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Borgstede SJ, Elly A, Helova A, Kwena Z, Darbes LA, Hatcher A, Thirumurthy H, Owino G, Pisu M, Owuor K, Braun T, Turan JM, Bukusi EA, Nghiem VT. Cost of Home-Based Couples Human Immunodeficiency Virus Counseling and Testing and Human Immunodeficiency Virus Self-Testing During Pregnancy and Postpartum in Southwestern Kenya. Value Health Reg Issues 2023; 34:125-132. [PMID: 36709657 PMCID: PMC9992305 DOI: 10.1016/j.vhri.2022.11.003] [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: 07/01/2022] [Revised: 11/05/2022] [Accepted: 11/30/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Home-based couples HIV testing and counseling and HIV self-testing (HIVST) for pregnant women can promote HIV status disclosure and male partner testing; however, cost data are lacking. We examined a home-based couples intervention (HBCI) and HIVST intervention costs per couple (unit cost) during pregnancy and postpartum in Kenya. METHODS This randomized controlled trial is comparing HBCI and HIVST for couples among pregnant women attending antenatal care clinics in two counties in southwestern Kenya. We used micro-costing to estimate the unit cost per couple receiving the intervention as the total of direct and indirect costs for each study arm in 2019 US$. We used a one-month window to conduct a time and motion study to determine personnel effort and resources. We then compared the unit cost by arm, identified key cost drivers, and conducted sensitivity analyses for cost uncertainties. RESULTS At base-case, the unit cost was $129.01 and $41.99, respectively, for HBCI and HIVST. Personnel comprised half of the unit cost for both arms. Staff spent more time on activities related to participant engagement in HBCI (accounting for 6.4% of the unit cost) than in HIVST (2.3%). Staff training was another key cost driver in HBCI (20.1% of the unit cost compared to 12.5% in HIVST). Sensitivity analyses revealed that the unit cost ranges were $104.64-$154.54 for HBCI and $30.49-$56.59 for HIVST. CONCLUSIONS Our findings may guide spending decisions for future HIV prevention and treatment programs for pregnant couples in resource-limited settings such as Kenya.
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Affiliation(s)
- Seth J Borgstede
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Assurah Elly
- Research, Care and Treatment Programme, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Anna Helova
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA; Sparkman Center for Global Health, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zachary Kwena
- Research, Care and Treatment Programme, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lynae A Darbes
- Center for Sexuality and Health Disparities, and Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Abigail Hatcher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - George Owino
- Research, Care and Treatment Programme, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Maria Pisu
- Department of Preventive Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin Owuor
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Thomas Braun
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Janet M Turan
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA; Sparkman Center for Global Health, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth A Bukusi
- Research, Care and Treatment Programme, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Van T Nghiem
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
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Associations between sexual identity, living with disability, bully victimisation, and HIV status and intimate partner violence among residents in Nigeria. BMC Public Health 2022; 22:1756. [PMID: 36114566 PMCID: PMC9479364 DOI: 10.1186/s12889-022-14186-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background The aim of the study was to determine the associations between sexual identity, disability and HIV status and bullying victimisation, and a history of physical, emotional and sexual violence in Nigeria. Methods This was a secondary analysis of a primary dataset generated through an online survey conducted between February 7 and 19, 2021. The 3197 participants for the primary study were recruited through snowballing. The dependent variables were physical, emotional and sexual violence. The independent variables were sexual identity (heterosexual and sexual minority), HIV status (negative, positive and unknown), bullying victimisation (yes/no) and living with disability (yes/no). A multivariate logistic regression model was developed for each form of IPV. Each model was adjusted for age, sex assigned at birth, marital status and education level. Results Respondents living with HIV had higher odds for physical (AOR: 2.01; 95% CI: 1.46–2.76; p < 0.001), sexual (AOR: 2.17; 95%CI: 1.55–3.05; p < 0.001), and emotional (AOR: 1.59; 95%CI: 1.24–2.06; p < 0.001) violence. Also, those with history of bullying victimisation had higher odds for physical (AOR: 3.79; 95%CI: 2.86 – 5.68; p < 0.001), sexual (AOR: 3.05; 95%CI: 2.27 – 4.10; p < 0.001) and emotional (AOR: 2.66; 95%CI: 2.10 – 3.37; p < 0.001) violence. In addition, females had higher odds of physical (AOR: 1.52; 95%CI: 1.13–2.043; p < 0.001) and sexual (AOR: 1.83; 95%CI: 1.34 – 2.50; p < 0.001) violence; and respondents cohabiting (AOR: 1.95; 95%CI: 1.12 – 3.28; p = 0.012) had higher odds for emotional violence. Respondents who were married have significantly lower odds of experiencing physical (AOR: 0.66; 95%CI: 0.45 – 9.60; p = 0.029), sexual (AOR: 0.40; 95%CI: 0.26 – 0.62; p < 0.001) and emotional (AOR: 0.68; 95%CI: 0.50 – 0.93; p = 0.015) violence when compared to singles. Younger respondents also had lower odds of experiencing sexual violence (AOR: 0.97; 95%CI: 0.95–0.99; p = 0.016). Conclusion HIV positive status and bullying victimisation seem to increase the risk for all forms of IPV while the experience of IPV did not differ by sexual identity and disability status. The associations between age, sex, marital status and IPV may suggest moderating roles of the factors taking cognisance of the cultural context of these relationships. Future relational analysis is necessary to further understand the pathways for the associations found between the variables in this study. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14186-6.
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Agyarko-Poku T, Bannor R, Sorvor E, Ankobea-Kokroe F. HIV status disclosure and sexual activity among pregnant women in Ghana. AIDS Care 2022; 35:385-391. [PMID: 36102039 DOI: 10.1080/09540121.2022.2121375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Human Human immunodeficiency virus (HIV) status disclosure to sexual partners is associated with prevention, care, treatment, and support for pregnant women with HIV. We aimed to assess HIV status disclosure and sexual activity among pregnant women with HIV. We conducted a cross-sectional hospital-based survey using quantitative methods. Data were collected from 118 pregnant women with HIV enrolled in the prevention of mother-to-child transmission (PMTCT) program from January to November 2019. Sixty-seven percent (67%) of these pregnant women did not know they had HIV until they were tested in the routine antenatal HIV testing program. HIV status nondisclosure rate was 62.7%, and the most common reason for nondisclosure was fear of loss of financial support (41.9%). Higher parity was associated with lower odds of disclosing HIV status (aOR = 0.36; p < 0.01). Sexual activity with partners and condom use were associated with HIV disclosure (ps < 0.01). Pregnant women who disclosed their HIV status to their partners were sexually active with them (37.3%), and all those who did not but were sexually active with their partners did not use condoms (36.2%) during the pregnancy. Our findings emphasize the need for interventions that encourage HIV status disclosure and affirm the importance of routine HIV testing for pregnant women.
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Affiliation(s)
- Thomas Agyarko-Poku
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Suntreso Government Hospital, Ghana Health Service, Kumasi, Ghana
| | - Richard Bannor
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
- UConn Center for mHealth and Social Media, Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Elizabeth Sorvor
- Suntreso Government Hospital, Ghana Health Service, Kumasi, Ghana
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana
| | - Frank Ankobea-Kokroe
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Bhushan NL, Stoner MCD, Groves AK, Kahn K, Pettifor AE. Partnership Dynamics and HIV-Related Sexual Behaviors Among Adolescent Mothers in South Africa: A Longitudinal Analysis of HIV Prevention Trials Network 068 Data. J Adolesc Health 2022; 71:63-69. [PMID: 35370076 PMCID: PMC9232891 DOI: 10.1016/j.jadohealth.2022.02.003] [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: 07/27/2021] [Revised: 01/26/2022] [Accepted: 02/03/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE In South Africa, adolescent mothers have a three times higher risk of HIV acquisition than nonadolescent mothers. Yet, limited evidence exists regarding how early childbearing may affect HIV risk. A better understanding of adolescent mothers' partnership dynamics and sexual behaviors is critical to tailoring interventions to prevent new infections. METHODS Data are from HIV Prevention Trials Network 068, a longitudinal study of adolescent girls and young women (AGYW) aged 13-20 in South Africa who were followed annually for up to 6 years. Log-binomial regression models were used to assess whether adolescent motherhood was associated with partnership dynamics (intimate partner violence, gender inequitable norms, low relationship power, no HIV prevention communication) and if the association between partnership dynamics and sexual behaviors (unprotected sex and transactional sex) varied by adolescent motherhood. Generalized estimating equations, with an exchangeable correlation structure, were used to account for nonindependence. RESULTS Adolescent mothers were more likely than nonadolescent mothers to be in partnerships characterized by intimate partner violence, low relationship power, gender inequitable norms, and no HIV prevention communication. A higher proportion were also more likely to experience these dynamics, as well as engage in transactional sex, after giving birth. Poor partnership dynamics put AGYW at a higher risk for unprotected sex and transactional sex, regardless of adolescent motherhood status. DISCUSSION Engaging adolescent mothers in interventions post birth and developing interventions that address power imbalances in AGYW's sexual partnerships have the potential to reduce engagement in HIV-related sexual behaviors and HIV risk in the long term.
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Affiliation(s)
- Nivedita L Bhushan
- Center for Communication Science, RTI International, Research Triangle Park, North Carolina.
| | - Marie C D Stoner
- Women's Global Health Imperative, RTI International, San Francisco, California
| | - Allison K Groves
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Audrey E Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Johnson MJ, Darbes LA, Hosegood V, Johnson MO, Fritz K, Ngubane T, van Rooyen H, McGrath N. Social Influence and Uptake of Couples HIV Testing and Counselling in KwaZulu-Natal, South Africa. AIDS Behav 2022; 26:764-774. [PMID: 34417920 PMCID: PMC8840905 DOI: 10.1007/s10461-021-03435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 11/17/2022]
Abstract
Social influences may create a barrier to couples HIV testing and counselling (CHTC) uptake in sub-Saharan Africa. This secondary analysis of data collected in the 'Uthando Lwethu' randomised controlled trial used discrete-time survival models to evaluate the association between within-couple average 'peer support' score and uptake of CHTC by the end of nine months' follow-up. Peer support was conceptualised by self-rated strength of agreement with two statements describing friendships outside of the primary partnership. Eighty-eight couples (26.9%) took up CHTC. Results tended towards a dichotomous trend in models adjusted only for trial arm, with uptake significantly less likely amongst couples in the higher of four peer support score categories (OR 0.34, 95% CI 0.18, 0.68 [7-10 points]; OR 0.53, 95% CI 0.28, 0.99 [≥ 11 points]). A similar trend remained in the final multivariable model, but was no longer significant (AOR 0.59, 95% CI 0.25, 1.42 [7-10 points]; AOR 0.88, 95% CI 0.36, 2.10 [≥ 11 points]). Accounting for social influences in the design of couples-focused interventions may increase their success.
