kahn K, Gómez-Olivé FX, Manne-Goehler J, Bärnighausen T. Home-based HIV testing strategies for middle-aged and older adults in rural South Africa. AIDS 2023; 37:2213-2221. [PMID: 37696252 PMCID: PMC10615729 DOI: 10.1097/qad.0000000000003698] [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] [Indexed: 09/13/2023]
Abstract
OBJECTIVE More than one in four adults over 40 years with HIV in South Africa are unaware of their status and not receiving antiretroviral therapy (ART). HIV self-testing may offer a powerful approach to closing this gap for aging adults. Here, we report the results of a randomized comparative effectiveness trial of three different home-based HIV testing strategies for middle-aged and older adults in rural South Africa. DESIGN Two thousand nine hundred and sixty-three individuals in the 'Health and Ageing in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)' cohort study were randomized 1 : 1 : 1 to one of three types of home-based and home-delivered HIV testing modalities: rapid testing with counseling; self-testing, and both rapid testing with counselling and self-testing. METHOD In OLS regression analyses, we estimated the treatment effects on HIV testing and HIV testing frequency at about 1 year after delivery. Finally, we assessed the potential adverse effects of these strategies on the secondary outcomes of depressive symptom as assessed by the CESD-20, linkage to care, and risky sexual behavior. RESULTS There were no significant differences in HIV testing uptake or testing frequency across groups. However, respondents in the self-testing treatment arms were more likely to shift from testing at home and a facility [self-testing (HIVST), -8 percentage points (pp); 95% confidence interval (CI) -14 to -2 pp; self-testing plus rapid testing and counselling (ST+RT+C); -9 pp, 95% CI -15 to -3 pp] to testing only at home (HIVST 5 pp; 95% CI 2 to 9 pp; ST+RT+C: 5 pp, 95% CI 1 to 9 pp) - suggesting a revealed preference for self-testing in this population. We also found no adverse effects of this strategy on linkage to care for HIV and common comorbidities, recent sexual partners, or condom use. Finally, those in the self-testing only arm had significantly decreased depressive symptom scores by 0.58 points (95% CI -1.16 to -0.01). CONCLUSION We find HIV self-testing to be a well tolerated and seemingly preferred home-based testing option for middle-aged and older adults in rural South Africa. This approach should be expanded to achieve the UNAIDS 95-95-95 targets.
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Affiliation(s)
- Maja E. Marcus
- Division of Infectious Diseases, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nomsa Mahlalela
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ndeye D. Drame
- Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - Julia K Rohr
- Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Stephen Tollman
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Center for Global Health Research, Umea University, Umea, Sweden
| | - Lisa Berkman
- Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - Kathleen Kahn
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Center for Global Health Research, Umea University, Umea, Sweden
| | - Francesc Xavier Gómez-Olivé
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Till Bärnighausen
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Africa Health Research Institute, Mtubatuba, South Africa
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Shimels T, Kassu RA, Bogale G, Bekele M, Getnet M, Getachew A, Shewamene Z, Abraha M. Adherence to Antiretroviral Medications Among People Living With HIV in the Era of COVID-19 in Central Ethiopia and Perceived Impact of the Pandemic. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023; 44:99-107. [PMID: 35944130 PMCID: PMC9364070 DOI: 10.1177/0272684x221094151] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM This study assessed the level of adherence to antiretroviral drugs and the associated factors among clients who have a follow-up at public health facilities in central Ethiopia. METHOD A multi-site cross-sectional study was conducted from August 1-30, 2020 at seven public health institutions. A systematic random sampling method was used to recruit 385 participants. Data was collected using a structured interviewer-administered questionnaire. Analysis was done using descriptive statistics, and binary logistic regression model. The OR with its 95% C.I was employed to present analytic outputs. Statistical significance for the multivariable model was considered at p ≤ 0.05. RESULTS Of the 371 participants, the majority were females (233, 62.8%), attended health centers (215, 58.0%), and were married (173, 46.6%). Eighty-nine (89, 24.0%) of the participants have at least one comorbidity. About 72 (19.0%) and 50 (13.5%) of the respondents stated that the COVID-19 has posed challenges on their follow-ups and availability of medications respectively. Nearly a half of the people living with HIV and comorbid T2DM or hypertension (29, 48.0%) reported that they had encountered an increase in the price of medications compared to the pre-COVID-19 times. About half of the respondents in the study setting have perfect adherence to antiretroviral therapy (ART) (200, 54.0%). Basic education (aOR = 3.02: 95% CI: 1.57-5.80), marriage (aOR = 2.27: 95% CI: 1.24-4.15), attendance to a health center (aOR = 0.59: 95% CI: 0.36-0.98) and sleep disturbance (aOR = 0.47: 95% CI: 0.26-0.84) showed a statistically significant association with adherence to ART. CONCLUSION About half of the respondents in the study settings have perfect adherence to their ART medications. As multiple factors interplay in the success rate of adherence to ART, stakeholders should place and strengthen practices, such as active follow-up and tracing of cases, ensuring medication affordability (access and low pricing), and psycho-social support to patients.
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Affiliation(s)
- Tariku Shimels
- Saint Paul’s Hospital Millennium
Medical College, Addis Ababa, Ethiopia
| | - Rodas A. Kassu
- Department of Neurology, Saint Paul’s Hospital Millennium
Medical College, Addis Ababa, Ethiopia
| | - Gelila Bogale
- United Vision Medical
Services, Addis Ababa, Ethiopia
| | - Mahteme Bekele
- Saint Paul’s Hospital Millennium
Medical College, Addis Ababa, Ethiopia
| | - Melsew Getnet
- Saint Paul’s Hospital Millennium
Medical College, Addis Ababa, Ethiopia
| | - Abrham Getachew
- Saint Paul’s Hospital Millennium
Medical College, Addis Ababa, Ethiopia
| | - Zewdneh Shewamene
- Faculty of Public Health and
Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mebratu Abraha
- Saint Paul’s Hospital Millennium
Medical College, Addis Ababa, Ethiopia
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TAPERA TALENT, ODIMEGWU CLIFFORD, PETLELE REBAONE, SELLO MATSHIDISOVALERIA, DZOMBA ARMSTRONG, ALADEJEBI OLUWATOYIN, PHIRI MILLION. Intersecting epidemics: COVID-19 and HIV in sub-Saharan Africa. A systematic review (2020-2022). J Public Health Afr 2023; 14:2658. [PMID: 37908391 PMCID: PMC10615161 DOI: 10.4081/jphia.2023.2658] [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: 04/19/2023] [Accepted: 05/14/2023] [Indexed: 11/02/2023] Open
Abstract
There has been significant progress with regards to winning the fight against HIV globally, particularly due to the introduction of antiretroviral therapy (ART). COVID-19 threatened to derail gains in the fight against HIV. As we have started to see with studies on COVID-19 and HIV, there is a need to 'provide an in-depth view' in understanding the dynamics between the two epidemics, especially in sub-Saharan Africa. We, therefore, undertook a systemic review of existing literature to synthesize the effects of COVID-19 on the utilization of HIV services in sub-Saharan Africa, the literature on the risks associated with HIV during the COVID-19 pandemic, and lastly, the innovations and strategies adopted to continue receiving treatment in sub-Saharan Africa. We conducted a systematic review of studies published between 2020 and April 2022. We searched for relevant sub-Saharan studies in the following databases: PubMed, Google Scholar, J-STOR, and Science Direct. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search identified 647 papers, and after screening, 41 were in line with the inclusion criteria and were included in the review. There was evidence of the negative effects of COVID-19 on reducing HIV testing, ART treatment, and HIV prevention services. There is evidence pointing to the need for people living with HIV to be prioritized for COVID-19 vaccinations. Innovations and strategies implemented to mitigate the effects of COVID-19 on HIV services include community-based ART distribution, multi-month ART dispensing, the use of digital technologies, and the use of the already existing HIV infrastructure to fight COVID-19. It is still imperative that future studies explore the predictors of utilization of HIV services in the advent of COVID-19.
