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Costs and cost-effectiveness of HIV counselling and testing modalities in Southern Mozambique. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:49. [PMID: 36068574 PMCID: PMC9447341 DOI: 10.1186/s12962-022-00378-9] [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: 08/18/2020] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Despite the high HIV associated burden, Mozambique lacks data on HIV counselling and testing (HCT) costs. To help guide national HIV/AIDS programs, we estimated the cost per test for voluntary counselling and testing (VCT) from the patient’s perspective and the costs per person tested and per HIV-positive individual linked to care to the healthcare provider for VCT, provider-initiated counselling and testing (PICT) and home-based testing (HBT). We also assessed the cost-effectiveness of these strategies for linking patients to care. Methods Data from a cohort study conducted in the Manhiça District were used to derive costs and linkage-to-care outcomes of the three HCT strategies. A decision tree was used to model HCT costs according to the likelihood of HCT linking individuals to care and to obtain the incremental cost-effectiveness ratios (ICERs) of PICT and HBT with VCT as the comparator. Sensitivity analyses were performed to assess robustness of base-case findings. Findings Based on costs and valuations in 2015, average and median VCT costs to the patient per individual tested were US$1.34 and US$1.08, respectively. Costs per individual tested were greatest for HBT (US$11.07), followed by VCT (US$7.79), and PICT (US$7.14). The costs per HIV-positive individual linked to care followed a similar trend. PICT was not cost-effective in comparison with VCT at a willingness-to-accept threshold of US$4.53, but only marginally given a corresponding base-case ICER of US$4.15, while HBT was dominated, with higher costs and lower impact than VCT. Base-case results for the comparison between PICT and VCT presented great uncertainty, whereas findings for HBT were robust. Conclusion PICT and VCT are likely equally cost-effective in Manhiça. We recommend that VCT be offered as the predominant HCT strategy in Mozambique, but expansion of PICT could be considered in limited-resource areas. HBT without facilitated linkage or reduced costs is unlikely to be cost-effective.
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Palma AM, Marra G, Bray R, Saito S, Awor AC, Jalloh MF, Kailembo A, Kirungi W, Mgomella GS, Njau P, Voetsch AC, Ward JA, Bärnighausen T, Harling G. Correcting for selection bias in HIV prevalence estimates: an application of sample selection models using data from population-based HIV surveys in seven sub-Saharan African countries. J Int AIDS Soc 2022; 25:e25954. [PMID: 35929226 PMCID: PMC9353488 DOI: 10.1002/jia2.25954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/09/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Population‐based biomarker surveys are the gold standard for estimating HIV prevalence but are susceptible to substantial non‐participation (up to 30%). Analytical missing data methods, including inverse‐probability weighting (IPW) and multiple imputation (MI), are biased when data are missing‐not‐at‐random, for example when people living with HIV more frequently decline participation. Heckman‐type selection models can, under certain assumptions, recover unbiased prevalence estimates in such scenarios. Methods We pooled data from 142,706 participants aged 15–49 years from nationally representative cross‐sectional Population‐based HIV Impact Assessments in seven countries in sub‐Saharan Africa, conducted between 2015 and 2018 in Tanzania, Uganda, Malawi, Zambia, Zimbabwe, Lesotho and Eswatini. We compared sex‐stratified HIV prevalence estimates from unadjusted, IPW, MI and selection models, controlling for household and individual‐level predictors of non‐participation, and assessed the sensitivity of selection models to the copula function specifying the correlation between study participation and HIV status. Results In total, 84.1% of participants provided a blood sample to determine HIV serostatus (range: 76% in Malawi to 95% in Uganda). HIV prevalence estimates from selection models diverged from IPW and MI models by up to 5% in Lesotho, without substantial precision loss. In Tanzania, the IPW model yielded lower HIV prevalence estimates among males than the best‐fitting copula selection model (3.8% vs. 7.9%). Conclusions We demonstrate how HIV prevalence estimates from selection models can differ from those obtained under missing‐at‐random assumptions. Further benefits include exploration of plausible relationships between participation and outcome. While selection models require additional assumptions and careful specification, they are an important tool for triangulating prevalence estimates in surveys with substantial missing data due to non‐participation.
