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Hollington M. Cox proportional hazard-model application: time to cervical cancer screening among women living with HIV in South Africa. Infect Agent Cancer 2024; 19:6. [PMID: 38431636 PMCID: PMC10909268 DOI: 10.1186/s13027-023-00527-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/06/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND There is an increased risk of cervical cancer among women living with HIV. While studies have long examined the association between cervical cancer among women with HIV, no study has examined the time taken for women with HIV to undergo cervical cancer screening as well as the hazard thereof in South Africa. METHODS The study used cross-sectional data from the 2016 South Africa Demographic and Health Survey. To allow for longitudinal analysis and to address the issue of right-censoring, the data were reformatted to a person-data file. The selection criteria were limited to women living with HIV (WLHIV) who had also responded to the question on cervical cancer screening. Descriptive statistics were employed to show the levels of HIV among women aged 15 and older in South Africa. Additionally, Kaplan‒Meier curves were employed to investigate the time to CCS by WLHIV in South Africa. Thereafter, an unadjusted Cox hazards regression model was employed to examine the hazard of undergoing CCS among WLHIV. Finally, it employed an adjusted model to examine the hazard of CCS among WLHIV while adjusting for other factors. RESULTS Nineteen percent (n = 1,159) of the women who participated in the study tested positive for HIV. Herein, it was found that the risk of CCS among WLHIV began at the age of approximately 19 years. Thereafter, the hazard of undergoing CCS among WLHIV began to decrease at 58 years. There was a significant association between CCS and WLHIV. Additionally, several covariates were found to be significantly associated with HIV. These were race, province, area of residence, marriage, educational attainment, employment, alcohol consumption, perceived health perception, and health insurance. CONCLUSION The hazard of CCS was lower among WLHIV compared to WLHIV who did not undergo CCS in South Africa. This puts HIV-positive women at risk of increased morbidity and mortality from potential cervical cancer and HIV comorbidity due to CCS deficits within this group. This is because they are susceptible to HPV and subsequent cervical cancer due to a compromised immune system. HIV-positive women need to routinely undergo CCS every 12 months from baseline for 3 years. Thereafter, they should undergo CCS once every 3 years to reduce their risk of developing the disease.
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Affiliation(s)
- Marcus Hollington
- Demography and Population Studies, University of the Witwatersrand, School of Public Health & School of Social Sciences, Johannesburg, South Africa.
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2
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Li W, Gao G, Sun F, Jiang L. The role of community factors in predicting depressive symptoms among Chinese workforce: a longitudinal study in rural and urban settings. BMC Public Health 2022; 22:1429. [PMID: 35897001 PMCID: PMC9326139 DOI: 10.1186/s12889-022-13647-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background The dual urban–rural division system in China has led to distinguishes in economic development, medical services, and education as well as in mental health disparities. This study examined whether community factors (community cohesion, supportive network size, foreseeable community threat, and medical insurance coverage) predict the depressive symptoms of Chinese workers and how community factors may work differently in rural and urban settings. Methods This secondary data analysis was conducted using data from the 2014 and 2016 China Labor-force Dynamics Survey (CLDS). The sample of this study includes 9,140 workers (6,157 rural labors and 2,983 urban labors) who took part in both the 2014 and 2016 CLDS. This study discusses the relation between community factors and depressive symptoms of Chinese workers by correlation analysis and regression analysis. All analyses were conducted using SPSS 24.0. Results The results indicate that rural workers have higher levels of depressive symptoms than urban workers. Medical benefits coverage predicts depressive symptoms of rural workforces (B = -0.343, 95%CI = -0.695 ~ 0.009, p < . 10), and community supportive network size predicts depressive symptoms of urban workforces (B = -.539, 95%CI = -0.842 ~ 0.236, p < . 01). Conclusions Policymakers may address depressive symptoms of rural labor through improved coverage of medical benefits. In urban areas, efforts can be made to strengthen community supportive network for the urban labor force.