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Affiliation(s)
- TALENT TAPERA
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of The Witwatersrand, Johannesburg
| | - CLIFFORD ODIMEGWU
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of The Witwatersrand, Johannesburg
| | - REBAONE PETLELE
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of The Witwatersrand, Johannesburg
| | - MATSHIDISO VALERIA SELLO
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of The Witwatersrand, Johannesburg
- Centre for Social Development in Africa, University of Johannesburg
| | - ARMSTRONG DZOMBA
- MRC/Wits Rural Public Health and Health Transitions Research Unit-Agincourt, Johannesburg, South Africa
| | - OLUWATOYIN ALADEJEBI
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of The Witwatersrand, Johannesburg
| | - MILLION PHIRI
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of The Witwatersrand, Johannesburg
- Department of Population Studies, School of Humanities and Social sciences, University of Zambia, Lusaka, Zambia
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Veettil SK, Schwerer L, Kategeaw W, Toth D, Samore MH, Hutubessy R, Chaiyakunapruk N. Scoping review of modelling studies assessing the impact of disruptions to essential health services during COVID-19. BMJ Open 2023; 13:e071799. [PMID: 37751952 PMCID: PMC10533712 DOI: 10.1136/bmjopen-2023-071799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Studies assessing the indirect impact of COVID-19 using mathematical models have increased in recent years. This scoping review aims to identify modelling studies assessing the potential impact of disruptions to essential health services caused by COVID-19 and to summarise the characteristics of disruption and the models used to assess the disruptions. METHODS Eligible studies were included if they used any models to assess the impact of COVID-19 disruptions on any health services. Articles published from January 2020 to December 2022 were identified from PubMed, Embase and CINAHL, using detailed searches with key concepts including COVID-19, modelling and healthcare disruptions. Two reviewers independently extracted the data in four domains. A descriptive analysis of the included studies was performed under the format of a narrative report. RESULTS This scoping review has identified a total of 52 modelling studies that employed several models (n=116) to assess the potential impact of disruptions to essential health services. The majority of the models were simulation models (n=86; 74.1%). Studies covered a wide range of health conditions from infectious diseases to non-communicable diseases. COVID-19 has been reported to disrupt supply of health services, demand for health services and social change affecting factors that influence health. The most common outcomes reported in the studies were clinical outcomes such as mortality and morbidity. Twenty-five studies modelled various mitigation strategies; maintaining critical services by ensuring resources and access to services are found to be a priority for reducing the overall impact. CONCLUSION A number of models were used to assess the potential impact of disruptions to essential health services on various outcomes. There is a need for collaboration among stakeholders to enhance the usefulness of any modelling. Future studies should consider disparity issues for more comprehensive findings that could ultimately facilitate policy decision-making to maximise benefits to all.
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Affiliation(s)
- Sajesh K Veettil
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
- Department of Pharmacotherapy, College of Pharmacy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
- School of Medicine, Taylor's University, 47500 Subang Jaya, Selangor, Malaysia
| | - Luke Schwerer
- USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, California, USA
- School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Warittakorn Kategeaw
- Department of Pharmacotherapy, College of Pharmacy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Damon Toth
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Mathematics, University of Utah, Salt Lake City, Utah, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Matthew H Samore
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Raymond Hutubessy
- Immunization, Vaccines and Biologicals (IVB) Department, World Health Organization, Geneva, Switzerland
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
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Akanbi MO, Bilaver LA, Achenbach C, Hirschhorn LR, Rivera AS, Adekolujo OS, Adekola KUA, Silas OA, Agaba PA, Agbaji O, Shehu NY, Sagay SA, Hou L, Murphy RL. Incident Kaposi sarcoma during the expansion of antiretroviral therapy eligibility in Nigeria: a retrospective cohort study. BMC Cancer 2023; 23:890. [PMID: 37735371 PMCID: PMC10512500 DOI: 10.1186/s12885-023-11402-3] [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: 01/26/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION The expansion of antiretroviral therapy (ART) eligibility could lead to earlier initiation of Human Immunodeficiency Virus (HIV) treatment and consequently reduce the risk of HIV-associated Kaposi Sarcoma (KS). We investigated the impact of changes in the Nigerian HIV treatment guidelines on KS incidence among adults enrolled in HIV care in Nigeria. METHODS We analyzed data of adults who enrolled for HIV care from January 2006 to December 2016 at one of Nigeria's largest HIV treatment centers. Based on changes in HIV treatment guidelines, we classified 2006-2009 as the pre-expansion period and 2010-2016 as the post-expansion period. We used Kaplan Meier curves to compare the incidence of KS in the pre-expansion to the post-expansion period. We used Cox regression models to assess the hazard for incident KS between the two periods after adjusting for potential confounders. RESULTS Among 14,479 patients with HIV, the overall KS incidence was 2.35; 95% CI 2.01-2.74/1,000 person-years. The incidence of KS decreased from 2.53 to 1.58 per 1,000 person-years from 2006 to 2009 to 2010-2016. In models adjusting for age, sex, CD4-T cell count, and ART use, the risk for KS remained lower in 2010-2016 compared to 2006-2009. In analyses restricted to time on ART, there was no significant difference in KS incidence between HIV patients who enrolled in 2006-2009 and 2010-2016 after adjusting for age, sex, and CD4 T-cell count. CONCLUSION The expansion of ART eligibility was associated with a reduced incidence of HIV-associated KS among adults initiating HIV care in Jos, Nigeria. The reduction was likely driven by earlier enrollment for HIV care and ART initiation.