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Affiliation(s)
- Matthew J. Johnson
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Mailpoint 95, Tremona Road, Southampton, SO16 6YD UK
- NIHR ARC Wessex Data Science Hub, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, UK
| | - Lynae A. Darbes
- Center for AIDS Prevention Studies, Division of Prevention Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA USA
- Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, USA
| | - Victoria Hosegood
- Department of Social Statistics and Demography, Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Mallory O. Johnson
- Center for AIDS Prevention Studies, Division of Prevention Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Katherine Fritz
- International Center for Research on Women, Washington, DC USA
| | | | - Heidi van Rooyen
- Human Sciences Research Council, Durban, South Africa
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nuala McGrath
- Department of Social Statistics and Demography, Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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Wall KM, Inambao M, Kilembe W, Karita E, Chomba E, Vwalika B, Mulenga J, Parker R, Sharkey T, Tichacek A, Hunter E, Yohnka R, Streeb G, Corso PS, Allen S. Cost-effectiveness of couples' voluntary HIV counselling and testing in six African countries: a modelling study guided by an HIV prevention cascade framework. J Int AIDS Soc 2020; 23 Suppl 3:e25522. [PMID: 32602618 PMCID: PMC7325504 DOI: 10.1002/jia2.25522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/17/2020] [Accepted: 04/23/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Couples' voluntary HIV counselling and testing (CVCT) is a high-impact HIV prevention intervention in Rwanda and Zambia. Our objective was to model the cost-per-HIV infection averted by CVCT in six African countries guided by an HIV prevention cascade framework. The HIV prevention cascade as yet to be applied to evaluating CVCT effectiveness or cost-effectiveness. METHODS We defined a priority population for CVCT in Africa as heterosexual adults in stable couples. Based on our previous experience nationalizing CVCT in Rwanda and scaling-up CVCT in 73 clinics in Zambia, we estimated HIV prevention cascade domains of motivation for use, access and effectiveness of CVCT as model parameters. Costs-per-couple tested were also estimated based on our previous studies. We used these parameters as well as country-specific inputs to model the impact of CVCT over a five-year time horizon in a previously developed and tested deterministic compartmental model. We consider six countries across Africa with varied HIV epidemics (South Africa, Zimbabwe, Kenya, Tanzania, Ivory Coast and Sierra Leone). Outcomes of interest were the proportion of HIV infections averted by CVCT, nationwide CVCT implementation costs and costs-per-HIV infection averted by CVCT. We applied 3%/year discounting to costs and outcomes. Univariate and Monte Carlo multivariate sensitivity analyses were conducted. RESULTS We estimated that CVCT could avert between 54% (Sierra Leone) and 62% (South Africa) of adult HIV infections. Average costs-per-HIV infection averted were lowest in Zimbabwe ($550) and highest in South Africa ($1272). Nationwide implementations would cost between 7% (Kenya) and 21% (Ivory Coast) of a country's President's Emergency Plan for AIDS Relief (PEPFAR) budget over five years. In sensitivity analyses, model outputs were most sensitive to estimates of cost-per-couple tested; the proportion of adults in heterosexual couples and HIV prevention cascade domains of CVCT motivation and access. CONCLUSIONS Our model indicates that nationalized CVCT could prevent over half of adult HIV infections for 7% to 21% of the modelled countries' five-year PEPFAR budgets. While other studies have indicated that CVCT motivation is high given locally relevant promotional and educational efforts, without required indicators, targets and dedicated budgets, access remains low.
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Affiliation(s)
- Kristin M Wall
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
- Department of EpidemiologyRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Mubiana Inambao
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
- Department of Obstetrics and GynecologyNdola Central HospitalNdolaZambia
| | - William Kilembe
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Etienne Karita
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | | | - Bellington Vwalika
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
- Department of Obstetrics and GynecologySchool of MedicineUniversity of ZambiaLusakaZambia
| | - Joseph Mulenga
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Rachel Parker
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Tyronza Sharkey
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Amanda Tichacek
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Eric Hunter
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
- Department of Pathology & Laboratory MedicineSchool of MedicineEmory UniversityAtlantaGAUSA
- Emory Vaccine CenterYerkes National Primate Research CenterEmory UniversityAtlantaGAUSA
| | - Robert Yohnka
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Gordon Streeb
- Departments of Economics and Political ScienceEmory UniversityAtlantaGAUSA
| | | | - Susan Allen
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
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Njau B, Lisasi E, Damian DJ, Mushi DL, Boulle A, Mathews C. Feasibility of an HIV self-testing intervention: a formative qualitative study among individuals, community leaders, and HIV testing experts in northern Tanzania. BMC Public Health 2020; 20:490. [PMID: 32293370 PMCID: PMC7161285 DOI: 10.1186/s12889-020-08651-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Achieving the 95-95-95 global targets by 2030, innovative HIV testing models, such as HIV self-testing are needed for people, who are unaware of their HIV status. We aimed to explore key informants, mountain climbing porters, and female bar workers' attitudes, perceived norms, and personal agency related to HIV self-testing. METHODS This was a formative qualitative study to inform the design of an HIV self-testing intervention in Northern Tanzania. Informed by the Integrated Behaviour Model, we conducted four focus group discussions, and 18 in-depth interviews with purposively selected participants. Data were analyzed using the framework method. RESULTS We recruited 55 participants. Most participants had positive attitudes towards HIVST, in that they anticipated positive consequences related to the introduction and uptake of HIVST. These included privacy and convenience, avoidance of long queues at health facilities, reduced counselor workload, and reduced indirect costs (given that transport to health facilities might not be required). Participants expressed the belief that significant people in their social environment, such as parents and peers, would approve their uptake of HIVST, and that they would accept HIVST. Additionally, features of HIVST that might facilitate its uptake were that it could be performed in private and would obviate visits to health facilities. Most participants were confident in their capacity to use HIVST kits, while a few were less confident about self-testing while alone. Strategies to maximize beliefs about personal agency and facilitate uptake included supplying the self-test kits in a way that was easy to access, and advocacy. Perceived potential constraints to the uptake of HIVST were the cost of buying the self-test kits, poverty, illiteracy, poor eyesight, fear of knowing one's HIV status, lack of policy/ guidelines for HIVST, and the absence of strategies for linkage to HIV care, treatment, and support. CONCLUSIONS The findings suggest that HIVST may be feasible to implement in this study setting, with the majority of participants reporting positive attitudes, supportive perceived norms, and self-efficacy. Hence, future HIVST interventions should address the negative beliefs, and perceived barriers towards HIVST to increase HIV testing among the target population in Northern Tanzania.
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Affiliation(s)
- Bernard Njau
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | - Esther Lisasi
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Damian J. Damian
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | - Declare L. Mushi
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | - Andrew Boulle
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre of Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Catherine Mathews
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Adinan J, Adamou B, Amour C, Shayo A, Kidayi PL, Msuya L. Feasibility of home-based HIV counselling and testing and linking to HIV services among women delivering at home in Geita, Tanzania: a household longitudinal survey. BMC Public Health 2019; 19:1758. [PMID: 31888642 PMCID: PMC6937982 DOI: 10.1186/s12889-019-8111-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 12/19/2019] [Indexed: 11/17/2022] Open
Abstract
Background Substantial number of women who deliver at home (WDH) are not captured in prevention of mother-to-child transmission (PMTCT) services. This delays HIV infection detection that negatively impacts endeavours to fight the HIV pandemic and the health of mothers and children. The study objective was to determine the feasibility of home-based HIV testing and linking to care for HIV services among WDH in Geita District Council, Tanzania. Methods A longitudinal household survey was conducted. The study involved all mentally-able women who delivered within 2 years (WDTY) preceding the survey and their children under the age of two. The study was conducted in Geita District Council in Geita Region, Tanzania from June to July 2017. Geita is among the region with high HIV prevalence and proportion of women delivering at home. Results Of the 993 women who participated in the study, 981 (98.8%) accepted household-based HIV counselling and testing (HBHCT) from the research team. HIV prevalence was 5.3% (52 women). HBHCT identified 26 (2.7%) new HIV infections; 23 (23.4%) were those tested negative at ANC and the remaining three (0.3%) were those who had no HIV test during the ANC visit. Among the 51 HIV+ women, 21 (40.4%) were enrolled in PMTCT services. Of the 32 HIV+ participants who delivered at home, eight (25.8%) were enrolled in the PMTCT compared to 100% (13/13) of the women who delivered at a health facility. Conclusion HBHCT uptake was high. HBHCT detected new HIV infection among WDH as well as seroconversion among women with previously negative HIV tests. The study findings emphasize the importance of extending re-testing to women who breastfeed. HBHCT is feasible and can be used to improve PMTCT services among WDH.
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Affiliation(s)
- Juma Adinan
- AMO School KCMC, P.O.Box 2316, Moshi, Tanzania. .,Kilimanjaro Christian Medical Centre, Community Health department, Moshi, Tanzania. .,Kilimanjaro Christian Medical University College, Institute of Public Health, Moshi, Tanzania.
| | - Bridgit Adamou
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Caroline Amour
- Kilimanjaro Christian Medical University College, Institute of Public Health, Moshi, Tanzania
| | - Aisa Shayo
- Kilimanjaro Christian Medical Centre, Paediatric and Child Health department, Moshi, Tanzania
| | - Paulo Lino Kidayi
- Kilimanjaro Christian Medical University College, Faculty of Nursing, Moshi, Tanzania
| | - Levina Msuya
- AMO School KCMC, P.O.Box 2316, Moshi, Tanzania.,Kilimanjaro Christian Medical Centre, Community Health department, Moshi, Tanzania.,Kilimanjaro Christian Medical Centre, Paediatric and Child Health department, Moshi, Tanzania
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Muiruri C, Swai SJ, Ramadhani HO, Knettel BA, Mahande MJ, Msuya SE, Bartlett JA. Individual and partner characteristics associated with HIV testing and counseling uptake among individuals 50 years or older in Tanzania. Int J STD AIDS 2019; 30:1425-1431. [PMID: 31747843 DOI: 10.1177/0956462419874990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
HIV prevention efforts have historically focused on people aged 15–49 years, despite mounting evidence of risk behavior and increased disease burden among older adults. We analyzed survey data from 600 adults aged ≥50 years in the Rombo District of Tanzania. Logistic regression models were performed to evaluate individual and partner-level factors associated with HIV testing and counseling (HTC) uptake. In this sample, more than half of participants were sexually active and condom use was rare, but only 57% had ever been tested for HIV. Ten were HIV infected (1.7%); this prevalence was approximately one-third that observed among the general population in Tanzania (4.7%). Individual factors associated with increased HTC uptake included younger age, female gender, greater educational attainment, and having health insurance. Partner factors associated with increased HTC uptake included lower partner age and higher partner education. This population demonstrated substantial HIV risk, warranting tailored interventions to raise awareness and increase HTC uptake.
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Affiliation(s)
- Charles Muiruri
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Duke Global Health Institute, Durham, NC, USA
| | | | - Habib O Ramadhani
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Institute of Human Virology, University of Maryland, Baltimore, MD, USA
| | | | - Michael J Mahande
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sia E Msuya
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - John A Bartlett
- Duke Global Health Institute, Durham, NC, USA.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Leddy AM, Weiss E, Yam E, Pulerwitz J. Gender-based violence and engagement in biomedical HIV prevention, care and treatment: a scoping review. BMC Public Health 2019; 19:897. [PMID: 31286914 PMCID: PMC6615289 DOI: 10.1186/s12889-019-7192-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 06/17/2019] [Indexed: 12/17/2022] Open
Abstract
Background While gender-based violence (GBV) has been shown to increase women’s risk of HIV acquisition, the role of GBV in the HIV testing to care continuum is less clear. Clarifying how GBV may act as a barrier to accessing HIV services, treatment and care - such as anti-retroviral treatment (ART) or pre-exposure prophylaxis (PrEP) - will not only provide insights into how to best meet individual women’s HIV care needs, but also inform public health oriented HIV epidemic control strategies. Methods Through a comprehensive scoping review, we synthesized and analyzed existing evidence regarding the influence of GBV on engagement in PrEP and the HIV care continuum among women living with HIV, including members of key populations (female sex workers, transgender women and women who use drugs). We explored PubMed, Scopus and Web of Science for peer-reviewed studies published in 2003–2017. Of the 279 sources identified, a subset of 51 sources met the criteria and were included in the scoping review. Results Studies were identified from 17 countries. The majority of studies utilized quantitative cross-sectional designs (n = 33), with the rest using longitudinal (n = 4), qualitative (n = 10) or mixed methods (n = 4) designs. Taken together, findings suggest that GBV impedes women’s uptake of HIV testing, care, and treatment, yet this can vary across different geographic and epidemic settings. Substantial gaps in the literature do still exist, including studies on the impact of GBV on engagement in PrEP, and research among key populations. Conclusions This scoping review contributes to our knowledge regarding the role GBV plays in women’s engagement in PrEP and the HIV care continuum. Findings reveal the need for more longitudinal research to provide insights into the causal pathways linking GBV and HIV care and treatment outcomes. Research is also needed to illuminate the impact of GBV on PrEP use and adherence as well as the impact of GBV on engagement along the HIV care continuum among key populations. It is critical that programs and research keep pace with these findings in order to reduce the global burden of GBV and HIV among women.