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Affiliation(s)
- Wanlian Li
- Emergency Management Teaching and Research Department, Guangdong Institute of Public Administration, No. 3 Jianshe Ave., Yuexiu District, Guangzhou, Guangdong, China
| | - Guanghan Gao
- Zhou Enlai School of Government, Nankai University, No. 38 Tongyan Road, Jinnan District, Tianjin, China
| | - Fei Sun
- School of Social Work, Michigan State University, 150 Baker Hall, 655 Auditorium Rd., East Lansing, MI, USA
| | - Lin Jiang
- School of Social Work, University of Texas Rio Grande Valley, 1201 W. University Drive, TX, Edinburg, USA.
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Small E, Nikolova SP, Childress S, Logie C. The role of education and income as protective factors against intimate partner violence and HIV exposure among Kenyan women. INTERNATIONAL JOURNAL OF QUALITATIVE STUDIES IN EDUCATION : QSE 2022; 37:230-245. [PMID: 38463447 PMCID: PMC10923337 DOI: 10.1080/09518398.2022.2035450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/01/2022] [Indexed: 03/12/2024]
Abstract
Introduction Intimate partner violence (IPV) is a public health problem that impacts approximately one in three women worldwide in their life-time. The purpose of the study was to explore the lived experiences of women teachers and violence in Kenya. It also explores the intersection between intimate partner violence, HIV risk, and gender inequality. Method Data were collected through two focus groups of a total of 15 women teachers. We recruited women ages 21-44 from two geographically diverse urban and rural schools. The data were analyzed using a thematic analysis method to identify text themes and meaning patterns. Results Three contextual experiences emerged: socio-cultural influences of gender norms, masculinity and patriarchy; uneven power dynamics; and institutionalized gender inequality. Discussion Findings suggest that education alone is not sufficient to end GBV. Comprehensive and gender transformative governmental policy approaches are needed to mitigate GBV in Kenya.
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Affiliation(s)
- Eusebius Small
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | | | - Saltanat Childress
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Carmen Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
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4
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Sadarang RAI. Prevalence and Factors Affecting Discrimination Towards People Living With HIV/AIDS in Indonesia. J Prev Med Public Health 2022; 55:205-212. [PMID: 35391532 PMCID: PMC8995940 DOI: 10.3961/jpmph.21.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/10/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives This study aimed to identify the behaviors associated with discrimination towards people living with HIV/AIDS (PLHA) in Indonesia and to determine the factors affecting discrimination. Methods Secondary data from the 2017 Indonesia Demographic and Health Survey were analyzed using a cross-sectional design. Discrimination was assessed based on the questions (1) “Should children infected with HIV/AIDS be allowed to attend school with non-infected children?” and (2) “Would you buy fresh vegetables from a farmer or shopkeeper known to be infected with HIV/AIDS?” Multivariable logistic regression was used to determine the factors affecting discrimination, with adjusted odds ratio (aOR) and 95% confidence interval (CIs) used to show the strength, direction, and significance of the associations among factors. Results In total, 68.9% of 21 838 individuals showed discrimination towards PLHA. The odds of discrimination were lower among women (aOR, 0.63; 95% CI, 0.55 to 0.71), rural dwellers (aOR, 0.81; 95% CI, 0.75 to 0.89), those who understood how HIV is transmitted from mother to child (aOR, 0.81; 95% CI, 0.73 to 0.89), and those who felt ashamed of their own family’s HIV status (aOR, 0.56; 95% CI, 0.52 to 0.61). The odds were higher among individuals who knew how to reduce the risk of getting HIV/AIDS (aOR, 1.27; 95% CI, 1.15 to 1.39), how HIV/AIDS is transmitted (aOR, 3.49; 95% CI, 3.09 to 3.95), and were willing to care for an infected relative (aOR, 2.78; 95% CI, 2.47 to 3.13). A model consisting of those variables explained 69% of the variance in discrimination. Conclusions Gender, residence, knowledge, and attitudes related to HIV/AIDS were explanatory factors for discrimination against PLHA. Improvements in HIV/AIDS education programs are needed to prevent discrimination.