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Affiliation(s)
- Maxwell O Akanbi
- Department of Hematology & Clinical Oncology, Michigan State University/ McLaren Greater Lansing, 2900 Collins Road, Michigan, 48910, USA.
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Department of Medicine, McLaren Hospital, Flint, MI, USA.
- College of Medicine, University of Jos, Jos, Plateau State, Nigeria.
| | - Lucy A Bilaver
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Chad Achenbach
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lisa R Hirschhorn
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Adovich S Rivera
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | | | | | - Patricia A Agaba
- College of Medicine, University of Jos, Jos, Plateau State, Nigeria
| | - Oche Agbaji
- College of Medicine, University of Jos, Jos, Plateau State, Nigeria
| | - Nathan Y Shehu
- College of Medicine, University of Jos, Jos, Plateau State, Nigeria
| | - Solomon A Sagay
- College of Medicine, University of Jos, Jos, Plateau State, Nigeria
| | - Lifang Hou
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Robert L Murphy
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Awaidy SA, Ghazy RM, Mahomed O. Progress of the Gulf Cooperation Council (GCC) Countries Towards Achieving the 95-95-95 UNAIDS Targets: A Review. J Epidemiol Glob Health 2023; 13:397-406. [PMID: 37079171 PMCID: PMC10116479 DOI: 10.1007/s44197-023-00097-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/30/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and partners launched the 90-90-90 targets. These were further updated to correspond to 95-95-95 by the year 2025. We present an overview of the progress made by Gulf Cooperated Council (GCC) countries towards meeting the global targets. METHODS We extracted data from Global AIDS Monitoring (GAM), UNAIDS AIDS Info, HIV case reporting database, and the WHO global policy uptake for six countries: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab of Emirates (UAE) to assess the HIV/AIDS burden in the six GCC countries, and the progress towards achieving the 95-95-95 goal. RESULTS By the end of 2021, an estimated 42,015 people living with HIV (PLHIV) were residing in the GCC countries with prevalence levels below 0.01%. Data from four GCC countries, Bahrain, Oman, Qatar and UAE, indicated that by 2021, 94%, 80%, 66%, and 85% of HIV-positive population knew their status, respectively. 68%, 93% (2020 data), 65%, 58% and 85% of PLHIV in Bahrain, Kuwait, Oman, Qatar and UAE who knew their status were on anti-retroviral therapy (ART), respectively, and 55%, 92%, 58% and 90% (2020 data) among those who were on ART had viral suppression in Bahrain, Kuwait, Oman and KSA, respectively. CONCLUSION The GCC countries have made great strides toward fulfilling the 95-95-95 targets, but the interim 2025 overall UNAIDS targets remain unmet. The GCC countries must strive diligently to accomplish the targets by emphasising early identification of the cases by enhanced screening and testing, as well as prompt commencement of ART therapy with viral load suppression.
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Affiliation(s)
| | - Ramy Mohamed Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Ozayr Mahomed
- Department of Public Health Medicine, University of KwaZulu Natal, Durban, Howard College Campus, South Africa.
- Dasman Diabetes Institute, Kuwait City, Kuwait.
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Mostert CM, Ngugi A, Muchungi K, Shah J, Bosire E, Merali Z, Kumar M. Streamlining Global and Local Data on HIV: Underscoring Role of Institutions and Ethics in Improving Quality of HIV Research. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1296-1300. [PMID: 37244416 DOI: 10.1016/j.jval.2023.05.010] [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: 01/09/2023] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVES There are inconsistencies in the South Africa HIV mortality data reported by Institute of Health Metrics and Evaluation (IHME), Joint United Nations Programme on HIV/AIDS (UNAIDS), and Statistics South Africa (StatsSA) platforms. Between 2006 and 2016, these global data sets (IHME and UNAIDS) show that HIV-related mortalities were improving in South Africa, whereas StatsSA argues the opposite. We explain the causes of this differing stands and highlight areas that may be improved to address such inconsistencies. METHODS This observational analysis uses data from IHME, UNAIDS, and StatsSA platforms. RESULTS We demonstrate that IHME and UNAIDS data sets are based on a mathematical compartmental model, which is not dynamic to all HIV epidemiological aspects. Such limitation may cause inflated improvement in HIV mortality outcomes that are not in line with HIV mortality evidence recorded at the household level as demonstrated by StatsSA. CONCLUSION There is a need to streamline the IHME, UNAIDS, and StatsSA data on HIV to improve the quality of HIV research and programming in South Africa.
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Affiliation(s)
- Cyprian M Mostert
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya; Department of Population Health, Aga Khan University, Nairobi, Kenya.
| | - Antony Ngugi
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Kendi Muchungi
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Jasmit Shah
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Edna Bosire
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Zul Merali
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Manasi Kumar
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
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Oduor C, Audi A, Kiplangat S, Auko J, Ouma A, Aol G, Nasimiyu C, O. Agogo G, Lo T, Munyua P, Herman-Roloff A, Bigogo G, K. Munywoki P. Estimating excess mortality during the COVID-19 pandemic from a population-based infectious disease surveillance in two diverse populations in Kenya, March 2020-December 2021. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002141. [PMID: 37611028 PMCID: PMC10446178 DOI: 10.1371/journal.pgph.0002141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/16/2023] [Indexed: 08/25/2023]
Abstract
Robust data on the impact of the COVID-19 pandemic on mortality in Africa are relatively scarce. Using data from two well-characterized populations in Kenya we aimed to estimate excess mortality during the COVID-19 pandemic period. The mortality data arise from an ongoing population-based infectious disease surveillance (PBIDS) platform, which has been operational since 2006 in rural western Kenya (Asembo, Siaya County) and an urban informal settlement (Kibera, Nairobi County), Kenya. PBIDS participants were regularly visited at home (2-3 times a year) by field workers who collected demographic data, including deaths. In addition, verbal autopsy (VA) interviews for all identified deaths are conducted. We estimated all-cause and cause-specific mortality rates before and during the height of the COVID-19 pandemic, and we compared associated mortality rates between the periods using incidence rate ratios. Excess deaths during the COVID-19 period were also estimated by modelling expected deaths in the absence of COVID-19 by applying a negative binomial regression model on historical mortality data from January 2016. Overall and monthly excess deaths were determined using the P-score metric. Spearman correlation was used to assess whether there is a relationship between the generated P-score and COVID-19 positivity rate. The all-cause mortality rate was higher during the COVID-19 period compared to the pre-COVID-19 period in Asembo [9.1 (95% CI, 8.2-10.0) vs. 7.8 (95% CI, 7.3-8.3) per 1000 person-years of observation, pyo]. In Kibera, the all-cause mortality rate was slightly lower during the COVID-19 period compared to the pre-COVID-19 period [2.6 (95% CI, 2.2-3.2 per 1000 pyo) vs. 3.1; 95% CI, 2.7-3.4 per 1000 pyo)]. An increase in all-cause mortality was observed (incidence rate ratio, IRR, 1.16; 95% CI, 1.04-1.31) in Asembo, unlike in Kibera (IRR, 0.88; 95% CI, 0.71-1.09). The notable increase in mortality rate in Asembo was observed among persons aged 50 to 64 years (IRR, 2.62; 95% CI, 1.95-3.52), persons aged 65 years and above (5.47; 95% CI, 4.60-6.50) and among females (IRR, 1.25; 95% CI, 1.07-1.46). These age and gender differences were not observed in Kibera. We observed an increase in the mortality rate due to acute respiratory infection, including pneumonia (IRR, 1.45;95% CI, 1.03-2.04), and a reduction in the mortality rate due to pulmonary tuberculosis (IRR, 0.22; 95% CI, 0.05-0.87) among older children and adults in Asembo. There was no statistically significant change in mortality rates due to leading specific causes of death in Kibera. Overall, during the COVID-19 period observed deaths were higher than expected deaths in Asembo (P-score = 6.0%) and lower than expected in Kibera (P-score = -22.3%).Using well-characterized populations in the two diverse geographic locations, we demonstrate a heterogenous impact of the COVID-19 pandemic on all-cause and cause-specific mortality rates in Kenya. We observed more deaths than expected during the COVID-19 period in our rural site in western Kenya contrary to the urban site in Nairobi, the capital city in Kenya.