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Affiliation(s)
- Anna M Leddy
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th St., 3rd Floor, San Francisco, CA, 94158, USA.
| | - Ellen Weiss
- Population Council, 4301 Connecticut Ave. NW, # 280, Washington, DC, 20008, USA
| | - Eileen Yam
- Population Council, 4301 Connecticut Ave. NW, # 280, Washington, DC, 20008, USA
| | - Julie Pulerwitz
- Population Council, 4301 Connecticut Ave. NW, # 280, Washington, DC, 20008, USA
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11
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Hailemariam TG, Nathan S, Seifu CN, Rawstorne P. Uptake of couples HIV testing and counselling among heterosexual couples in Sub-Saharan Africa: a systematic review and meta-analysis. AIDS Care 2019; 32:137-147. [DOI: 10.1080/09540121.2019.1619667] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Tewodros Getachew Hailemariam
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
- School of Public Health, Wolaita Sodo University, Sodo, Ethiopia
| | - Sally Nathan
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | | | - Patrick Rawstorne
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
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12
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Conserve DF, Issango J, Kilale AM, Njau B, Nhigula P, Memiah P, Mbita G, Choko AT, Hamilton A, King G. Developing national strategies for reaching men with HIV testing services in Tanzania: results from the male catch-up plan. BMC Health Serv Res 2019; 19:317. [PMID: 31109335 PMCID: PMC6528365 DOI: 10.1186/s12913-019-4120-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/24/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND According to the 2016-2017 Tanzania HIV Impact Survey, 55% of men diagnosed with HIV during the survey self-reported that they were unaware of their HIV status. As a response, the Government of Tanzania launched a Test and Treat campaign in June 2018 with a focus on reaching men and developed the 2018-2020 Male Catch-Up plan. This article reports (1) the enablers and barriers of HIV testing services (HTS) uptake among men (2) and describes the strategies that were proposed as part of the Male Catch-Up Plan to address some of these barriers. METHOD Qualitative in-depth interviews were conducted with 23 men in Dar es Salaam to explore HTS enablers and barriers. To develop the Male Catch-Up Plan strategies, a desk review of published studies, and analyses of national implementers of HIV/AIDS interventions were conducted. An additional 123 interviews were also carried out with key implementers of HIV/AIDS interventions, healthcare workers, secondary school boys and members of the community in Iringa and Tanga. RESULTS Enablers of HTS included the desire to check one's health, high HIV risk perception, wanting to protect oneself if tested negative, and being encouraged by their sexual partners. Barriers of HTS were fear of a positive test result, and low HIV risk perception. Proposed strategies from the Male Catch-Up Plan to address these barriers included non-biomedical and biomedical approaches. Non-biomedical strategies are social and cultural approaches to promote an enabling environment to encourage health seeking behavior, safe behavior, and providing peer education programs and social marketing to promote condoms. Biomedical approaches consisted of expanding targeted HIV testing, HIV self-testing, and integrating HIV services with other health services. CONCLUSION A number of barriers contribute to the low uptake of HTS among men in Tanzania. National strategies have been developed to address these HTS barriers and guide the national Test and Treat campaign focusing on increasing HTS uptake among men.
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Affiliation(s)
- Donaldson F. Conserve
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Jumanne Issango
- Tanzania Commission for AIDS (TACAIDS), Dar es Salaam, Tanzania
| | | | - Bernard Njau
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Patrick Nhigula
- Darla Moore School of Business, University of South Carolina, Columbia, USA
| | | | | | - Augustine T. Choko
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Akeen Hamilton
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Gary King
- Department of Biobehavioral Health, Pennsylvania State University, University Park, State College, PA USA
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Brief Report: "Give Me Some Time": Facilitators of and Barriers to Uptake of Home-Based HIV Testing During Household Contact Investigation for Tuberculosis in Kampala, Uganda. J Acquir Immune Defic Syndr 2019; 77:400-404. [PMID: 29300218 DOI: 10.1097/qai.0000000000001617] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Integrating home-based HIV counseling and testing (HCT) with tuberculosis (TB) evaluation could improve the uptake of HIV testing among household contacts of patients with active TB. We sought to identify the facilitators of and barriers to HCT during household contact investigation for TB in Kampala, Uganda. METHODS We nested semi-structured interviews with 28 household contacts who were offered home-based HCT in a household-randomized trial of home-based strategies for TB contact investigation. Respondents reflected on their experiences of the home visit, the social context of the household, and their decision to accept or decline HIV testing. We used content analysis to identify and evaluate facilitators of and barriers to testing, then categorized the emergent themes using the Capability, Opportunity, Motivation, and Behavior (COM-B) model. RESULTS Facilitators included a preexisting desire to confirm HIV status or to show support for the index TB patient; a perception that home-based services are convenient; and positive perceptions of lay health workers. Key barriers included fear of results and feeling psychologically unprepared to receive results. The social influence of other household members operated as both a facilitator and a barrier. CONCLUSIONS Preexisting motivation, psychological readiness to test, and the social context of the household are major contributors to the decision to test for HIV at home. Uptake might be improved by providing normalizing information about HCT before the visit, by offering a second HCT opportunity, by offering self-tests with follow-up counseling, or by introducing HCT using "opt-out" language.
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Conserve DF, Muessig KE, Maboko LL, Shirima S, Kilonzo MN, Maman S, Kajula L. Mate Yako Afya Yako: Formative research to develop the Tanzania HIV self-testing education and promotion (Tanzania STEP) project for men. PLoS One 2018; 13:e0202521. [PMID: 30148846 PMCID: PMC6110473 DOI: 10.1371/journal.pone.0202521] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 08/03/2018] [Indexed: 11/22/2022] Open
Abstract
The purpose of this formative research, guided by the Integrated Behavioral Model, was to assess men's attitudes and personal agency towards HIV self-testing (HIVST) and confirmatory HIV testing in order to inform the development of the Tanzania STEP (Self-Testing Education and Promotion) Project, a peer-based HIV self-testing intervention for young men in Tanzania. Qualitative in-depth interviews were conducted with 23 men in Dar es Salaam, Tanzania who socialize in networks locally referred to as "camps". Men reported privacy, confidentiality, and saving time as the primary reasons for their self-testing interest. Most participants had high perceived control and self-efficacy to self-test and seek confirmatory HIV testing. Nevertheless, men reported concerns related to their ability to perform the test and the potential lack of post-test counseling. Specific recommendations for the intervention included providing HIVST education and pre-test counseling, and using mobile health (mHealth) strategies for participants to reach a healthcare professional for further assistance. The findings suggest that while HIVST is highly acceptable among men in Tanzania, future interventions will need to address the challenges that men may face with HIVST before promoting it as an alternative or supplement to facility-based HIV testing.
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Affiliation(s)
- Donaldson F. Conserve
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Kathryn E. Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | - Sylvia Shirima
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Mrema N. Kilonzo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Lusajo Kajula
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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15
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Leblanc NM, Mitchell J. Providers' Perceptions of Couples' HIV Testing and Counseling (CHTC): Perspectives From a U.S. HIV Epicenter. ACTA ACUST UNITED AC 2018; 7:22-33. [PMID: 30319926 DOI: 10.1037/cfp0000097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Current epidemiology demonstrate the significance of couple-based HIV transmission among vulnerable U.S. populations and its contribution to health disparity in HIV prevalence. Couples HIV testing and counseling (CHTC) can be used to address couple-based HIV risk in the U.S. Though a globally recognized service, the literature lacks U.S.-based healthcare providers' (HCP) perspectives of CHTC. To address this research gap, a qualitative descriptive design was used to ascertain HCPs' perceptions about CHTC. Semi-structured in-depth interviews were conducted with 22 HCPs who were experienced with engaging patients or clients across the HIV care continuum. Overall, HCPs supported CHTC among different U.S. POPULATIONS Content and thematic analysis revealed HCPs perceived CHTC to be an evolution from current HIV testing approaches and a mechanism to screen people who may not otherwise. CHTC was perceived to have biomedical and bio-behavioral merit that warranted consideration for implementation within health service settings and among populations with heightened HIV risk. This strategy was perceived to be a mechanism for introducing PrEP and conception health into one's practice. CHTC also signaled patients reorienting perceptions of personal health as being linked to the health of another individual. Providers recognized that couples have evolved to be increasingly non-heteronormative and thought that CHTC should be offered to all couples. However, participants also noted that HCPs in the U.S. need to be comfortable with promoting sexual health among various populations for implementation of CHTC to be successful.
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Affiliation(s)
- Natalie M Leblanc
- Post-doctorate Associate at the University of Rochester School of Nursing, Rochester, NY
| | - Jason Mitchell
- Assistant Professor in Office of Public Health Studies at the University of Hawai'i at Mānoa, Honolulu, HI
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Limaye RJ, Berman A, Brown J, Kakhobwe T. Perceptions of why Malawians engage in concurrent sexual partnerships among a select population of radio listeners: findings from an exploratory study. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018; 17:1-8. [PMID: 29471730 DOI: 10.2989/16085906.2017.1362014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Concurrent sexual partnerships have been identified as a potential driver in the HIV epidemic in Southern Africa. This study utilised an innovative approach to explore perceptions of why Malawians may engage in these relationships, and their suggestions for reducing the practice among a select population of radio listeners. Using radio listener feedback in the form of text messages, we analysed approximately 1 000 text messages sent by individuals who listened to a reality radio programme that included real stories, told by Malawians, on topics related to HIV/AIDS. Listeners suggested that lack of satisfaction with one's partner was the overarching reason why individuals had concurrent sexual partnerships. Within the context of lack of satisfaction, listeners cited alcohol use, poor communication and gendered norms as factors related to satisfaction. Listeners suggested that couple communication could increase satisfaction, which, in turn, could reduce concurrent sexual partnerships. Prevention efforts should consider how to utilise couple communication to improve satisfaction as an approach to reduce HIV risk in Southern Africa.