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Affiliation(s)
- Rimawati Aulia Insani Sadarang
- Public Health Department, Faculty of Medicine and Health Science, Universitas Islam Negeri Alauddin Makassar, Gowa, Indonesia
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5
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Yu D, Li X, Yu J, Shi X, Liu P, Tian P. Whether Urbanization Has Intensified the Spread of Infectious Diseases-Renewed Question by the COVID-19 Pandemic. Front Public Health 2021; 9:699710. [PMID: 34900884 PMCID: PMC8652246 DOI: 10.3389/fpubh.2021.699710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 10/05/2021] [Indexed: 12/30/2022] Open
Abstract
The outbreak of the COVID-19 epidemic has triggered adiscussion of the relationship between urbanization and the spread of infectious diseases. Namely, whether urbanization will exacerbate the spread of infectious diseases. Based on 31 provincial data from 2002 to 2018 in China, the impact of urbanization on the spread of infectious diseases from the dimensions of "population" and "land" is analyzed in this paper by using the GMM (generalized method of moments) model. The empirical study shows that the population increase brought by urbanization does not aggravate the spread of infectious diseases. On the contrary, urban education, employment and entrepreneurship, housing, medical and health care, and other basic public services brought by population urbanization can help reduce the risk of the spread of infectious diseases. The increasing density of buildings caused by land urbanization increases the risk of the spread of infectious diseases. Moreover, the impact of urbanization on the spread of infectious diseases has regional heterogeneity. Therefore, the prevention and control of disease play a crucial role.
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Affiliation(s)
- Dongsheng Yu
- School of Economics, Zhongnan University of Economics and Law, Wuhan, China
| | - Xiaoping Li
- School of Economics, Zhongnan University of Economics and Law, Wuhan, China
| | - Juanjuan Yu
- School of Economics, Zhongnan University of Economics and Law, Wuhan, China
| | - Xunpeng Shi
- Australia-China Relations Institute, University of Technology Sydney, Sydney, NSW, Australia
| | - Pei Liu
- School of Economics, Zhengzhou University of Aeronautics, Zhengzhou, China
| | - Pu Tian
- School of Economics, Zhongnan University of Economics and Law, Wuhan, China
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Loevinsohn G, Hamahuwa M, Sinywimaanzi P, Fenstermacher KZJ, Shaw-Saliba K, Pekosz A, Monze M, Rothman RE, Simulundu E, Thuma PE, Sutcliffe CG. Facility-based surveillance for influenza and respiratory syncytial virus in rural Zambia. BMC Infect Dis 2021; 21:986. [PMID: 34548020 PMCID: PMC8453466 DOI: 10.1186/s12879-021-06677-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/10/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND While southern Africa experiences among the highest mortality rates from respiratory infections, the burden of influenza and respiratory syncytial virus (RSV) in rural areas is poorly understood. METHODS We implemented facility-based surveillance in Macha, Zambia. Outpatients and inpatients presenting with influenza-like illness (ILI) underwent testing for influenza A, influenza B, and RSV and were prospectively followed for 3 to 5 weeks to assess clinical course. Log-binomial models assessed correlates of infection and clinical severity. RESULTS Between December 2018 and December 2019, 17% of all outpatients presented with ILI and 16% of inpatients were admitted with an acute respiratory complaint. Influenza viruses and RSV were detected in 17% and 11% of outpatient participants with ILI, and 23% and 16% of inpatient participants with ILI, respectively. Influenza (July-September) and RSV (January-April) prevalence peaks were temporally distinct. RSV (relative risk [RR]: 1.78; 95% confidence interval [CI] 1.51-2.11), but not influenza, infection was associated with severe disease among patients with ILI. Underweight patients with ILI were more likely to be infected with influenza A (prevalence ratio [PR]: 1.72; 95% CI 1.04-2.87) and to have severe influenza A infections (RR: 2.49; 95% CI 1.57-3.93). CONCLUSIONS Populations in rural Zambia bear a sizeable burden of viral respiratory infections and severe disease. The epidemiology of infections in this rural area differs from that reported from urban areas in Zambia.
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Affiliation(s)
- Gideon Loevinsohn
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6535, Baltimore, MD, 21205, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Kathryn Shaw-Saliba
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew Pekosz
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mwaka Monze
- Virology Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Richard E Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Philip E Thuma
- Macha Research Trust, Macha, Choma, Zambia
- Department of Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine G Sutcliffe
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6535, Baltimore, MD, 21205, USA.