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Affiliation(s)
- Clifford Oduor
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Allan Audi
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Samwel Kiplangat
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Joshua Auko
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Alice Ouma
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - George Aol
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Carolyne Nasimiyu
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - George O. Agogo
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Terrence Lo
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Peninah Munyua
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Amy Herman-Roloff
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Godfrey Bigogo
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Patrick K. Munywoki
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Nairobi, Kenya
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Chappell E, Chimwaza A, Manika N, Wedderburn CJ, Mupambireyi Nenguke Z, Gannon H, Cowan F, Gibb T, Heys M, Fitzgerald F, Phillips A, Chimhuya S, Gibb DM, Ford D, Mushavi A, Bwakura-Dangarembizi M. Impact of the COVID-19 pandemic on the provision and uptake of services for the prevention of mother-to-child transmission of HIV in Zimbabwe. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002296. [PMID: 37578953 PMCID: PMC10424857 DOI: 10.1371/journal.pgph.0002296] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/21/2023] [Indexed: 08/16/2023]
Abstract
Zimbabwe is targeting elimination of mother-to-child transmission of HIV by December 2025, however the COVID-19 pandemic challenged health service delivery globally. Monthly aggregated data were extracted from DHIS-2 for all facilities delivering antenatal care (ANC). ZIMSTAT and Spectrum demographic estimates were used for population-level denominators. Programme indicators are among those in HIV care and population indicators reflect the total population. The mean estimated proportion of pregnant women booking for ANC per month did not change (91% pre-pandemic vs 91% during pandemic, p = 0.95), despite dropping to 47% in April 2020. At a programme-level, the estimated proportion of women who received at least one HIV test fell in April 2020 (3.6% relative reduction vs March (95% CI 2.2-5.1), p<0.001) with gradual recovery towards pre-pandemic levels. The estimated proportion of women who were retested among those initially negative in pregnancy fell markedly in April 2020 (39% reduction (32-45%), p<0.001) and the subsequent increase was much slower, only reaching 39% by September 2021 compared to average 53% pre-pandemic. The mean estimated proportion of pregnant women with HIV on ART was unchanged at programme-level (98% vs 98%, p = 0.26), but decreased at population-level (86% vs 80%, p = 0.049). Antiretroviral prophylaxis coverage decreased among HIV-exposed infants, at programme- (94% vs 87%, p = 0.001) and population-levels (76% vs 68%, p<0.001). There was no significant change in HIV-exposed infants receiving EID (programme: 107% vs 103%, p = 0.52; population: 87% vs 79%, p = 0.081). The estimated proportion of infants with HIV diagnosed fell from 27% to 18%, (p<0.001), while the estimated proportion on ART was stable at a programme (88% vs 90%, p = 0.82) but not population (22% vs 16%, p = 0.004) level. Despite a drop at the start of the pandemic most programme indicators rapidly recovered. At a population-level indicators were slower to return, suggesting less women with HIV identified in care.
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Affiliation(s)
| | | | - Ngoni Manika
- Ministry of Health and Child Care, Harare, Zimbabwe
| | - Catherine J. Wedderburn
- MRC Clinical Trials Unit at UCL, London, United Kingdom
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | | | - Hannah Gannon
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Frances Cowan
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Tom Gibb
- Picturing Health, United Kingdom
| | - Michelle Heys
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Felicity Fitzgerald
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | | | - Simbarashe Chimhuya
- Child and Adolescent Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Diana M. Gibb
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Deborah Ford
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | | | - Mutsa Bwakura-Dangarembizi
- Child and Adolescent Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Mangale DI, Onyango A, Mugo C, Mburu C, Chhun N, Wamalwa D, Njuguna I, Means AR, John-Stewart G, Weiner BJ, Beima-Sofie K. Characterizing provider-led adaptations to mobile phone delivery of the Adolescent Transition Package (ATP) in Kenya using the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS): a mixed methods approach. Implement Sci Commun 2023; 4:95. [PMID: 37580836 PMCID: PMC10424422 DOI: 10.1186/s43058-023-00446-y] [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: 02/02/2023] [Accepted: 05/30/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in disruptions to routine HIV services for youth living with HIV (YLH), provoking rapid adaptation to mitigate interruptions in care. The Adolescent Transition to Adult Care for HIV-infected adolescents (ATTACH) study (NCT03574129) was a hybrid I cluster randomized trial testing the effectiveness of a healthcare worker (HCW)-delivered disclosure and transition intervention - the Adolescent Transition Package (ATP). During the pandemic, HCWs leveraged phone delivery of the ATP and were supported to make adaptations. We characterized real-time, provider-driven adaptations made to support phone delivery of the ATP. METHODS We conducted continuous quality improvement (CQI) meetings with HCWs involved in phone delivery of the ATP at 10 intervention sites. CQI meetings used plan-do-study-act (PDSA) cycles and were audio-recorded. Adaptations were coded by two-independent coders using the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). Adaptation testing outcomes (adopt, retest, or abandon) and provider experience implementing the adaptations were also recorded. We summarized adaptation characteristics, provider experience, and outcomes. RESULTS We identified 72 adaptations, 32 were unique. Overall, adaptations included modification to context (53%, n = 38), content (49%, n = 35), and evaluation processes (13%, n = 9). Context adaptations primarily featured changes to personnel, format, and setting, while content and evaluation adaptations were frequently achieved by simple additions, repetition, and tailoring/refining of the phone delivery strategy. Nine adaptations involved abandoning, then returning to phone delivery. HCWs sought to increase reach, improve fidelity, and intervention fit within their context. Most adaptations (96%, n = 69) were perceived to increase the feasibility of phone delivery when compared to before the changes were introduced, and HCWs felt 83% (n = 60) of adaptations made phone delivery easier. Most adaptations were either incorporated into routine workflows (47%) or tested again (47%). CONCLUSION Adaptation of phone delivery was a feasible and effective way of addressing challenges with continuity of care for YLH during the COVID-19 pandemic. Adaptations were primarily context adaptions. While FRAME-IS was apt for characterizing adaptations, more use cases are needed to explore the range of its utility. TRIAL REGISTRATION Trial registered on ClinicalTrial.gov as NCT03574129.