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Affiliation(s)
- Rupali J Limaye
- a Johns Hopkins Center for Communication Programs , Baltimore , Maryland
| | - Amanda Berman
- a Johns Hopkins Center for Communication Programs , Baltimore , Maryland
| | - Jane Brown
- a Johns Hopkins Center for Communication Programs , Baltimore , Maryland
| | - Triza Kakhobwe
- b Johns Hopkins Center for Communication Programs , Lilongwe , Malawi
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17
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McMahon JM, Chimenti R, Trabold N, Fedor T, Mittal M, Tortu S. Risk of Intimate Partner Violence and Relationship Conflict Following Couple-Based HIV Prevention Counseling: Results From the Harlem River Couples Project. JOURNAL OF INTERPERSONAL VIOLENCE 2017; 32:3709-3734. [PMID: 26319710 PMCID: PMC4769677 DOI: 10.1177/0886260515600878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Heterosexual transmission of HIV often occurs in the context of intimate sexual partnerships. There is mounting evidence that couple-based HIV prevention interventions may be more effective than individual-based interventions for promoting risk reduction within such relationships. Yet, concerns have been raised about the safety of couple-based prevention approaches, especially with regard to the risk of intimate partner violence against women. Although several international studies have examined the potential for adverse consequences associated with couple-based interventions, with inconsistent results, there is little data from U.S. studies to shed light on this issue. The current study analyzed data from a randomized trial conducted in New York City with 330 heterosexual couples to examine whether participation in couple-based or relationship-focused HIV counseling and testing (HIV-CT) interventions resulted in an increased likelihood of post-intervention breakups, relationship conflicts, or emotional, physical, or sexual abuse, compared with standard individual HIV-CT. Multinomial logistic regression was used to model the odds of experiencing change in partner violence from baseline to follow-up by treatment condition. A high prevalence of partner-perpetrated violence was reported by both male and female partners across treatment conditions, but there was no conclusive evidence of an increase in relationship dissolution or partner violence subsequent to participation in either the couple-based HIV-CT intervention or relationship-focused HIV-CT intervention compared with controls. Qualitative data collected from the same participants support this interpretation. HIV prevention interventions involving persons in primary sexual partnerships should be sensitive to relationship dynamics and the potential for conflict, and take precautions to protect the safety of both male and female participants.
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Affiliation(s)
| | | | | | | | - Mona Mittal
- 3 University of Maryland, College Park, MD, USA
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18
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Matovu JKB, Bukuluki PW, Mafigiri DK, Mudondo H. HIV counseling and testing practices among clients presenting at a market HIV clinic in Kampala, Uganda: a cross-sectional study. Afr Health Sci 2017; 17:729-737. [PMID: 29085400 PMCID: PMC5656195 DOI: 10.4314/ahs.v17i3.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Uptake of HIV counseling and testing (HCT) among informal sector workers is not well documented. OBJECTIVE To assess HCT practices among clients presenting for HIV services at a market HIV clinic in Kampala, Uganda. METHODS Between August 1 and September 15, 2009, clients presenting for HIV services at a market HIV clinic were invited to participate in the study. Socio-demographic and HCT data were collected from consenting adults aged 16+ years. Descriptive statistics were performed using STATA version 14.1. RESULTS Of 224 individuals who consented to the interview, n=139 62 % were market vendors while n=85 38 % were engaged in other market-related activities. Majority of the respondents, n=165, 73.7 %, had ever tested for HIV; of these, n=148,89.7 % had ever tested for 2+ times. The main reasons for repeat testing were the need to confirm previous HIV test results, n=126, 85.1% and the belief that the previous HIV test results were false, n=35, 23.6 %. Uptake of couples' HCT was low, n=63, 38.2 %, despite the fact that n=200, 89 % had ever heard of couples' HCT. CONCLUSION These findings indicate high rates of repeat testing but low rates of couples' HCT uptake in this population.
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Affiliation(s)
- Joseph KB Matovu
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Paul W Bukuluki
- Department of Social Work & Social Administration, School of Social Sciences, Makerere University College of Humanities and Social Sciences, Kampala, Uganda
| | - David K Mafigiri
- Department of Social Work & Social Administration, School of Social Sciences, Makerere University College of Humanities and Social Sciences, Kampala, Uganda
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Mtenga SM, Geubbels E, Tanner M, Merten S, Pfeiffer C. 'It is not expected for married couples': a qualitative study on challenges to safer sex communication among polygamous and monogamous partners in southeastern Tanzania. Glob Health Action 2016; 9:32326. [PMID: 27633036 PMCID: PMC5025524 DOI: 10.3402/gha.v9.32326] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/08/2016] [Accepted: 08/12/2016] [Indexed: 12/04/2022] Open
Abstract
Background Behavioral change approaches for human immunodeficiency virus (HIV) prevention in Tanzania encourage married partners to observe safe sex practices (condom use, avoidance of, or safe sex with multiple partners). To implement this advice, partners need to communicate with each other about safer sex, which is often challenging. Although social-structural factors are crucial in understanding sexual behavior, only a few studies focus on understanding safer sex dialogue in a broader social context. Design Drawing on the WHO-Commission on the Social Determinants of Health (WHO-CSDH) framework, this study explored key social-structural constructs for studying health in the context of improving safer sex dialogue between polygamous and monogamous partners. Twenty-four in-depth interviews (IDIs) and six focus group discussions (FGDs) with 38 men and women aged 18–60 years were conducted in Ifakara town located in Kilombero district, Tanzania. The study was nested within the community health surveillance project MZIMA (Kiswahili: ‘being healthy’). Partners’ experiences of safer sex dialogue in polygamous and monogamous relations were investigated and the challenges to safer sex dialogue explored. Results The study revealed that open safer sex dialogue in marriage is limited and challenged by social norms about marriage (a view that safer sex dialogue imply that partners are ‘not really’ married); marital status (a belief that safer sex dialogue is not practical in polygamous marriages, the elder wife should be exempted from the dialogue since she is at lower risk of engaging in extramarital affairs); relationship quality (marital conflicts, extramarital affairs, trust, and sexual dissatisfaction); and gender power relations (the notion that females’ initiative to discuss condom use and HIV couple counseling and testing may lead to conflict or divorce). Conclusions Implementing safer sex practices requires interventions beyond promotion messages. HIV prevention interventions in Tanzania should be carefully adapted to the local context including respective social norms, gender systems, marital context and relationship uncertainties as aspects that facilitate or hinder safer sex dialogue between partners. The WHO-CSDH framework could be strengthened by explicitly integrating relationship quality, marital status, and social norms as additional determinants of health.
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Affiliation(s)
- Sally Mmanyi Mtenga
- Ifakara Health Institute (IHI), Ifakara, Tanzania.,Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,Society Gender and Health, University of Basel, Basel, Switzerland;
| | - Eveline Geubbels
- Ifakara Health Institute (IHI), Ifakara, Tanzania.,INDEPTH Network, Accra, Ghana
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,Society Gender and Health, University of Basel, Basel, Switzerland.,INDEPTH Network, Accra, Ghana
| | - Sonja Merten
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,Society Gender and Health, University of Basel, Basel, Switzerland
| | - Constanze Pfeiffer
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,Society Gender and Health, University of Basel, Basel, Switzerland
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Davis J, Vyankandondera J, Luchters S, Simon D, Holmes W. Male involvement in reproductive, maternal and child health: a qualitative study of policymaker and practitioner perspectives in the Pacific. Reprod Health 2016; 13:81. [PMID: 27423461 PMCID: PMC4947267 DOI: 10.1186/s12978-016-0184-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 05/18/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The importance of involving men in reproductive, maternal and child health programs is increasingly recognised globally. In the Pacific region, most maternal and child health services do not actively engage expectant fathers and fathers of young children and few studies have been conducted on the challenges, benefits and opportunities for involving fathers. This study explores the attitudes and beliefs of maternal and child health policymakers and practitioners regarding the benefits, challenges, risks and approaches to increasing men's involvement in maternal and child health education and clinical services in the Pacific. METHODS In-depth interviews were conducted with 17 senior maternal and child health policymakers and practitioners, including participants from five countries (Cook Island, Fiji, Papua New Guinea, Solomon Island, and Vanuatu) and four regional organisations in the Pacific. Qualitative data generated were analysed thematically. RESULTS Policymakers and practitioners reported that greater men's involvement would result in a range of benefits for maternal and child health, primarily through greater access to services and interventions for women and children. Perceived challenges to greater father involvement included sociocultural norms, difficulty engaging couples before first pregnancy, the physical layout of clinics, and health worker workloads and attitudes. Participants also suggested a range of strategies for increasing men's involvement, including engaging boys and men early in the life-cycle, in community and clinic settings, and making health services more father-friendly through changes to clinic spaces and health worker recruitment and training. CONCLUSIONS These findings suggest that increasing men's involvement in maternal and child health services in the Pacific will require initiatives to engage men in community and clinic settings, engage boys and men of all ages, and improve health infrastructure and service delivery to include men. Our findings also suggest that while most maternal and child health officials consulted perceived many benefits of engaging fathers, perceived challenges to doing so may prevent the development of policies that explicitly direct health providers to routinely include fathers in maternal and child health services. Pilot studies assessing feasibility and acceptability of context-appropriate strategies for engaging fathers will be useful in addressing concerns regarding challenges to engaging fathers.
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Affiliation(s)
- Jessica Davis
- Centre for International Health, Burnet Institute, Melbourne, Victoria, Australia.
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia.
| | | | - Stanley Luchters
- Centre for International Health, Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
- International Centre for Reproductive Health, Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - David Simon
- Centre for International Health, Burnet Institute, Melbourne, Victoria, Australia
- Present Address: West Gippsland Healthcare Group, Warragul, Australia
| | - Wendy Holmes
- Centre for International Health, Burnet Institute, Melbourne, Victoria, Australia
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Evans C, Nalubega S, McLuskey J, Darlington N, Croston M, Bath-Hextall F. The views and experiences of nurses and midwives in the provision and management of provider-initiated HIV testing and counseling: a systematic review of qualitative evidence. ACTA ACUST UNITED AC 2016; 13:130-286. [PMID: 26767819 DOI: 10.11124/jbisrir-2015-2345] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/25/2015] [Accepted: 10/22/2015] [Indexed: 10/31/2022]
Abstract
BACKGROUND Global progress towards HIV prevention and care is contingent upon increasing the number of those aware of their status through HIV testing. Provider-initiated HIV testing and counseling is recommended globally as a strategy to enhance uptake of HIV testing and is primarily conducted by nurses and midwives. Research shows that provider-initiated HIV testing and counseling implementation is sub-optimal. The reasons for this are unclear. OBJECTIVES The review aimed to explore nurses' and midwives' views and experiences of the provision and management of provider-initiated HIV testing and counseling. INCLUSION CRITERIA TYPES OF PARTICIPANTS All cadres of nurses and midwives were considered, including those who undertake routine HIV testing as part of a diverse role and those who are specifically trained as HIV counselors. Types of phenomenon of interest: The review sought to understand the views and experiences of the provision and management of provider-initiated HIV testing and counseling (including perceptions, opinions, beliefs, practices and strategies related to HIV testing and its implementation in practice). CONTEXT The review included only provider-initiated HIV testing and counseling. It excluded all other models of HIV testing. The review included all countries and all healthcare settings. Types of studies: This review considered all forms of qualitative study design and methodology. Qualitative elements of a mixed method study were included if they were presented separately within the publication. SEARCH STRATEGY A three-step search strategy was utilized. Eight databases were searched for papers published from 1996 to October 2014, followed by hand searching of reference lists. Only studies published in the English language were considered. METHODOLOGICAL QUALITY Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute. DATA EXTRACTION Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA SYNTHESIS Qualitative research findings were pooled using a pragmatic meta-aggregative approach and the Joanna Briggs Institute Qualitative Assessment and Review Instrument software. RESULTS This review included 21 publications from 18 research studies, representing a wide range of countries and healthcare settings. There were 245 findings which were aggregated into 12 categories and five synthesized findings. 1. Nurses/midwives are supportive of provider-initiated HIV testing and counseling if it is perceived to enhance patient care and to align with perceived professional roles. 2. Nurses'/midwives' ability to perform provider-initiated HIV testing and counseling well requires an appropriate infrastructure and adequate human and material resources. 3. At the organizational level, nurses'/midwives' engagement with provider-initiated HIV testing and counseling is facilitated by an inclusive management structure, alongside the provision of ongoing training and clinical supervision. Provider-initiated HIV testing and counseling is hindered by difficulties in fitting it into existing workloads and routines. 4. Nurses/midwives perceive that good quality care in provider-initiated HIV testing and counseling involves finding a balance between public health needs and individual patient needs. Good care requires time and the ability to apply a patient centred approach. 5. The emotional work involved in provider-initiated HIV testing and counseling can be stressful. Nurses/Midwives may require support to deal with complex moral and ethical issues. CONCLUSIONS This review shows that provider-initiated HIV testing and counseling is supported by nurses/midwives who strive to implement it according to principles of good care and a patient centered approach. Nurses/midwives face multiple operational, infra-structural, resource and ethical challenges in the implementation of provider-initiated HIV testing and counseling. IMPLICATIONS FOR PRACTICE The implementation process for provider-initiated HIV testing and counseling would benefit from using a quality improvement framework. Nurses/midwives undertaking provider-initiated HIV testing and counseling require management support, ongoing training and adequate infrastructure/resources. Additional guidance is required on legal/ethical issues in testing of children and in third party disclosure. IMPLICATIONS FOR RESEARCH Operational research is required to determine an optimal skill mix and optimal methods of integrating provider-initiated HIV testing and counseling into existing work routines.