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7
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Jooste S, Mabaso M, Taylor M, North A, Shean Y, Simbayi LC, Reddy T, Mwandingi L, Schmidt T, Nevhungoni P, Manda S, Zuma K. Geographical variation in HIV testing in South Africa: Evidence from the 2017 national household HIV survey. South Afr J HIV Med 2021; 22:1273. [PMID: 34522430 PMCID: PMC8424727 DOI: 10.4102/sajhivmed.v22i1.1273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/21/2021] [Indexed: 11/01/2022] Open
Abstract
Background Identification of the geographical areas with low uptake of HIV testing could assist in spatial targeting of interventions to improve the uptake of HIV testing. Objectives The objective of this research study was to map the uptake of HIV testing at the district level in South Africa. Method The secondary analysis used data from the Human Sciences Research Council's 2017 National HIV Prevalence, Incidence, Behaviour and Communication Survey, where data were collected using a multistage stratified random cluster sampling approach. Descriptive spatial methods were used to assess disparities in the proportion of those ever tested for HIV at the district level in South Africa. Results The districts with the highest overall coverage of people ever having tested for HIV (> 85%) include West Rand in Gauteng, Lejweleputswa and Thabo Mofutsanyane in Free State, and Ngaka Modiri Molema in North-West. These provinces also had the least variation in HIV testing coverage between their districts. Districts in KwaZulu-Natal had the widest variation in coverage of HIV testing. The districts with the lowest uptake of HIV testing were uMkhanyakude (54.7%) and Ugu (61.4%) in KwaZulu-Natal and Vhembe (61.0%) in Limpopo. Most districts had a higher uptake of HIV testing amongst female than male participants. Conclusion The uptake of HIV testing across various districts in South Africa seems to be unequal. Intervention programmes must improve the overall uptake of HIV testing, especially in uMkhanyakude and Ugu in KwaZulu-Natal and Vhembe in Limpopo. Interventions must also focus on enhancing uptake of HIV testing amongst male participants in most districts. Strategies that would improve the uptake of HIV testing include HIV self-testing and community HIV testing, specifically home-based testing.
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Affiliation(s)
- Sean Jooste
- Human Sciences Research Council, Cape Town, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Myra Taylor
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Alicia North
- Human Sciences Research Council, Cape Town, South Africa
| | - Yolande Shean
- Human Sciences Research Council, Cape Town, South Africa
| | - Leickness C Simbayi
- Human Sciences Research Council, Cape Town, South Africa.,Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Tarylee Reddy
- South African Medical Research Council, Durban, South Africa
| | - Leonard Mwandingi
- Human Sciences Research Council, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town, South Africa.,Ministry of Health and Social Sciences, Windhoek, Namibia
| | | | | | - Samuel Manda
- South African Medical Research Council, Pretoria, South Africa.,Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - Khangelani Zuma
- Human Sciences Research Council, Pretoria, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Andrus E, Mojola SA, Moran E, Eisenberg M, Zelner J. Has the relationship between wealth and HIV risk in Sub-Saharan Africa changed over time? A temporal, gendered and hierarchical analysis. SSM Popul Health 2021; 15:100833. [PMID: 34141854 PMCID: PMC8184650 DOI: 10.1016/j.ssmph.2021.100833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/29/2022] Open
Abstract
This study examines the relationship between wealth and HIV infection in Sub-Saharan Africa to determine whether and how this relationship has varied over time, within and across countries, by gender, and urban environment. The analysis draws on DHS and AIS data from 27 Sub-Saharan African countries, which spanned the 14 years between 2003 and 2016. We first use logistic regression analyses to assess the relationship between individual wealth, HIV infection and gender by country and year stratified on urban environment. We then use meta-regression analyses to assess the relationship between country level measures of wealth and the odds of HIV infection by gender and individual level wealth, stratified on urban environment. We find that there is a persistent and positive relationship between wealth and the odds of HIV infection across countries, but that the strength of this association has weakened over time. The rate of attenuation does not appear to differ between urban/rural strata. Likewise, we also find that these associations were most pronounced for women and that this relationship was persistent over the study period and across urban and rural strata. Overall, our findings suggest that the relationship between wealth and HIV infection is beginning to reverse and that in the coming years, the relationship between wealth and HIV infection in Sub-Saharan Africa may more clearly mirror the predominant global picture.