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Affiliation(s)
| | - Alvin Onyango
- Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Cyrus Mugo
- Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Caren Mburu
- Department of Global Health, University of Washington, Seattle, USA
| | - Nok Chhun
- Department of Global Health, University of Washington, Seattle, USA
| | - Dalton Wamalwa
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Irene Njuguna
- Department of Global Health, University of Washington, Seattle, USA
- Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
- Department of Pediatrics, School of Medicine, Seattle, USA
- Department of Medicine, University of Washington, Seattle, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, USA
- Department of Health Services, University of Washington, Seattle, USA
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Naidoo K, Hoque M, Buckus S, Hoque M, Jagernath K. Prevention-of-mother-to-child-transmission (PMTCT) program outcomes in South Africa in the pre-COVID and COVID eras. BMC Public Health 2023; 23:1395. [PMID: 37474920 PMCID: PMC10357590 DOI: 10.1186/s12889-023-16214-5] [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: 04/12/2023] [Accepted: 06/28/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Two decades after implementing the Prevention of Mother to Child transmission (PMTCT) program, South Africa has still not managed to eliminate intrauterine mother-to-child (MTCT) HIV transmission. During the COVID pandemic access to maternal health services was reduced, potentially compromising the PMTCT program. METHOD A retrospective record review was conducted at a midwife-run obstetric unit in a high HIV prevalence setting. Data on pregnant women who delivered between January 2019 and December 2020 were analysed to evaluate predictors for MTCT, and compare pre-COVID and COVID-era changes in maternal and infant HIV incidence and prevalence. RESULTS A total of 1660 women delivered at the facility over a 24-month period (Jan 2019-Dec 2020), of whom 92.8% enrolled for antenatal care in 2019 and 94.6% in 2020. A significantly greater proportion of women were aware of their HIV status before enrolling for antenatal care in the pre-COVID (2019) than COVID (2020) period (88% vs 40.2%; p < 0.05). There was a significant increase in new HIV infection after enrolling for antenatal care during the COVID period compared to pre-COVID period (120 vs 62 women, p < 0.05). There was also a significant increase in the HIV prevalence among women who delivered during the COVID period than in the pre-COVID era (43.5% compared to 35.8%, p < 0.05). However, more than 95% of HIV-positive women initiated ART in both periods. Overall, a total of thirteen infants tested HIV positive (2.1% MTCT rate), with no difference in MTCT between 2019 and 2020. Infants born to women on antiretroviral therapy (ART) were 93% less likely to have a positive PCR test than those whose mothers who were not on ART. (OR = 0.07, 95% CI 0.031:0.178, p < 0.05). CONCLUSION The increase in maternal HIV incidence and prevalence during the COVID era suggest a lapse in HIV prevention strategies during the COVID pandemic. There is an urgent need to improve community test-and-treat campaigns among women of reproductive age in the community and increase access to HIV pre-exposure prophylaxis for pregnant women, especially during periods of health crises.
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Affiliation(s)
- Keshena Naidoo
- Department of Family Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Monjurul Hoque
- Kwadabeka Community Health Centre, KwaDabeka, South Africa
| | - Somaya Buckus
- Kwadabeka Community Health Centre, KwaDabeka, South Africa
| | - Maariyah Hoque
- South African College of Applied Psychology, Pretoria, South Africa
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Mutai CK, McSharry PE, Ngaruye I, Musabanganji E. Use of unsupervised machine learning to characterise HIV predictors in sub-Saharan Africa. BMC Infect Dis 2023; 23:482. [PMID: 37468851 DOI: 10.1186/s12879-023-08467-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Significant regional variations in the HIV epidemic hurt effective common interventions in sub-Saharan Africa. It is crucial to analyze HIV positivity distributions within clusters and assess the homogeneity of countries. We aim at identifying clusters of countries based on socio-behavioural predictors of HIV for screening. METHOD We used an agglomerative hierarchical, unsupervised machine learning, approach for clustering to analyse data for 146,733 male and 155,622 female respondents from 13 sub-Saharan African countries with 20 and 26 features, respectively, using Population-based HIV Impact Assessment (PHIA) data from the survey years 2015-2019. We employed agglomerative hierarchical clustering and optimal silhouette index criterion to identify clusters of countries based on the similarity of socio-behavioural characteristics. We analyse the distribution of HIV positivity with socio-behavioural predictors of HIV within each cluster. RESULTS Two principal components were obtained, with the first describing 62.3% and 70.1% and the second explaining 18.3% and 20.6% variance of the total socio-behavioural variation in females and males, respectively. Two clusters per sex were identified, and the most predictor features in both sexes were: relationship with family head, enrolled in school, circumcision status for males, delayed pregnancy, work for payment in last 12 months, Urban area indicator, known HIV status and delayed pregnancy. The HIV positivity distribution with these variables was significant within each cluster. CONCLUSIONS /FINDINGS The findings provide a potential use of unsupervised machine learning approaches for substantially identifying clustered countries based on the underlying socio-behavioural characteristics.
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Affiliation(s)
- Charles K Mutai
- African Center of Excellence in Data Science, University of Rwanda, Kigali, BP 4285, Rwanda.