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Affiliation(s)
- Catrin Evans
- University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom
| | - Sylivia Nalubega
- University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom
| | - John McLuskey
- University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom
| | - Nicola Darlington
- University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom
| | | | - Fiona Bath-Hextall
- University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom
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Effect of Community Support Agents on Retention of People Living With HIV in Pre-antiretroviral Care: A Randomized Controlled Trial in Eastern Uganda. J Acquir Immune Defic Syndr 2015; 70:e36-43. [PMID: 26079842 DOI: 10.1097/qai.0000000000000723] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Over 50% of people living with HIV (PLHIV) in sub-Saharan Africa are lost to follow-up between diagnosis and initiation of antiretroviral treatment during pre-antiretroviral (pre-ARV) care. The effect of providing home counseling visits by community support agents on 2-year retention in pre-ARV care was evaluated through a randomized controlled trial in eastern Uganda. METHODS Four hundred newly screened HIV-positive patients were randomly assigned to receive posttest counseling alone (routine arm) or posttest counseling and monthly home counseling visits by community support agents to encourage them go back for routine pre-ARV care (intervention arm). The outcome measure was the proportion of new PLHIV in either arm who attended their scheduled pre-ARV care visits for at least 6 of the anticipated 8 visits in the first 24 months after HIV diagnosis. The difference between the 2 study arms was assessed using the χ and T tests. Mantel-Haenszel Risk Ratios and multivariate logistic models were used to assess the adjusted effect of the intervention on the outcome. RESULTS In all models generated, participants receiving monthly home counseling visits were 2.5 times more likely to be retained in pre-ARV compared with those in standard care over a period of 24 months (adjusted risk ratio, 2.5; 95% confidence interval: 2.0 to 3.0). CONCLUSION Monthly follow-up home visits by community workers more than doubled the retention of PLHIV in pre-ARV care in rural Uganda and can be applicable in similar resource-poor settings.
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Muhindo R, Nakalega A, Nankumbi J. Predictors of couple HIV counseling and testing among adult residents of Bukomero sub-county, Kiboga district, rural Uganda. BMC Public Health 2015; 15:1171. [PMID: 26603280 PMCID: PMC4659154 DOI: 10.1186/s12889-015-2526-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 11/18/2015] [Indexed: 12/22/2022] Open
Abstract
Background Studies have shown that couple HIV counseling and testing (CHCT) increased rates of sero-status disclosure and adoption of safer sexual behaviors with better linkage to treatment and care. However, current evidence suggests that new HIV infections are occurring among heterosexual couples in stable relationships where the majority of the individuals are not aware of their partner’s serostatus. This study examined the predictors of CHCT uptake among married or cohabiting couples of Bukomero sub-county Kiboga district in Uganda. Methods This cross-sectional correlational study was conducted among 323 individuals who were either married or cohabiting, aged 18–49 years. Participants were enrolled from randomly selected households in Bukomero sub-county. Data were collected using an interviewer-administered questionnaire on socio-demographics, self-rating on awareness of CHCT benefits, couple discussion about HIV testing and CHCT practices. Couples were compared between those who had reported to have tested as a couple and those who had not. Binary logistic regression was performed to determine the adjusted odds ratio [aOR] and 95 % confidence intervals [CI] for CHCT uptake and the other independent variables. Results Of the participants 288 (89.2 %) reported to have ever taken an HIV test only 99 (34.4 %) did so as a couple. The predictors of testing for HIV as a couple were discussing CHCT with the partner (adjusted odds ratio 4.95[aOR], 95 % confidence interval [CI]:1.99–12.98; p < 0.001), awareness of CHCT benefits (aOR 3.23; 95 % CI 1.78–5.87; p < 0.001) and having time to test as a couple (aOR 2.61; 95 % CI 1.22–5.61; p <0.05). Conclusion Uptake of HIV counseling and testing among couples was low. Discussing CHCT with partner, awareness of CHCT benefits, and availability of time to test as a couple were predictive of CHCT uptake. Thus CHCT campaigns should emphasize communication and discussion of HIV counseling and testing among partners.
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Affiliation(s)
- Richard Muhindo
- Department of Nursing, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | | | - Joyce Nankumbi
- Department of Nursing, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
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Conroy AA, Wong LH. How reliable are self-reports of HIV status disclosure? Evidence from couples in Malawi. Soc Sci Med 2015; 144:28-37. [PMID: 26379084 DOI: 10.1016/j.socscimed.2015.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 08/20/2015] [Accepted: 09/04/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The majority of research on human immunodeficiency virus (HIV) disclosure utilizes the perspective from a single individual, which cannot be substantiated in the absence of supporting data such as from a primary partner. OBJECTIVES The objectives of this study were to evaluate: (1) the extent to which self-reported HIV disclosure was confirmed by a primary partner; (2) individual and relationship-level predictors of self-reported versus confirmed disclosure; and (3) whether confirmed disclosure was a stronger predictor of correctly assessing a partner's HIV status compared to self-reported disclosure. METHODS As part of an 8-wave longitudinal study from 2009 to 2011 in southern Malawi, 366 individuals (183 couples) were interviewed about their primary relationship (wave 3), individually tested for HIV (wave 4), and then asked whether they disclosed to their primary partner (wave 5). RESULTS While 93% of respondents reported that they disclosed, only 64% of respondents had confirmed reports from their partner. Having communicated with partner about HIV was positively associated with self-reported disclosure; this association remained significant but became more precise in the models for confirmed disclosure. Confirmed disclosure, but not self-report, was a significant predictor of correctly assessing a partner's HIV status. Being male, having lower perceived partner infidelity, having higher relationship unity, and testing HIV-negative were positively and significantly associated with correct assessment. Dyadic data from two partners provide an improved measure of disclosure as compared to a single individual's self-report and could be used to identify behavioral and biomedical opportunities to prevent HIV transmission within couples.
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Affiliation(s)
- Amy A Conroy
- Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158, USA.
| | - Lauren H Wong
- Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158, USA
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Leddy A, Chakravarty D, Dladla S, de Bruyn G, Darbes L. Sexual communication self-efficacy, hegemonic masculine norms and condom use among heterosexual couples in South Africa. AIDS Care 2015; 28:228-33. [PMID: 26344386 DOI: 10.1080/09540121.2015.1080792] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Hegemonic masculine norms (HMN), which promote sexual risk-taking among males and the subordination of women, are believed to play a key role in the HIV epidemic among heterosexual couples in South Africa (SA). Sexual communication self-efficacy (SCSE) (i.e., a couple's confidence in their ability to communicate about HIV prevention) may be a key leverage point for increasing HIV prevention behaviors among this population. We interviewed 163 sexually active heterosexual couples in Soweto, SA to investigate the association between SCSE, HMN, and consistent condom use. We collected information on demographics, relationship dynamics, and sexual activity. We utilized the SCSE scale to measure couples' SCSE, and a subscale of the Gender Equitable Men scale to measure HMN among males. We performed bivariate and multivariable analyses to determine the association of consistent condom use with couples' SCSE as well as the male partner's endorsement of HMN. We found that couples with higher SCSE have greater odds of consistent condom use (adjusted odds ratio [AOR] = 1.30, 95% CI: 1.15-1.47). Furthermore, male endorsement of HMN was found to be negatively associated with consistent condom use among couples (AOR = 0.47, 95% CI: 0.24-0.89). Joint HIV serostatus was not significantly associated with the outcome. Future interventions that equip heterosexual couples with sexual communication skills, while simultaneously promoting more gender equitable norms, may increase consistent condom use and thereby reduce the transmission of HIV among this at-risk population.
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Affiliation(s)
- Anna Leddy
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Deepalika Chakravarty
- b Center for AIDS Prevention Studies and Global Health Sciences , University of California San Francisco , San Francisco , CA , USA.,c Center for Research and Education on Gender and Sexuality , San Francisco State University , San Francisco , CA , USA
| | - Sibongile Dladla
- d Perinatal HIV Research Unit, University of the Witwaterstrand , Soweto , South Africa
| | - Guy de Bruyn
- d Perinatal HIV Research Unit, University of the Witwaterstrand , Soweto , South Africa
| | - Lynae Darbes
- b Center for AIDS Prevention Studies and Global Health Sciences , University of California San Francisco , San Francisco , CA , USA
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Mtenga S, Shamba D, Wamoyi J, Kakoko D, Haafkens J, Mongi A, Kapiga S, Geubbels E. How long-distance truck drivers and villagers in rural southeastern Tanzania think about heterosexual anal sex: a qualitative study. Sex Transm Infect 2015; 91:576-80. [PMID: 26113730 PMCID: PMC4680186 DOI: 10.1136/sextrans-2015-052055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/25/2015] [Indexed: 11/04/2022] Open
Abstract
Objective To explore ideas of truck drivers and villagers from rural Tanzania about heterosexual anal sex (HAS) and the associated health risks. Methods Qualitative study using 8 in-depth interviews (IDIs) and 2 focus group discussions (FGDs) with truck drivers and 16 IDIs and 4 FGDs with villagers from the Morogoro region. Study participants included 24 women and 46 men. Data analysis was performed thematically employing standard qualitative techniques. Results Reasons why men would practice HAS included sexual pleasure, the belief that anal sex is safer than vaginal sex, alternative sexual practice, exploration and proof of masculinity. Reasons why women would practice HAS included financial need, retaining a partner, alternative for sex during menses, pregnancy prevention and beauty enhancement because HAS is believed to ‘fatten the female buttocks’. Most participants believed that condoms are not needed during HAS. This was linked to the ideas that infections only ‘reside in wet places’ (vagina) and that the anus is not ‘conducive’ for condom use; condoms reduce ‘dryness’ and ‘friction’ (pleasure) and may ‘get stuck inside’. Conclusions The study participants reported practices and ideas about HAS that put them at risk for HIV and sexually transmitted infections. Greater attention to education about HAS is urgently needed in Tanzania, where this sexual practice is still regarded as a taboo. This study offers useful information that could be included in sex education programmes.