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Affiliation(s)
- Emily Andrus
- University of Michigan, Department of Epidemiology, School of Public Health, Ann Arbor, MI, USA
| | - Sanyu A. Mojola
- Department of Sociology, School of Public and International Affairs, Office of Population Research, Princeton University, Princeton, NJ, USA
| | - Elizabeth Moran
- University of Michigan, Department of Epidemiology, School of Public Health, Ann Arbor, MI, USA
| | - Marisa Eisenberg
- University of Michigan, Department of Epidemiology, School of Public Health, Ann Arbor, MI, USA
| | - Jon Zelner
- University of Michigan, Department of Epidemiology, School of Public Health, Ann Arbor, MI, USA
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Maulide Cane R, Melesse DY, Kayeyi N, Manu A, Wado YD, Barros A, Boerma T. HIV trends and disparities by gender and urban-rural residence among adolescents in sub-Saharan Africa. Reprod Health 2021; 18:120. [PMID: 34134720 PMCID: PMC8210344 DOI: 10.1186/s12978-021-01118-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/03/2022] Open
Abstract
Background In sub-Saharan Africa HIV transmission is a major challenge in adolescents, especially among girls and those living in urban settings. Major international efforts have aimed at reducing sexual transmission of HIV. This analysis aims to assess the trends in HIV prevalence by gender in adolescents, as well as urban–rural disparities. Methods HIV prevalence data at ages 15–19 years were obtained for 31 countries with a national survey since 2010 and for 23 countries with one survey circa 2005 and a recent survey circa 2015. Country medians and average annual rates of changes were used to summarize the trends for two subregions in sub-Saharan Africa, Eastern and Southern Africa and West and Central Africa, which largely correspond with higher and lower HIV prevalence countries. Data on HIV incidence at ages 15–24 and prevalence at 5–9 and 10–14 years were reviewed from 11 recent national surveys. Trends in urban–rural disparities in HIV prevalence and selected indicators of sexual and HIV testing behaviours were assessed for females and males 15–24 years, using the same surveys. Results HIV prevalence among girls 15–19 years declined in eastern and Southern Africa from 5.7 to 2.6% during 2005–2015 (country median), corresponding with an average annual rate of reduction of 6.5% per year. Among boys, the median HIV prevalence declined from 2.1 to 1.2%. Changes were also observed in West and Central Africa where median HIV prevalence among girls decreased from 0.7 to 0.4% (average annual rate of reduction 5.9%), but not for boys (0.3%). Girl-boy differences at 10–14 years were small with a country median HIV of 1.0% and 1.3%, respectively. Urban females and males 15–24 had at least 1.5 times higher HIV prevalence than their rural counterparts in both subregions, and since the urban–rural declines were similar, the gaps persisted during 2005–2015. Conclusions HIV prevalence among adolescents declined in almost all countries during the last decade, in both urban and rural settings. The urban–rural gap persisted and HIV transmission to girls, but not boys, is still a major challenge in Eastern and Southern African countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01118-7.
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Affiliation(s)
- Réka Maulide Cane
- Women's and Children's Health Program, Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.