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Affiliation(s)
- Anton M. Palma
- ICAP at Columbia UniversityNew YorkNew YorkUSA
- Institute for Clinical and Translational SciencesUniversity of California IrvineIrvineCaliforniaUSA
| | | | - Rachel Bray
- ICAP at Columbia UniversityNew YorkNew YorkUSA
| | - Suzue Saito
- ICAP at Columbia UniversityNew YorkNew YorkUSA
| | - Anna Colletar Awor
- Division of Global HIV and TuberculosisCenter for Global HealthCDCKampalaUganda
| | - Mohamed F. Jalloh
- Division of Global HIV and TuberculosisCenter for Global HealthCDCDar es SalaamTanzania
| | - Alexander Kailembo
- National Institutes of HealthNational Institute of Dental and Craniofacial ResearchBethesdaMarylandUSA
| | | | - George S. Mgomella
- Division of Global HIV and TuberculosisCenter for Global HealthCDCDar es SalaamTanzania
- University of CambridgeCambridgeUK
| | - Prosper Njau
- Division of Global HIV and TuberculosisCenter for Global HealthCDCDar es SalaamTanzania
| | | | - Jennifer A. Ward
- Division of Global HIV and TuberculosisCenter for Global HealthCDCKampalaUganda
| | - Till Bärnighausen
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt)University of the WitwatersrandJohannesburgSouth Africa
- Department of Epidemiology & Harvard Center for Population and Development StudiesHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Heidelberg Institute of Global HealthUniversity of HeidelbergHeidelbergGermany
| | - Guy Harling
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt)University of the WitwatersrandJohannesburgSouth Africa
- Department of Epidemiology & Harvard Center for Population and Development StudiesHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Institute for Global HealthUniversity College LondonLondonUK
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Ajayi A, Awopegba O, Owolabi E, Ajala A. Coverage of HIV testing among pregnant women in Nigeria: progress, challenges and opportunities. J Public Health (Oxf) 2021; 43:e77-e84. [PMID: 31786595 DOI: 10.1093/pubmed/fdz152] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study assessed the progress, opportunities and challenges in scaling up of HIV testing for pregnant women in Nigeria. METHODS Data were retrieved from the 2016-2017 fifth multiple cluster survey. Adjusted and unadjusted logistic regression models were used to examine demographic factors associated with HIV testing while controlling for geopolitical zones. RESULTS At the population level, the coverage of HIV testing among pregnant women increased by 10% points from 32.8 to 42.7% between 2013 and 2017. Also, the coverage of antenatal HIV testing grew by 20 points, from 50.1 to 70.5% over the period. However, women were still more likely to be tested for HIV during pregnancy if they were older than 24 years [adjusted odds ratio (AOR) 1.33, 95% CI 1.04-1.69], had higher education [AOR 6.94, 95% CI 5.07-9.49], resided in urban areas [AOR 1.26, 95% CI 1.07, 1.50] and belong to richest wealth quintile [AOR 7.43, 95% CI 5.72-9.66]. CONCLUSION Our findings suggest that progress has been made in scaling up of antenatal coverage of HIV testing. However, the level of HIV testing during pregnancy remains low and far below the 95% national target. Appropriate interventions are needed in resource-poor communities where antenatal care utilization is very low.