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Affiliation(s)
- S Mtenga
- Department of Impact Evaluation, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - D Shamba
- Department of Impact Evaluation, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - J Wamoyi
- National Institute for Medical Research Institute (NIMR), Mwanza Center, Mwanza, Tanzania
| | - D Kakoko
- Department of Behavioural Sciences, Muhimbili University of Health and Allied Science (MUHAS), School of Public Health, Dar es Salaam, Tanzania
| | - J Haafkens
- Department of General Practice, Centre for Social Science and Global Health, University of Amsterdam and Academic Medical Centre, Amsterdam, The Netherlands
| | - A Mongi
- Mwanza Intervention Trial Unit (MITU), Mwanza, Tanzania
| | - S Kapiga
- Mwanza Intervention Trial Unit (MITU), Mwanza, Tanzania
| | - E Geubbels
- Department of Impact Evaluation, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
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De Schacht C, Hoffman HJ, Mabunda N, Lucas C, Alons CL, Madonela A, Vubil A, Ferreira OC, Calú N, Santos IS, Jani IV, Guay L. High rates of HIV seroconversion in pregnant women and low reported levels of HIV testing among male partners in Southern Mozambique: results from a mixed methods study. PLoS One 2014; 9:e115014. [PMID: 25542035 PMCID: PMC4277288 DOI: 10.1371/journal.pone.0115014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 11/17/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Prevention of acute HIV infections in pregnancy is required to achieve elimination of pediatric HIV. Identification and support for HIV negative pregnant women and their partners, particularly serodiscordant couples, are critical. A mixed method study done in Southern Mozambique estimated HIV incidence during pregnancy, associated risk factors and factors influencing partner's HIV testing. METHODS Between April 2008 and November 2011, a prospective cohort of 1230 HIV negative pregnant women was followed during pregnancy. A structured questionnaire, HIV testing, and collection of dried blood spots were done at 2-3 scheduled visits. HIV incidence rates were calculated by repeat HIV testing and risk factors assessed by Poisson regression. A qualitative study including 37 individual interviews with men, women, and nurses and 11 focus group discussions (n = 94) with men, women and grandmothers explored motivators and barriers to uptake of male HIV testing. RESULTS HIV incidence rate was estimated at 4.28/100 women-years (95%CI: 2.33-7.16). Significant risk factors for HIV acquisition were early sexual debut (RR 3.79, 95%CI: 1.04-13.78, p = 0.04) and living in Maputo Province (RR 4.35, 95%CI: 0.97-19.45, p = 0.05). Nineteen percent of women reported that their partner had tested for HIV (93% knew the result with 8/213 indicating an HIV positive partner), 56% said their partner had not tested and 19% did not know their partner test status. Of the 14 seroconversions, only one reported being in a serodiscordant relationship. Fear of discrimination or stigma was reported as a key barrier to male HIV testing, while knowing the importance of getting tested and receiving care was the main motivator. CONCLUSIONS HIV incidence during pregnancy is high in Southern Mozambique, but knowledge of partners' HIV status remains low. Knowledge of both partners' HIV status is critical for maximal effectiveness of prevention and treatment services to reach elimination of pediatric HIV/AIDS.
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Affiliation(s)
- Caroline De Schacht
- Elizabeth Glaser Pediatric AIDS Foundation, Research Department, Maputo, Mozambique
- * E-mail:
| | - Heather J. Hoffman
- The George Washington University, Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, Washington, D.C., United States of America
| | | | - Carlota Lucas
- Elizabeth Glaser Pediatric AIDS Foundation, Research Department, Maputo, Mozambique
| | - Catharina L. Alons
- Elizabeth Glaser Pediatric AIDS Foundation, Research Department, Maputo, Mozambique
- Elizabeth Glaser Pediatric AIDS Foundation, Research Department, Washington, D.C., United States of America
| | - Ana Madonela
- Elizabeth Glaser Pediatric AIDS Foundation, Research Department, Maputo, Mozambique
| | | | - Orlando C. Ferreira
- Federal University of Rio de Janeiro, Biology Institute, Rio de Janeiro, Brazil
| | | | | | | | - Laura Guay
- The George Washington University, Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, Washington, D.C., United States of America
- Elizabeth Glaser Pediatric AIDS Foundation, Research Department, Washington, D.C., United States of America
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Labhardt ND, Motlomelo M, Cerutti B, Pfeiffer K, Kamele M, Hobbins MA, Ehmer J. Home-based versus mobile clinic HIV testing and counseling in rural Lesotho: a cluster-randomized trial. PLoS Med 2014; 11:e1001768. [PMID: 25513807 PMCID: PMC4267810 DOI: 10.1371/journal.pmed.1001768] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 11/03/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The success of HIV programs relies on widely accessible HIV testing and counseling (HTC) services at health facilities as well as in the community. Home-based HTC (HB-HTC) is a popular community-based approach to reach persons who do not test at health facilities. Data comparing HB-HTC to other community-based HTC approaches are very limited. This trial compares HB-HTC to mobile clinic HTC (MC-HTC). METHODS AND FINDINGS The trial was powered to test the hypothesis of higher HTC uptake in HB-HTC campaigns than in MC-HTC campaigns. Twelve clusters were randomly allocated to HB-HTC or MC-HTC. The six clusters in the HB-HTC group received 30 1-d multi-disease campaigns (five villages per cluster) that delivered services by going door-to-door, whereas the six clusters in MC-HTC group received campaigns involving community gatherings in the 30 villages with subsequent service provision in mobile clinics. Time allocation and human resources were standardized and equal in both groups. All individuals accessing the campaigns with unknown HIV status or whose last HIV test was >12 wk ago and was negative were eligible. All outcomes were assessed at the individual level. Statistical analysis used multivariable logistic regression. Odds ratios and p-values were adjusted for gender, age, and cluster effect. Out of 3,197 participants from the 12 clusters, 2,563 (80.2%) were eligible (HB-HTC: 1,171; MC-HTC: 1,392). The results for the primary outcomes were as follows. Overall HTC uptake was higher in the HB-HTC group than in the MC-HTC group (92.5% versus 86.7%; adjusted odds ratio [aOR]: 2.06; 95% CI: 1.18-3.60; p = 0. 011). Among adolescents and adults ≥ 12 y, HTC uptake did not differ significantly between the two groups; however, in children <12 y, HTC uptake was higher in the HB-HTC arm (87.5% versus 58.7%; aOR: 4.91; 95% CI: 2.41-10.0; p<0.001). Out of those who took up HTC, 114 (4.9%) tested HIV-positive, 39 (3.6%) in the HB-HTC arm and 75 (6.2%) in the MC-HTC arm (aOR: 0.64; 95% CI: 0.48-0.86; p = 0.002). Ten (25.6%) and 19 (25.3%) individuals in the HB-HTC and in the MC-HTC arms, respectively, linked to HIV care within 1 mo after testing positive. Findings for secondary outcomes were as follows: HB-HTC reached more first-time testers, particularly among adolescents and young adults, and had a higher proportion of men among participants. However, after adjusting for clustering, the difference in male participation was not significant anymore. Age distribution among participants and immunological and clinical stages among persons newly diagnosed HIV-positive did not differ significantly between the two groups. Major study limitations included the campaigns' restriction to weekdays and a relatively low HIV prevalence among participants, the latter indicating that both arms may have reached an underexposed population. CONCLUSIONS This study demonstrates that both HB-HTC and MC-HTC can achieve high uptake of HTC. The choice between these two community-based strategies will depend on the objective of the activity: HB-HTC was better in reaching children, individuals who had never tested before, and men, while MC-HTC detected more new HIV infections. The low rate of linkage to care after a positive HIV test warrants future consideration of combining community-based HTC approaches with strategies to improve linkage to care for persons who test HIV-positive. TRIAL REGISTRATION ClinicalTrials.gov NCT01459120. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Niklaus Daniel Labhardt
- Clinical Research Unit, Medical Services and Diagnostic, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
- * E-mail: (NDL); (MM)
| | - Masetsibi Motlomelo
- SolidarMed Lesotho, Seboche Hospital, Butha-Buthe, Lesotho
- * E-mail: (NDL); (MM)
| | - Bernard Cerutti
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Matovu JKB, Wanyenze RK, Wabwire-Mangen F, Nakubulwa R, Sekamwa R, Masika A, Todd J, Serwadda D. "Men are always scared to test with their partners … it is like taking them to the Police": Motivations for and barriers to couples' HIV counselling and testing in Rakai, Uganda: a qualitative study. J Int AIDS Soc 2014; 17:19160. [PMID: 25239379 PMCID: PMC4169647 DOI: 10.7448/ias.17.1.19160] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/15/2014] [Accepted: 08/18/2014] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Uptake of couples' HIV counselling and testing (couples' HCT) can positively influence sexual risk behaviours and improve linkage to HIV care among HIV-positive couples. However, less than 30% of married couples have ever tested for HIV together with their partners. We explored the motivations for and barriers to couples' HCT among married couples in Rakai, Uganda. METHODS This was a qualitative study conducted among married individuals and selected key informants between August and October 2013. Married individuals were categorized by prior HCT status as: 1) both partners never tested; 2) only one or both partners ever tested separately; and 3) both partners ever tested together. Data were collected on the motivations for and barriers to couples' HCT, decision-making processes from tested couples and suggestions for improving couples' HCT uptake. Eighteen focus group discussions with married individuals, nine key informant interviews with selected key informants and six in-depth interviews with married individuals that had ever tested together were conducted. All interviews were audio-recorded, translated and transcribed verbatim and analyzed using Nvivo (version 9), following a thematic framework approach. RESULTS Motivations for couples' HCT included the need to know each other's HIV status, to get a treatment companion or seek HIV treatment together - if one or both partners were HIV-positive - and to reduce mistrust between partners. Barriers to couples' HCT included fears of the negative consequences associated with couples' HCT (e.g. fear of marital dissolution), mistrust between partners and conflicting work schedules. Couples' HCT was negotiated through a process that started off with one of the partners testing alone initially and then convincing the other partner to test together. Suggestions for improving couples' HCT uptake included the need for couple- and male-partner-specific sensitization, and the use of testimonies from tested couples. CONCLUSIONS Couples' HCT is largely driven by individual and relationship-based factors while fear of the negative consequences associated with couples' HCT appears to be the main barrier to couples' HCT uptake in this setting. Interventions to increase the uptake of couples' HCT should build on the motivations for couples' HCT while dealing with the negative consequences associated with couples' HCT.