| | - Dessalegn Y Melesse
- Institute for Global Public Health, University of Manitoba, Winnipeg, Canada
| | | | - Adom Manu
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | | | | | - Ties Boerma
- Institute for Global Public Health, University of Manitoba, Winnipeg, Canada
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10
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DeBeaudrap P, Beninguisse G, Mouté C, Temgoua CD, Kayiro PC, Nizigiyimana V, Pasquier E, Zerbo A, Barutwanayo E, Niyondiko D, Ndayishimiye N. The multidimensional vulnerability of people with disability to HIV infection: Results from the handiSSR study in Bujumbura, Burundi. EClinicalMedicine 2020; 25:100477. [PMID: 32954240 PMCID: PMC7486319 DOI: 10.1016/j.eclinm.2020.100477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In resource-limited contexts, available data indicate that people with disability are disproportionally affected by the HIV epidemic. While disability resulting from chronic HIV infection has received some attention, few epidemiologic studies have examined the vulnerability of people with disability to HIV acquisition. The aims of the study were as follows: to estimate and compare HIV prevalence among people with and without disability living in Bujumbura, Burundi; to examine how the interaction among disability, gender and socioeconomic environment shapes vulnerability to HIV; and to identify potential pathways to higher HIV risk. METHODS In this cross-sectional population-based study, 623 persons with disability (302 with disability onset ≤10 years ["early disability"]) and 609 persons without disability matched for age, sex and location were randomly selected to be tested for HIV and to participate in an interview about their life history, their social environment and their knowledge of sexual health. FINDINGS A total of 68% of men and 75% of women with disability were affected by multidimensional poverty compared to 54% and 46% of their peers without disability (p<0.0001). Higher HIV prevalence was observed among women with disability (12.1% [8.2-16]) than among those without (3.8% [1.7-6], ORa 3.8, p<0.0001), while it was similar among men with disability and those without (p = 0·8). Women with disability were also at higher risk of sexual violence than were those without (ORa 2.7, p<0.0001). The vulnerability of women with early disability to HIV was higher among those who were socially isolated (HIV prevalence in this group: 19% [12-27]). In addition, education level and sexual violence mediated 53% of the association between early disability and HIV (p = 0.001). INTERPRETATION This study highlights how the intersection of disability, gender and social environment shapes vulnerability to HIV. It also shows that the vulnerability to HIV of women who grew up with a disability is mediated by sexual violence. FUNDING This research was funded by the Netherlands Organization for Scientific Research (Grant W08.560.005) and the Initiative HIV-TB-Malaria (new name of the organisation).
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Affiliation(s)
- Pierre DeBeaudrap
- Centre Population et Développement, (Ceped), Institut de recherche pour le développement (IRD) and Paris University, Inserm ERL 1244, 45 rue des Saints-Pères, 75006 Paris, France
| | - Gervais Beninguisse
- Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
| | - Charles Mouté
- Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
| | | | - Pierre Claver Kayiro
- Institut de statistiques et d’études économiques du Burundi (ISTEEBU), Bujumbura, Burundi
| | - Vénérand Nizigiyimana
- Institut de statistiques et d’études économiques du Burundi (ISTEEBU), Bujumbura, Burundi
| | | | | | | | | | - Nicolas Ndayishimiye
- Institut de statistiques et d’études économiques du Burundi (ISTEEBU), Bujumbura, Burundi
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11
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Rabkin M, Strauss M, Mantell JE, Mapingure M, Masvawure TB, Lamb MR, Zech JM, Musuka G, Chingombe I, Msukwa M, Boccanera R, Gwanzura C, George G, Apollo T. Optimizing differentiated treatment models for people living with HIV in urban Zimbabwe: Findings from a mixed methods study. PLoS One 2020; 15:e0228148. [PMID: 31990930 PMCID: PMC6986745 DOI: 10.1371/journal.pone.0228148] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/09/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Zimbabwe is scaling up HIV differentiated service delivery (DSD) to improve treatment outcomes and health system efficiencies. Shifting stable patients into less-intensive DSD models is a high priority in order to accommodate the large numbers of newly-diagnosed people living with HIV (PLHIV) needing treatment and to provide healthcare workers with the time and space needed to treat people with advanced HIV disease. DSD is also seen as a way to improve service quality and enhance retention in care. National guidelines support five differentiated antiretroviral treatment models (DART) for stable HIV-positive adults, but little is known about patient preferences, a critical element needed to guide DART scale-up and ensure person-centered care. We designed a mixed-methods study to explore treatment preferences of PLHIV in urban Zimbabwe. METHODS The study was conducted in Harare, and included 35 health care worker (HCW) key informant interviews (KII); 8 focus group discussions (FGD) with 54 PLHIV; a discrete choice experiment (DCE) in which 500 adult DART-eligible PLHIV selected their preferences for health facility (HF) vs. community location, individual vs. group meetings, provider cadre and attitude, clinic operation times, visit frequency, visit duration and cost to patient; and a survey with the 500 DCE participants exploring DART knowledge and preferences. RESULTS Patient preferences were consistent in the FGDs, DCE and survey. Participants strongly preferred respectful HCWs, HF-based services, individual DART models, and less costly services. Patients also preferred less frequent visits and shorter wait times. They were indifferent to variations in HCW cadre and distances from home to HF. These preferences were mostly homogenous, with only minor differences between male vs. female and older vs. younger patients. HCWs in the KII correctly characterized facility-based individual models as the one most favored by patients; HCWs also preferred this model, which they felt decongested HFs and reduced their workload. CONCLUSIONS DART-eligible PLHIV in Harare found it relatively easy to access HFs, and preferred attributes associated with facility-based individual models. Prioritizing these for scale-up in urban areas may be the most efficient way to sustain positive patient outcomes and increase health system performance.