- Department of Mathematics, Physics and Computing, Moi University, Eldoret, Kenya.
| | - Patrick E McSharry
- African Center of Excellence in Data Science, University of Rwanda, Kigali, BP 4285, Rwanda
- College of Engineering, Carnegie Mellon University Africa, Kigali, BP 6150, Rwanda
- Oxford-Man Institute of Quantitative Finance, Oxford University, Oxford, OX2 6ED, UK
| | - Innocent Ngaruye
- College of Science and Technology, University of Rwanda, Kigali, Rwanda
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Chebet JJ, McMahon SA, Tarumbiswa T, Hlalele H, Maponga C, Mandara E, Ernst K, Alaofe H, Baernighausen T, Ehiri JE, Geldsetzer P, Nichter M. Motivations for pre-exposure prophylaxis uptake and decline in an HIV-hyperendemic setting: findings from a qualitative implementation study in Lesotho. AIDS Res Ther 2023; 20:43. [PMID: 37415180 PMCID: PMC10324220 DOI: 10.1186/s12981-023-00535-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Pre-Exposure Prophylaxis (PrEP) has demonstrated clinical efficacy in preventing HIV infection, yet its uptake remains low. This study, conducted in five PrEP implementing districts in Lesotho, examined factors motivating persons at risk of HIV infection to adopt or reject PrEP when offered freely. METHODS In-depth interviews were undertaken with stakeholders directly engaged with PrEP policy (n = 5), program implementation (n = 4), and use (current PrEP users = 55, former PrEP users = 36, and PrEP decliners (n = 6)). Focus group discussions (n = 11, 105 total participants) were conducted with health staff directly providing HIV and PrEP services. RESULTS Demand for PrEP was reported highest among those at greatest risk for HIV acquisition: those in serodiscordant relationships and/or engaged in sex work. Culturally sensitive PrEP counseling was described as an opportunity to transfer knowledge, build trust, and address user concerns. Conversely, top-down counseling resulted in PrEP distrust and confusion about HIV status. Key motivations for PrEP uptake revolved around sustaining core social relationships, desire for safer conception, and caring for ailing relatives. The decline of PrEP initiation was driven by a combination of individual-level factors (risk perception, perceived side effects, disbelief of the drug's efficacy and PrEP's daily pill regimen), societal factors (lack of social support and HIV-related stigma), and structural factors related to PrEP access. CONCLUSIONS Our findings suggest strategies for effective national PrEP rollout and implementation include: (1) demand creation campaigns which highlight positive aspects of PrEP, while simultaneously addressing apprehensions for uptake; (2) strengthening health provider counseling capacity; and (3) addressing societal and structural HIV-related stigma.
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Affiliation(s)
- Joy J. Chebet
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ USA
| | - Shannon A. McMahon
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | | | | | | | - Kacey Ernst
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ USA
| | - Halimatou Alaofe
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ USA
| | - Till Baernighausen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Africa Health Research Institute (AHRI), Durban, South Africa
| | - John E. Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ USA
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA USA
- Chan Zuckerberg Biohub, San Francisco, CA USA
| | - Mark Nichter
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ USA
- School of Anthropology, University of Arizona, Tucson, AZ USA
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Andia-Biraro I, Baluku JB, Olum R, Bongomin F, Kyazze AP, Ninsiima S, Ssekamatte P, Kibirige D, Biraro S, Seremba E, Kabugo C. Effect of COVID-19 pandemic on inpatient service utilization and patient outcomes in Uganda. Sci Rep 2023; 13:9693. [PMID: 37322097 PMCID: PMC10272226 DOI: 10.1038/s41598-023-36877-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 06/12/2023] [Indexed: 06/17/2023] Open
Abstract
COVID-19 has had devastating effects on health systems but reports from sub-Saharan Africa are few. We compared inpatient admissions, diagnostic tests performed, clinical characteristics and inpatient mortality before and during the COVID-19 pandemic at an urban tertiary facility in Uganda. We conducted a retrospective chart review of patients admitted at Kiruddu National Referral Hospital in Uganda between January-July 2019 (before the pandemic) and January-July 2020 (during the pandemic). Of 3749 inpatients, 2014 (53.7%) were female, and 1582 (42.2%) had HIV. There was a 6.1% decline in admissions from 1932 in 2019 to 1817 in 2020. There were significantly fewer diagnostic tests performed in 2020 for malaria, tuberculosis, and diabetes. Overall, 649 (17.3%) patients died. Patients admitted during the COVID-19 pandemic (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 1.04-1.5, p = 0.018), patients aged ≥ 60 years (aOR 1.6, 95% CI 1.2-2.1, p = 0.001), HIV co-infected (aOR 1.5, 95% CI 1.2-1.9, p < 0.001), and those admitted as referrals (aOR 1.5, 95% CI 1.2-1.9, p < 0.001) had higher odds of dying. The COVID-19 pandemic disrupted inpatient service utilization and was associated with inpatient mortality. Policy makers need to build resilience in health systems in Africa to cope with future pandemics.
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Affiliation(s)
- Irene Andia-Biraro
- Makerere University College of Health Sciences, Kampala, Uganda
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Joseph Baruch Baluku
- Kiruddu National Referral Hospital, Kampala, Uganda.
- Makerere University Lung Institute, PO Box 26343, Kampala, Uganda.
| | - Ronald Olum
- Department of Medicine, St Francis Hospital Nsambya, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | | | - Sandra Ninsiima
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Samuel Biraro
- Clockworks Research Company Limited, Kampala, Uganda
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Silverio-Murillo A, Balmori de la Miyar JR, Martínez-Alfaro A. Non-COVID-19 deaths in times of pandemic. J Public Health (Oxf) 2023; 45:e196-e203. [PMID: 36371730 PMCID: PMC10273375 DOI: 10.1093/pubmed/fdac115] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 07/04/2022] [Accepted: 09/26/2022] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVE To investigate the effect of the COVID-19 pandemic on non-COVID-19 deaths in Mexico. METHODS This study analyzes monthly administrative data on 15 different causes of death in Mexico from 2017 to 2020. The effects of the COVID-19 pandemic on non-COVID-19 deaths are conducted using a difference-in-differences methodology and an event study. RESULTS The evidence shows mixed results. There is an increase in six causes of death: diabetes (36.8%), hypertension (25.8%), heart attacks (40.9%), bronchitis- asthma (24.2%), anemia (28.6%) and prostate cancer (21.4%). There is a decrease in two causes of death: traffic accidents (8.8%) and HIV (13.8%). There are null effects for seven causes of death: breast cancer, cerebrovascular disease, malnutrition, alcohol-related liver disease, renal insufficiency, homicides and suicides. CONCLUSIONS The COVID-19 pandemic affected non-COVID-19 deaths caused by diseases that require intensive healthcare services. Conversely, this pandemic reduced social interactions, which contributed to a decrease on deaths such as traffic accidents.