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Affiliation(s)
- Joseph K B Matovu
- Department of Community Health & Behavioral Sciences, School of Public Health, Makerere University, Kampala, Uganda;
| | - Rhoda K Wanyenze
- Department of Disease Control & Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - Fred Wabwire-Mangen
- Regional Center for Quality of Health Care, School of Public Health, Kampala, Makerere University, Uganda
| | - Rosette Nakubulwa
- Department of Qualitative Research, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Richard Sekamwa
- Department of Qualitative Research, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Annet Masika
- Department of Qualitative Research, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Jim Todd
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Serwadda
- Department of Disease Control & Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
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Muloongo K, Tshuma N, Chimoyi L, Setswe G, Sarfo B, Nyasulu P. Factors contributing to home-based acceptability of rapid testing for HIV infection among the inner city commuter population in Johannesburg, South Africa. Trans R Soc Trop Med Hyg 2014; 108:632-8. [PMID: 25129890 DOI: 10.1093/trstmh/tru122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The study aimed to determine factors contributing to the acceptability of home-based HIV counselling and testing (HBHCT) among commuters in Johannesburg inner city. METHODS Simple random sampling was used to select participants in a venue based intercept survey at Noord Street taxi rank in Johannesburg central business district. A total of 1146 individuals were interviewed and logistic regression analysis assessed factors associated with HBHCT acceptability. RESULTS HBHCT acceptability was 64%. Home testing was preferred as an alternative to testing at a health facility. High school education (adjusted odds ratio [aOR] 0.61, CI: 0.46-0.85), inner city residence aOR 0.70, CI: 0.52-0.94), previous HIV testing in the hospital (aOR 0.22, CI: 0.15-0.32) and at home (aOR 0.18, CI: 0.11-0.27) were significantly less likely associated with HBHCT acceptability. Being married (aOR 1.64, CI: 1.15-2.32), recent HIV testing (aOR 1.85, CI: 1.15-2.99) and having experienced negative health worker attitude (aOR 2.41, CI: 1.66-3.48) were significantly more likely associated with HBHCT acceptability. CONCLUSIONS High acceptability of HBHCT among urban-based commuters plus factors that would deter HBHCT acceptability were identified. Further research to identify strategies to improve HBHCT acceptability among commuter populations is needed.
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Affiliation(s)
- Keith Muloongo
- Community AIDS Response, Norwood, Johannesburg, South Africa
| | - Ndumiso Tshuma
- Community AIDS Response, Norwood, Johannesburg, South Africa
| | - Lucy Chimoyi
- Wits Reproductive Health and HIV Research Institute (WHRI), Hillbrow, Johannesburg, South Africa
| | - Geoffrey Setswe
- HIV/AIDS, STI and TB (HAST) Research Program, Human Sciences Research Council Pretoria, South Africa
| | - Bismark Sarfo
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon-Accra, Ghana
| | - Peter Nyasulu
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa School of Health Sciences, Monash University, Ruimsig, Johannesburg, South Africa
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Njau B, Ostermann J, Brown D, Mühlbacher A, Reddy E, Thielman N. HIV testing preferences in Tanzania: a qualitative exploration of the importance of confidentiality, accessibility, and quality of service. BMC Public Health 2014; 14:838. [PMID: 25124140 PMCID: PMC4141951 DOI: 10.1186/1471-2458-14-838] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 08/04/2014] [Indexed: 11/10/2022] Open
Abstract
Background HIV counseling and testing (HCT), an effective preventive strategy and an entry point for care, remains under-utilized in Tanzania. Limited uptake of HCT, despite the widespread availability of varied testing options, suggests that existing options may not align well with population preferences for testing. Methods Between October and December 2011, we conducted an exploratory study in the Kilimanjaro Region to develop a conceptual framework for understanding which characteristics of HIV testing are associated with preferences for testing. Forty individuals (55% women, 53% never having tested) participated in in-depth interviews and focus groups to identify factors that influence whether and where people test for HIV. Results A variety of discrete characteristics of testing venues, test providers, and testing procedures (e.g. distance to testing, counselor experience, type of HIV test, and availability of antiretroviral therapy) mapped conceptually to three domains: confidentiality of testing and test results, quality of HCT, and accessibility and availability of ancillary services. We noted heterogeneous preferences and demonstrate that while some test characteristics overlap and reinforce across multiple domains, others demand clients to make trade-offs between domains. Conclusion Testing decisions appear to be influenced by an array of often inter-linked factors across multiple domains, including quality, confidentiality, and accessibility; perceptions of these factors varied greatly across participants and across available testing options. HCT interventions that jointly target barriers spanning the three domains have the potential to increase uptake of HIV testing and deserve further exploration.
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Jones D, Kashy D, Chitalu N, Kankasa C, Mumbi M, Cook R, Weiss S. Risk reduction among HIV-seroconcordant and -discordant couples: the Zambia NOW2 intervention. AIDS Patient Care STDS 2014; 28:433-41. [PMID: 24983201 DOI: 10.1089/apc.2014.0039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Heterosexual HIV transmission remains the leading cause of HIV incidence in adult men and women in sub-Saharan Africa. This study assessed whether an HIV risk-reduction intervention would be more likely to increase sexual barrier acceptability and decrease risk behavior when delivered to couples in gender concordant groups or in an individual format. This study also examined the mutual impact of couple members as a source of influence on acceptability, and assessed whether product acceptability, intimate partner violence (IPV), and/or partner communication predicted sexual barrier use. HIV seroconcordant and serodiscordant couples (n=216) were recruited in Lusaka, Zambia, and randomized to a four session gender-concordant intervention. Participants were assessed at baseline, 6, and 12 months. Willingness to use barriers (p=0.012), acceptability (p<0.001), and barrier use (p<0.001) increased over time in both conditions, and were influenced by gender preferences. IPV decreased (p=0.040) and positive communication increased (p<0.001) in both conditions. Individual and gender concordant group sessions achieved similar increases in sexual barrier use following the intervention. Results highlight the influence of partners as well as product acceptability as predictors of sexual barrier use among couples in sub-Saharan Africa. Future prevention studies should consider both product acceptability and partner influence to achieve optimal sexual risk behavior outcomes.
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Affiliation(s)
- Deborah Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Deborah Kashy
- Department of Psychology, Michigan State University, East Lansing, Michigan
| | - Ndashi Chitalu
- Department of Paediatrics, University of Zambia School of Medicine, Lusaka, Zambia
| | - Chipepo Kankasa
- Department of Paediatrics, University of Zambia School of Medicine, Lusaka, Zambia
| | - Mirriam Mumbi
- University Teaching Hospital, University of Zambia, Lusaka, Zambia
| | - Ryan Cook
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Stephen Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
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Mantell JE, DiCarlo AL, Remien RH, Zerbe A, Morris D, Pitt B, Nkonyana JP, Abrams EJ, El-Sadr W. 'There's no place like home': perceptions of home-based HIV testing in Lesotho. HEALTH EDUCATION RESEARCH 2014; 29:456-469. [PMID: 24599266 PMCID: PMC4021194 DOI: 10.1093/her/cyu004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 01/23/2014] [Indexed: 05/31/2023]
Abstract
HIV testing has the potential to reduce HIV transmission by identifying and counseling individuals with HIV, reducing risk behaviors, linking persons with HIV to care and earlier treatment, and reducing perinatal transmission. In Lesotho, a high HIV prevalence country in which a large proportion of the population has never tested for HIV, home-based testing (HBT) may be an important strategy to increase HIV testing. We identified factors influencing acceptability of HIV prevention strategies among a convenience sample of 200 pregnant or post-partum Basotho women and 30 Basotho men. We first conducted cross-sectional surveys, followed by key informant interviews with all 30 men and focus group discussions with a sub-set of 62 women. In total, 82% of women reported positive perceptions of HBT; women and men viewed HBT as a potential way to increase testing among men and saw the home as a comfortable, supportive environment for testing and counseling couples and families together. Potential barriers to HBT uptake included concerns about confidentiality, privacy, coercion to test, conflict within the family and fear of HIV/AIDS-associated stigma. Participants emphasized community mobilization and education as important elements of HBT.
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Affiliation(s)
- J E Mantell
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100.
| | - A L DiCarlo
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100.Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100
| | - R H Remien
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100
| | - A Zerbe
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100
| | - D Morris
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100
| | - B Pitt
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100
| | - J P Nkonyana
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100
| | - E J Abrams
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100
| | - W El-Sadr
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100
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Ostermann J, Njau B, Brown DS, Mühlbacher A, Thielman N. Heterogeneous HIV testing preferences in an urban setting in Tanzania: results from a discrete choice experiment. PLoS One 2014; 9:e92100. [PMID: 24643047 PMCID: PMC3958474 DOI: 10.1371/journal.pone.0092100] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/17/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Efforts to reduce Human Immunodeficiency Virus (HIV) transmission through treatment rely on HIV testing programs that are acceptable to broad populations. Yet, testing preferences among diverse at-risk populations in Sub-Saharan Africa are poorly understood. We fielded a population-based discrete choice experiment (DCE) to evaluate factors that influence HIV-testing preferences in a low-resource setting. METHODS Using formative work, a pilot study, and pretesting, we developed a DCE survey with five attributes: distance to testing, confidentiality, testing days (weekday vs. weekend), method for obtaining the sample for testing (blood from finger or arm, oral swab), and availability of HIV medications at the testing site. Cluster-randomization and Expanded Programme on Immunization (EPI) sampling methodology were used to enroll 486 community members, ages 18-49, in an urban setting in Northern Tanzania. Interviewer-assisted DCEs, presented to participants on iPads, were administered between September 2012 and February 2013. RESULTS Nearly three of five males (58%) and 85% of females had previously tested for HIV; 20% of males and 37% of females had tested within the past year. In gender-specific mixed logit analyses, distance to testing was the most important attribute to respondents, followed by confidentiality and the method for obtaining the sample for the HIV test. Both unconditional assessments of preferences for each attribute and mixed logit analyses of DCE choice patterns suggest significant preference heterogeneity among participants. Preferences differed between males and females, between those who had previously tested for HIV and those who had never tested, and between those who tested in the past year and those who tested more than a year ago. CONCLUSION The findings suggest potentially significant benefits from tailoring HIV testing interventions to match the preferences of specific populations, including males and females and those who have never tested for HIV.
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Affiliation(s)
- Jan Ostermann
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, United States of America
| | - Bernard Njau
- Community Health Department, Kilimanjaro Christian Medical College, Moshi, Tanzania
| | - Derek S. Brown
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, United States of America
- Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Axel Mühlbacher
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, United States of America
- Stiftungsinstitut Gesundheitsökonomie und Medizinmanagement, Hochschule Neubrandenburg, Neubrandenburg, Germany
| | - Nathan Thielman
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- School of Medicine, Duke University, Durham, North Carolina, United States of America
- * E-mail:
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Darbes LA, van Rooyen H, Hosegood V, Ngubane T, Johnson MO, Fritz K, McGrath N. Uthando Lwethu ('our love'): a protocol for a couples-based intervention to increase testing for HIV: a randomized controlled trial in rural KwaZulu-Natal, South Africa. Trials 2014; 15:64. [PMID: 24552199 PMCID: PMC3936910 DOI: 10.1186/1745-6215-15-64] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 02/03/2014] [Indexed: 11/29/2022] Open
Abstract
Background Couples-based HIV counseling and testing (CHCT) is a proven strategy to reduce the risk of HIV transmission between partners, but uptake of CHCT is low. We describe the study design of a randomized controlled trial (RCT) aimed to increase participation in CHCT and reduce sexual risk behavior for HIV among heterosexual couples in rural KwaZulu-Natal, South Africa. We hypothesize that the rate of participation in CHCT will be higher and sexual risk behavior will be lower in the intervention group as compared to the control. Methods/design Heterosexual couples (N = 350 couples, 700 individuals) are being recruited to participate in a randomized trial of a couples-based intervention comprising two group sessions (one mixed gender, one single gender) and four couples’ counseling sessions. Couples must have been in a relationship together for at least 6 months. Quantitative assessments are conducted via mobile phones by gender-matched interviewers at baseline, 3, 6, and 9 months post-randomization. Intervention content is aimed to improve relationship dynamics, and includes communication skills and setting goals regarding CHCT. Discussion The Uthando Lwethu (‘our love’) intervention is the first couples-based intervention to have CHCT as its outcome. We are also targeting reductions in unprotected sex. CHCT necessitates the testing and mutual disclosure of both partners, conditions that are essential for improving subsequent outcomes such as disclosure of HIV status, sexual risk reduction, and improving treatment outcomes. Thus, improving rates of CHCT has the potential to improve health outcomes for heterosexual couples in a rural area of South Africa that is highly impacted by HIV. The results of our ongoing clinical trial will provide much needed information regarding whether a relationship-focused approach is effective in increasing rates of participation in CHCT. Our intervention represents an attempt to move away from individual-level conceptualizations, to a more integrated approach for HIV prevention. Trial registration Study Name: Couples in Context: An RCT of a Couples-based HIV Prevention Intervention ClinicalTrials.gov identifier: NCT01953133. South African clinical trial registration number: DOH-27-0212-3937
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Affiliation(s)
- Lynae A Darbes
- Center for AIDS Prevention Studies, University of California, 50 Beale Street, San Francisco, CA 94105, USA.