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Affiliation(s)
- Miriam Rabkin
- ICAP at Columbia University, New York, New York, United States of America
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
- * E-mail:
| | - Michael Strauss
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa
| | - Joanne E. Mantell
- Department of Psychiatry, Division of Gender, Sexuality and Health, Columbia University, New York, New York, United States of America
- The New York State Psychiatric Institute, New York, New York, United States of America
| | | | - Tsitsi B. Masvawure
- Department of Sociology and Anthropology, College of the Holy Cross, Worcester, Massachusetts, United States of America
| | - Matthew R. Lamb
- ICAP at Columbia University, New York, New York, United States of America
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Jennifer M. Zech
- ICAP at Columbia University, New York, New York, United States of America
| | | | | | | | - Rodrigo Boccanera
- Health Resources and Services Administration (HRSA), Bethesda, Maryland, United States of America
| | - Clorata Gwanzura
- Ministry of Health and Child Care, HIV/AIDS and STIs Unit, Harare, Zimbabwe
| | - Gavin George
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa
| | - Tsitsi Apollo
- Ministry of Health and Child Care, HIV/AIDS and STIs Unit, Harare, Zimbabwe
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Riley ED, Vittinghoff E, Koss CA, Christopoulos KA, Clemenzi-Allen A, Dilworth SE, Carrico AW. Housing First: Unsuppressed Viral Load Among Women Living with HIV in San Francisco. AIDS Behav 2019; 23:2326-2336. [PMID: 31324996 PMCID: PMC7478361 DOI: 10.1007/s10461-019-02601-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
While poverty is an established barrier to achieving success at each step of the HIV care continuum, less is known about specific aspects of poverty and how they overlap with behavior in exceptionally low-income individuals who live in well-resourced areas. We considered unsuppressed viral load over 3 years among women living with HIV in San Francisco who used homeless shelters, low-income hotels and free meal programs. One-hundred twenty study participants were followed; 60% had > 1 unsuppressed viral load and 19% were unsuppressed at every visit. Across six-month intervals, the odds of unsuppressed viral load were 11% higher for every 10 nights spent sleeping on the street [Adjusted Odds Ratio (AOR) 1.11, 95% CI 1.02-1.20]; 16% higher for every 10 nights spent sleeping in a shelter (AOR/10 nights 1.16, 95% CI 1.06-1.27); 4% higher for every 10 nights spent sleeping in a single-room occupancy hotel (AOR/10 nights 1.04, 95% CI 1.02-1.07); and over threefold higher among women who experienced any recent incarceration (AOR 3.56, 95% CI 1.84-6.86). Violence and recent use of outpatient health care did not significantly predict viral suppression in adjusted analysis. While strategies to promote retention in care are important for vulnerable persons living with HIV, they are insufficient to ensure sustained viral suppression in low-income women experiencing homelessness and incarceration. Results presented here in combination with prior research linking incarceration to homelessness among women indicate that tailored interventions, which not only consider but prioritize affordable housing, are critical to achieving sustained viral suppression in low-income women living with HIV.
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Affiliation(s)
- Elise D Riley
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA.