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Winters S, Sabasaba A, Fahey CA, Packel L, Katabaro E, Ndungile Y, Njau PF, McCoy SI. Increased prevalence of depression and anxiety among adults initiating antiretroviral therapy during the COVID-19 pandemic in Shinyanga region, Tanzania. AIDS Res Ther 2023; 20:36. [PMID: 37301833 PMCID: PMC10256977 DOI: 10.1186/s12981-023-00534-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Concerns about the interconnected relationship between HIV and mental health were heightened during the COVID-19 pandemic. This study assessed whether there were temporal changes in the mental health status of people living with HIV presenting for care in Shinyanga region, Tanzania. Specifically, we compared the prevalence of depression and anxiety before and during COVID-19, with the goal of describing the changing needs, if any, to person-centered HIV services. METHODS We analyzed baseline data from two randomized controlled trials of adults initiating ART in Shinyanga region, Tanzania between April-December 2018 (pre-COVID-19 period, n = 530) and May 2021-March 2022 (COVID-19 period, n = 542), respectively. We compared three mental health indicators that were similarly measured in both surveys: loss of interest in things, hopelessness about the future, and uncontrolled worrying. We also examined depression and anxiety which were measured using the Hopkins Symptom Checklist-25 in the pre-COVID-19 period and the Patient Health Questionnaire-4 in the COVID-19 period, respectively, and classified as binary indicators per each scale's threshold. We estimated prevalence differences (PD) in adverse mental health status before and during the COVID-19 pandemic, using stabilized inverse probability of treatment weighting to adjust for underlying differences in the two study populations. RESULTS We found significant temporal increases in the prevalence of feeling 'a lot' and 'extreme' loss of interest in things ['a lot' PD: 38, CI 34,41; 'extreme' PD: 9, CI 8,12)], hopelessness about the future [' a lot' PD: 46, CI 43,49; 'extreme' PD: 4, CI 3,6], and uncontrolled worrying [' a lot' PD: 34, CI 31,37; 'extreme' PD: 2, CI 0,4] during the COVID-19 pandemic. We also found substantially higher prevalence of depression [PD: 38, CI 34,42] and anxiety [PD: 41, CI 37,45]. CONCLUSIONS After applying a quasi-experimental weighting approach, the prevalence of depression and anxiety symptoms among those starting ART during COVID-19 was much higher than before the pandemic. Although depression and anxiety were measured using different, validated scales, the concurrent increases in similarly measured mental health indicators lends confidence to these findings and warrants further research to assess the possible influence of COVID-19 on mental health among adults living with HIV. Trial Registration NCT03351556, registered November 24, 2017; NCT04201353, registered December 17, 2019.
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Affiliation(s)
- Solis Winters
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, 94704, USA.
| | - Amon Sabasaba
- Health for a Prosperous Nation, Dar es Salaam, Tanzania
| | - Carolyn A Fahey
- School of Public Health, University of Washington, Seattle, USA
| | - Laura Packel
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, 94704, USA
| | | | | | | | - Sandra I McCoy
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, 94704, USA
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46
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Birri Makota RB, Musenge E. Predicting HIV infection in the decade (2005-2015) pre-COVID-19 in Zimbabwe: A supervised classification-based machine learning approach. PLOS DIGITAL HEALTH 2023; 2:e0000260. [PMID: 37285368 DOI: 10.1371/journal.pdig.0000260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 04/24/2023] [Indexed: 06/09/2023]
Abstract
The burden of HIV and related diseases have been areas of great concern pre and post the emergence of COVID-19 in Zimbabwe. Machine learning models have been used to predict the risk of diseases, including HIV accurately. Therefore, this paper aimed to determine common risk factors of HIV positivity in Zimbabwe between the decade 2005 to 2015. The data were from three two staged population five-yearly surveys conducted between 2005 and 2015. The outcome variable was HIV status. The prediction model was fit by adopting 80% of the data for learning/training and 20% for testing/prediction. Resampling was done using the stratified 5-fold cross-validation procedure repeatedly. Feature selection was done using Lasso regression, and the best combination of selected features was determined using Sequential Forward Floating Selection. We compared six algorithms in both sexes based on the F1 score, which is the harmonic mean of precision and recall. The overall HIV prevalence for the combined dataset was 22.5% and 15.3% for females and males, respectively. The best-performing algorithm to identify individuals with a higher likelihood of HIV infection was XGBoost, with a high F1 score of 91.4% for males and 90.1% for females based on the combined surveys. The results from the prediction model identified six common features associated with HIV, with total number of lifetime sexual partners and cohabitation duration being the most influential variables for females and males, respectively. In addition to other risk reduction techniques, machine learning may aid in identifying those who might require Pre-exposure prophylaxis, particularly women who experience intimate partner violence. Furthermore, compared to traditional statistical approaches, machine learning uncovered patterns in predicting HIV infection with comparatively reduced uncertainty and, therefore, crucial for effective decision-making.
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Affiliation(s)
- Rutendo Beauty Birri Makota
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eustasius Musenge
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Simushi P, Kalunga MN, Mwakyoma T, Mwewa M, Muchaili L, Hazeemba N, Mulenga C, Mwewa P, Chiyenu KOR, Kachimba J, Choonga P, Shibemba A, Hamooya BM, Zambwe M, Chipimo PJ, Kasonka L. Verification of dried blood spot as a sample type for HIV viral load and early infant diagnosis on Hologic Panther in Zambia. BMC Res Notes 2023; 16:75. [PMID: 37165436 PMCID: PMC10172060 DOI: 10.1186/s13104-023-06344-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 04/28/2023] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVE Zambia has embarked on improving the diagnostic capacity by setting up high throughput and accurate machines in the testing process and introduction of dried blood spot (DBS) as a sample type. This was a cross sectional study to verify dried blood spot as a sample type for HIV viral load and early infant diagnosis (EID) on Hologic Panther platform and Evaluate the analytical performance (precision, linearity and measurement of uncertainty) of the Hologic Panther. RESULTS The specificity and sensitivity of EID performance of Aptima Quant Dx assay on Hologic panther machine against the gold standard machine COBAS Taqman (CAP/CTM) was 100% with an overall agreement of 100%. The quantitative HIV Viral Load (VL) accuracy had a positive correlation of (0.96) obtained against the gold standard (plasma samples) run on COBAS4800 platform. Analytical performance of the Hologic panther machine was evaluated; Precision low positive repeatability 3.50154 and within lab 2.268915 at mean 2.88 concentration and precision high positive repeatability 1.116955 and within lab 2.010677 at mean 5.09 concentration were obtained confirming manufacturers claims. Uncertainty of measurement for this study was found to be ± 71 copies/ml. Linearity studies were determined and all points were within acceptable limits. We therefore recommend DBS as a sample type alternative to plasma for the estimation of HIV-1 viral load and EID diagnosis on the Hologic panther machine.