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Walcott MM, Hatcher AM, Kwena Z, Turan JM. Facilitating HIV status disclosure for pregnant women and partners in rural Kenya: a qualitative study. BMC Public Health 2013; 13:1115. [PMID: 24294994 PMCID: PMC3907031 DOI: 10.1186/1471-2458-13-1115] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 11/26/2013] [Indexed: 01/23/2024] Open
Abstract
Background Women’s ability to safely disclose their HIV-positive status to male partners is essential for uptake and continued use of prevention of mother-to-child transmission (PMTCT) services. However, little is known about the acceptability of potential approaches for facilitating partner disclosure. To lay the groundwork for developing an intervention, we conducted formative qualitative research to elicit feedback on three approaches for safe HIV disclosure for pregnant women and male partners in rural Kenya. Methods This qualitative acceptability research included in-depth interviews with HIV-infected pregnant women (n = 20) and male partners of HIV-infected women (n = 20) as well as two focus groups with service providers (n = 16). The participants were recruited at health care facilities in two communities in rural Nyanza Province, Kenya, during the period June to November 2011. Data were managed in NVivo 9 and analyzed using a framework approach, drawing on grounded theory. Results We found that facilitating HIV disclosure is acceptable in this context, but that individual participants have varying expectations depending on their personal situation. Many participants displayed a strong preference for couples HIV counseling and testing (CHCT) with mutual disclosure facilitated by a trained health worker. Home-based approaches and programs in which pregnant women are asked to bring their partners to the healthcare facility were equally favored. Participants felt that home-based CHCT would be acceptable for this rural setting, but special attention must be paid to how this service is introduced in the community, training of the health workers who will conduct the home visits, and confidentiality. Conclusion Pregnant couples should be given different options for assistance with HIV disclosure. Home-based CHCT could serve as an acceptable method to assist women and men with safe disclosure of HIV status. These findings can inform the design and implementation of programs geared at promoting HIV disclosure among pregnant women and partners, especially in the home-setting.
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Affiliation(s)
| | | | | | - Janet M Turan
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, RPHB 330, 1530 3rd Ave S, Birmingham, AL 35294, USA.
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Matovu JKB, Denison J, Wanyenze RK, Ssekasanvu J, Makumbi F, Ovuga E, McGrath N, Serwadda D. Trends in HIV counseling and testing uptake among married individuals in Rakai, Uganda. BMC Public Health 2013; 13:618. [PMID: 23816253 PMCID: PMC3702530 DOI: 10.1186/1471-2458-13-618] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 06/25/2013] [Indexed: 11/18/2022] Open
Abstract
Background Despite efforts to promote HIV counseling and testing (HCT) among couples, few couples know their own or their partners’ HIV status. We assessed trends in HCT uptake among married individuals in Rakai district, southwestern Uganda. Methods We analysed data for 21,798 married individuals aged 15-49 years who were enrolled into the Rakai Community Cohort Study (RCCS) between 2003 and 2009. Married individuals were interviewed separately but were retrospectively linked to their partners at analysis. All participants had serologic samples obtained for HIV testing, and had the option of receiving HCT together (couples’ HCT) or separately (individual HCT). Individuals were categorized as concordant HIV-positive if both partners had HIV; concordant HIV-negative if both did not have HIV; or HIV-discordant if only one of the partners had HIV. We used χ2 tests to assess linear trends in individual and couples’ HCT uptake in the entire sample and conducted multinomial logistic regression on a sub-sample of 10,712 individuals to assess relative risk ratios (RRR) and 95% Confidence Intervals (95% CI) associated with individual and couples’ HCT uptake. Analysis was done using STATA version 11.0. Results Uptake of couples’ HCT was 27.2% in 2003/04, 25.1% in 2005/06, 28.5% in 2006/08 and 27.8% in 2008/09 (χ2 for trend = 2.38; P = 0.12). Uptake of individual HCT was 57.9% in 2003/04, 60.2% in 2005/06, 54.0% in 2006/08 and 54.4% in 2008/09 (χ2 for trend = 8.72; P = 0.003). The proportion of couples who had never tested increased from 14.9% in 2003/04 to 17.8% in 2008/09 (χ2 for trend = 18.16; P < 0.0001). Uptake of couples’ HCT was significantly associated with prior HCT (Adjusted [Adj.] RRR = 6.80; 95% CI: 5.44, 8.51) and being 25-34 years of age (Adj. RRR = 1.81; 95% CI: 1.32, 2.50). Uptake of individual HCT was significantly associated with prior HCT (Adj. RRR = 6.26; 95% CI: 4.24, 9.24) and the female partner being HIV-positive (Adj. RRR = 2.46; 95% CI: 1.26, 4.80). Conclusion Uptake of couples’ HCT remained consistently low (below 30%) over the years, while uptake of individual HCT declined over time. These findings call for innovative strategies to increase demand for couples’ HCT, particularly among younger couples and those with no prior HCT.
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Tabana H, Doherty T, Rubenson B, Jackson D, Ekström AM, Thorson A. 'Testing Together Challenges the Relationship': Consequences of HIV Testing as a Couple in a High HIV Prevalence Setting in Rural South Africa. PLoS One 2013; 8:e66390. [PMID: 23824067 PMCID: PMC3688905 DOI: 10.1371/journal.pone.0066390] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 05/05/2013] [Indexed: 11/25/2022] Open
Abstract
Objective We conducted qualitative individual and combined interviews with couples to explore their experiences since the time of taking an HIV test and receiving the test result together, as part of a home-based HIV counselling and testing intervention. Methods This study was conducted in October 2011 in rural KwaZulu-Natal, South Africa, about 2 years after couples tested and received results together. Fourteen couples were purposively sampled: discordant, concordant negative and concordant positive couples. Findings Learning about each other’s status together challenged relationships of the couples in different ways depending on HIV status and gender. The mutual information confirmed suspected infidelity that had not been discussed before. Negative women in discordant partnerships remained with their positive partner due to social pressure and struggled to maintain their HIV negative status. Most of the couple relationships were characterized by silence and mistrust. Knowledge of sero-status also led to loss of sexual intimacy in some couples especially the discordant. For most men in concordant negative couples, knowledge of status was an awakening of the importance of fidelity and an opportunity for behaviour change, while for concordant positive and discordant couples, it was seen as proof of infidelity. Although positive HIV status was perceived as confirmation of infidelity, couples continued their relationship and offered some support for each other, living and managing life together. Sexual life in these couples was characterized by conflict and sometimes violence. In the concordant negative couples, trust was enhanced and behaviour change was promised. Conclusions Findings suggest that testing together as couples challenged relationships in both negative and positive ways. Further, knowledge of HIV status indicated potential to influence behaviour change especially among concordant negatives. In the discordant and concordant positive couples, traditional gender roles exposed women’s vulnerability and their lack of decision-making power.
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Affiliation(s)
- Hanani Tabana
- Health Systems Research Unit, Medical Research Council of South Africa, Cape Town, South Africa
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- * E-mail:
| | - Tanya Doherty
- Health Systems Research Unit, Medical Research Council of South Africa, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Bellville, Cape Town, South Africa
| | - Birgitta Rubenson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Debra Jackson
- School of Public Health, University of the Western Cape, Bellville, Cape Town, South Africa
| | - Anna Mia Ekström
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Thorson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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Evaluation of Using Routine Infant Immunization Visits to Identify and Follow-Up HIV-Exposed Infants and Their Mothers in Tanzania. J Acquir Immune Defic Syndr 2013; 63:e9-e15. [DOI: 10.1097/qai.0b013e31828a3e3f] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Vamos S, Cook R, Chitalu N, Mumbi M, Weiss SM, Jones D. Quality of relationship and sexual risk behaviors among HIV couples in Lusaka, Zambia. AIDS Care 2013; 25:1102-8. [PMID: 23336258 PMCID: PMC3636183 DOI: 10.1080/09540121.2012.749339] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Relationship quality and partner dynamics provide important insights into understanding sexual behavior within HIV sero-positive and sero-discordant couples. Individuals in long-term partnerships may be vulnerable to HIV/sexually transmitted infections (STI) within their relationships due to misperceptions of their partners risk behaviors and potential concurrent (e.g., extramarital, nonprimary) sexual partnerships. This study sought to examine relationship quality among HIV sero-positive and sero-discordant couples in Zambia, and its association with safer sex behavior. This study utilized data drawn from an ongoing translational study, The Partnership II Project - a couples-based sexual risk reduction intervention in Lusaka, Zambia. Couples (n=240) were assessed on demographics, relationship quality, and sexual risk behavior. Overall, couples perceiving their relationships more positively engaged in less risky sexual behavior (i.e., more condom use (b=0.011, t=3.14, p=0.002) and fewer partners (χ(2)=11.4, p=0.003). Within the dyad, condom use was "actor driven," indicating that the association between relationship quality and condom use did not depend on the partner's evaluation of the relationship. Safer sex behavior was positively influenced by communication about condoms. Results support the paradigm shift from prevention strategies with HIV-positive and at-risk individuals to concentrated efforts addressing male-female dyads, and suggest that interventions to address the role of couples' relationship quality, a modifiable target for decreasing sexual risk behavior, are needed.
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Affiliation(s)
- Szonja Vamos
- University of Miami Miller School of Medicine, Dept. of Psychiatry and Behavioral Sciences, Miami, USA
| | - Ryan Cook
- University of Miami Miller School of Medicine, Dept. of Psychiatry and Behavioral Sciences, Miami, USA
| | - Ndashi Chitalu
- University of Zambia, University Teaching Hosptial, Lusaka, Zambia
| | - Miriam Mumbi
- University of Zambia, University Teaching Hosptial, Lusaka, Zambia
| | - Stephen M. Weiss
- University of Miami Miller School of Medicine, Dept. of Psychiatry and Behavioral Sciences, Miami, USA
| | - Deborah Jones
- University of Miami Miller School of Medicine, Dept. of Psychiatry and Behavioral Sciences, Miami, USA
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Abstract
Virtual prevention of HIV transmission from parents to children is possible. This is cause for hope and renewed energy for prevention in general. The Global Plan is the most concerted and ambitious plan to date to protect children and to promote their care. But the inspiring and much appreciated global targets cannot be achieved, nor will they be realized in spirit in addition to form, without joint action between health services, affected women, their partners, families and communities and the wider society. In turn, this engagement is only possible under enabling political, legal, material and social conditions. Much has already been achieved, and community engagement can everywhere be seen in efforts to increase demand, to supply services and to create and improve enabling environments. Some of these initiatives are highly organized and expansive, with demonstrated success. Others are local but essential adjuncts to health services. The nature of this engagement varies because the challenges are different across countries and parts of countries. To be sustained and effective, community action must simultaneously be inclusive and supportive for those people who are affected, it must be appreciated and assigned a place within the broad systemic response, and it must promote and defend social justice.
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