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine A Koss
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA
| | - Katerina A Christopoulos
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA
| | - Angelo Clemenzi-Allen
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA
| | - Samantha E Dilworth
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
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Igulot P, Magadi MA. Socioeconomic Status and Vulnerability to HIV Infection in Uganda: Evidence from Multilevel Modelling of AIDS Indicator Survey Data. AIDS Res Treat 2018; 2018:7812146. [PMID: 29983999 PMCID: PMC6011175 DOI: 10.1155/2018/7812146] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/23/2018] [Accepted: 04/19/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is controversy on the association between socioeconomic status (SES) and HIV infection. Some evidence claims higher SES is negatively associated with HIV infection while others report the reverse. OBJECTIVES To examine the association between SES and HIV infection in Uganda and to examine whether the SES-HIV relationship varies by gender, rural-urban place of residence, and time (2004-2005 and 2011) in Uganda. METHODS Multilevel analysis was applied to 39,766 individual cases obtained in 887 clusters of Uganda HIV/AIDS Indicators Survey conducted in 2004-2005 and 2011. RESULTS Household wealth is associated with increased vulnerability in the general population and in rural areas. Compared with no educational attainment, secondary or higher education is associated with reduced vulnerability to the risk of HIV infection by 37% in the general population. However, this effect was stronger in urban than rural areas. Besides individual-level factors, unobserved community factors too play an important role and account for 9% of unexplained variance after individual-level factors are considered. CONCLUSION Household wealth increases vulnerability but education reduces it. The social environment influences vulnerability to HIV infection independent of individual-level factors. HIV/AIDS awareness targeting sexual practices of wealthy individuals and those with primary-level educational attainment together with improving educational attainment and addressing contextual factors influencing vulnerability to HIV infection are necessary strategies to reduce HIV infections in Uganda.
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Howell EM, Kigozi NG, Heunis JC. Community-based directly observed treatment for TB patients to improve HIV services: a cross-sectional study in a South African province. BMC Health Serv Res 2018; 18:255. [PMID: 29625569 PMCID: PMC5889613 DOI: 10.1186/s12913-018-3074-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 03/28/2018] [Indexed: 11/13/2022] Open
Abstract
Background There is uncertainty about how directly observed treatment (DOT) support for tuberculosis (TB) can be delivered most effectively and how DOT support can simultaneously be used to strengthen human immunodeficiency virus (HIV) prevention and control among TB patients. This study describes how DOT support by community health workers (CHWs) was used in four municipalities in the Free State province – a high TB/HIV burden, poorly-resourced setting – to provide HIV outreach, referrals, and health education for TB patients. Methods The study was part of a larger cross-sectional study of HIV counselling and testing (HCT) among 1101 randomly-selected TB patients registered at 40 primary health care (PHC) facilities (clinics and community health centres) across small town/rural and large town/urban settings. Univariate analysis of percentages, chi-square tests and t-tests for difference in means were used to describe differences between the types of TB treatment support and patient characteristics, as well as the types of – and patient satisfaction with – HIV information and referrals received from various types of treatment supporters including home-based DOT supporters, clinic-based DOT supporters or support from family/friends/employers. Multivariate logistic regression was used to predict the likelihood of not having receiving home-based DOT and of never having received HIV counselling. The independent variables include poverty-related health and socio-economic risk factors for poor outcomes. Statistical significance is shown using a 95% confidence interval and a 0.05 p-value. Results Despite the fact that DOT support for all TB patients was the goal of South African health policy at the time (2012), most TB patients were not receiving formal DOT support. Only 155 (14.1%) were receiving home-based DOT, while 114 (10.4%) received clinic-based DOT. TB patients receiving home-based DOT reported higher rates of HIV counselling than other patients. Conclusions Public health providers should train DOT supporters to provide HIV prevention and target DOT to those at greatest risk of HIV, particularly those at greatest socio-economic risk.
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Affiliation(s)
- Embry M Howell
- The Urban Institute, Health Policy Center, 2100 M St., N.W, Washington, D.C., 20037, USA
| | - N Gladys Kigozi
- Centre for Health Systems Research & Development, University of the Free State, P.O. Box 399, Bloemfontein, 9300, South Africa
| | - J Christo Heunis
- Centre for Health Systems Research & Development, University of the Free State, P.O. Box 399, Bloemfontein, 9300, South Africa.
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