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Affiliation(s)
- Precious Simushi
- Livingstone University Teaching Hospital Laboratory, Livingstone, Zambia
| | | | - Tuku Mwakyoma
- Livingstone University Teaching Hospital Laboratory, Livingstone, Zambia
| | - Mulenga Mwewa
- Livingstone University Teaching Hospital Laboratory, Livingstone, Zambia
| | - Lweendo Muchaili
- Livingstone University Teaching Hospital Laboratory, Livingstone, Zambia
| | - Nchimunya Hazeemba
- Livingstone University Teaching Hospital Laboratory, Livingstone, Zambia
| | - Chileshe Mulenga
- Livingstone University Teaching Hospital Laboratory, Livingstone, Zambia
| | - Patience Mwewa
- Livingstone University Teaching Hospital Laboratory, Livingstone, Zambia
| | | | - John Kachimba
- Livingstone University Teaching Hospital Laboratory, Livingstone, Zambia
| | | | | | | | - Mowa Zambwe
- Benefits Department, Workers Compensation Fund Control Board, Lusaka, Zambia
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Dutta D, Liu J, Xiong H. The Impact of COVID-19 on People Living with HIV-1 and HIV-1-Associated Neurological Complications. Viruses 2023; 15:1117. [PMID: 37243203 PMCID: PMC10223371 DOI: 10.3390/v15051117] [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: 04/12/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative pathogen of the coronavirus disease 2019 (COVID-19) pandemic, a fatal respiratory illness. The associated risk factors for COVID-19 are old age and medical comorbidities. In the current combined antiretroviral therapy (cART) era, a significant portion of people living with HIV-1 (PLWH) with controlled viremia is older and with comorbidities, making these people vulnerable to SARS-CoV-2 infection and COVID-19-associated severe outcomes. Additionally, SARS-CoV-2 is neurotropic and causes neurological complications, resulting in a health burden and an adverse impact on PLWH and exacerbating HIV-1-associated neurocognitive disorder (HAND). The impact of SARS-CoV-2 infection and COVID-19 severity on neuroinflammation, the development of HAND and preexisting HAND is poorly explored. In the present review, we compiled the current knowledge of differences and similarities between SARS-CoV-2 and HIV-1, the conditions of the SARS-CoV-2/COVID-19 and HIV-1/AIDS syndemic and their impact on the central nervous system (CNS). Risk factors of COVID-19 on PLWH and neurological manifestations, inflammatory mechanisms leading to the neurological syndrome, the development of HAND, and its influence on preexisting HAND are also discussed. Finally, we have reviewed the challenges of the present syndemic on the world population, with a particular emphasis on PLWH.
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Affiliation(s)
- Debashis Dutta
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA
| | | | - Huangui Xiong
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA
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Fauk NK, Gesesew HA, Seran AL, Ward PR. Barriers to access to antiretroviral therapy by people living with HIV in an indonesian remote district during the COVID-19 pandemic: a qualitative study. BMC Infect Dis 2023; 23:296. [PMID: 37147599 PMCID: PMC10161978 DOI: 10.1186/s12879-023-08221-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/04/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Coronavirus disease (COVID-19) pandemic has a significant influence on the access to healthcare services. This study aimed to understand the views and experiences of people living with HIV (PLHIV) about barriers to their access to antiretroviral therapy (ART) service in Belu district, Indonesia, during the COVID-19 pandemic. METHODS This qualitative inquiry employed in-depth interviews to collect data from 21 participants who were recruited using a snowball sampling technique. Data analysis was guided by a thematic framework analysis. RESULTS The findings showed that fear of contracting COVID-19 was a barrier that impeded participants' access to ART service. Such fear was influenced by their awareness of their vulnerability to the infection, the possibility of unavoidable physical contact in public transport during a travelling to HIV clinic and the widespread COVID-19 infection in healthcare facilities. Lockdowns, COVID-19 restrictions and lack of information about the provision of ART service during the pandemic were also barriers that impeded their access to the service. Other barriers included the mandatory regulation for travellers to provide their COVID-19 vaccine certificate, financial difficulty, and long-distance travel to the HIV clinic. CONCLUSIONS The findings indicate the need for dissemination of information about the provision of ART service during the pandemic and the benefits of COVID-19 vaccination for the health of PLHIV. The findings also indicate the need for new strategies to bring ART service closer to PLHIV during the pandemic such as a community-based delivery system. Future large-scale studies exploring views and experiences of PLHIV about barriers to their access to ART service during the COVID-19 pandemic and new intervention strategies are recommended.
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Affiliation(s)
- Nelsensius Klau Fauk
- Research Centre on Public Health, Equity and Human Flourishing (PHEHF), Torrens University, 88 Wakefield Street, 5000, Adelaide, South Australia, Australia
- Institute of Resource Governance and Social Change, 85227, Kupang, Indonesia
| | - Hailay Abrha Gesesew
- Research Centre on Public Health, Equity and Human Flourishing (PHEHF), Torrens University, 88 Wakefield Street, 5000, Adelaide, South Australia, Australia.
- College of Health Sciences, Mekelle University, P.O. Box 231, Mekelle, Tigray, Ethiopia.
| | - Alfonsa Liquory Seran
- Health Department of Belu District, Atapupu Public Health Centre, 85752, Atambua, Belu, Indonesia
| | - Paul Russell Ward
- Research Centre on Public Health, Equity and Human Flourishing (PHEHF), Torrens University, 88 Wakefield Street, 5000, Adelaide, South Australia, Australia
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Jaafari Z, Mirzaei H, Moradi Y, Nasiri N, Mehmandoost S, Khezri M, Tavakoli F, Abbaszadeh S, Sharifi H. The impact of the COVID-19 pandemic on the provision of HIV/AIDS-related services in Iran: a qualitative study. BMC Health Serv Res 2023; 23:430. [PMID: 37138294 PMCID: PMC10155158 DOI: 10.1186/s12913-023-09407-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/15/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Providing services to people living with HIV (PLWH) faced many challenges during the COVID-19 pandemic. This study aimed to examine the impact of the COVID-19 pandemic on providing HIV/AIDS-related services in Iran. METHODS In this qualitative study, the participants were included by purposive sampling between November 2021 and February 2022. Virtually focused group discussion (FGD) meetings were conducted with the first group including policymakers, service providers, and researchers (n = 17), and the interviews were conducted telephonic and face-to-face using a semi-structured guide with the second group including people who received services (n = 38). Data were analyzed by content analysis using the inductive method in MAXQDA 10 software. RESULTS Six categories were obtained, including mostly affected services, ways of the effect of COVID-19, healthcare systems reaction, effects on social inequality, opportunities created by the pandemic, and suggestions for the future. In addition, people who received services believed the COVID-19 pandemic has affected their life in several ways, including getting COVID-19, mental and emotional problems during the pandemic, financial problems, changes in the care plan, and changes in high-risk behaviors. CONCLUSION Considering the level of community involvement with the issue of COVID-19 and the shock caused by the pandemic, as mentioned by the world health organization, it is necessary to improve health systems' resilience for better preparedness for similar conditions.
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Affiliation(s)
- Zahra Jaafari
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Mirzaei
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Yousef Moradi
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Naser Nasiri
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Soheil Mehmandoost
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehrdad Khezri
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
| | - Fatemeh Tavakoli
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Samaneh Abbaszadeh
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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