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Affiliation(s)
- Ai Ajayi
- Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Centre, APHRC Campus, Nairobi, 00100, Kenya
| | - Oe Awopegba
- Economics and Business Policy Department, Nigerian Institute of Social and Economic Research, 200284, Ibadan, Nigeria
| | - Eo Owolabi
- Department of Nursing Science, Faculty of Health Sciences, University of Fort Hare, East London, 5200, South Africa
| | - A Ajala
- Department of Nursing Science, Faculty of Health Sciences, University of Ibadan, 200284, Ibadan, Nigeria
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Funsani P, Jiang H, Yang X, Zimba A, Bvumbwe T, Qian X. Why pregnant women delay to initiate and utilize free antenatal care service: a qualitative study in theSouthern District of Mzimba, Malawi. GLOBAL HEALTH JOURNAL 2021. [DOI: 10.1016/j.glohj.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Awopegba OE, Kalu A, Ahinkorah BO, Seidu AA, Ajayi AI. Prenatal care coverage and correlates of HIV testing in sub-Saharan Africa: Insight from demographic and health surveys of 16 countries. PLoS One 2020; 15:e0242001. [PMID: 33166351 PMCID: PMC7652338 DOI: 10.1371/journal.pone.0242001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/26/2020] [Indexed: 11/19/2022] Open
Abstract
Background Prenatal screening of pregnant women for HIV is central to eliminating mother-to-child-transmission (MTCT) of HIV. While some countries in sub-Saharan Africa (SSA) have scaled up their prevention of MTCT programmes, ensuring a near-universal prenatal care HIV testing, and recording a significant reduction in new infection among children, several others have poor outcomes due to inadequate testing. We conducted a multi-country analysis of demographic and health surveys (DHS) to assess the coverage of HIV testing during pregnancy and also examine the factors associated with uptake. Methods We analysed data of 64,933 women from 16 SSA countries with recent DHS datasets (2015–2018) using Stata version 16. Adjusted and unadjusted logistic regression models were used to examine correlates of prenatal care uptake of HIV testing. Statistical significance was set at p<0.05. Results Progress in scaling up of prenatal care HIV testing was uneven across SSA, with only 6.1% of pregnant women tested in Chad compared to 98.1% in Rwanda. While inequality in access to HIV testing among pregnant women is pervasive in most SSA countries and particularly in West and Central Africa sub-regions, a few countries, including Rwanda, South Africa, Zimbabwe, Malawi and Zambia have managed to eliminate wealth and rural-urban inequalities in access to prenatal care HIV testing. Conclusion Our findings highlight the between countries and sub-regional disparities in prenatal care uptake of HIV testing in SSA. Even though no country has universal coverage of prenatal care HIV testing, East and Southern African regions have made remarkable progress towards ensuring no pregnant woman is left untested. However, the West and Central Africa regions had low coverage of prenatal care testing, with the rich and well educated having better access to testing, while the poor rarely tested. Addressing the inequitable access and coverage of HIV testing among pregnant women is vital in these sub-regions.
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Affiliation(s)
- Oluwafemi Emmanuel Awopegba
- Economics and Business Policy Department, Nigerian Institute of Social and Economic Research, Ibadan, Nigeria
| | - Amarachi Kalu
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology, Sydney, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Anthony Idowu Ajayi
- Population Dynamics and Reproductive Health Unit, African Population and Health Research Centre, APHRC Campus, Nairobi, Kenya
- * E-mail:
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Chu DT, Vo HL, Tran DK, Nguyen Si Anh H, Bao Hoang L, Tran Nhu P, Nguyen Ngoc K, Thu Nguyen T, Pham Van Q, Tien NLB, Thanh VV, Nga VT, Luu Quang T, Minh LB, Pham VH. Socioeconomic Inequalities in the HIV Testing during Antenatal Care in Vietnamese Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3240. [PMID: 31487845 PMCID: PMC6765951 DOI: 10.3390/ijerph16183240] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/30/2019] [Accepted: 09/01/2019] [Indexed: 11/16/2022]
Abstract
Although HIV (human immunodeficiency virus) testing for all women has been promoted by Vietnam's Ministry of Health since 2000, test acceptance rates in this country were reported to be less than 30% in the community. This country has been facing the barriers to approach the national services towards transmission prevention from mother to child including HIV testing during antenatal care (ANC) towards mothers. Here, we aim to assess the socioeconomic inequalities in HIV testing during ANC among Vietnamese women. This study used available data from the Vietnam Multiple Indicator Cluster Survey 2014. Overall, the prevalence of HIV testing during antenatal care was 30% and the concentrate index (CCI) was 0.1926. There was significant inequality between women classified as poor and rich, and when stratified by social characteristics, inequality was found in women aged 15-49 years (CCI: 0.4), living in rural areas (CCI: 0.3), belonging to ethnic minorities (CCI: 0.5) and having primary or less education (CCI: 0.4). In the multivariate logistic regression analysis, ethnicity and socioeconomic status were significant factors associated with HIV testing during ANC. We found the prevalence of HIV testing during ANC was low, and its inequalities were associated with age, living area, ethnicity, education, and economic status.
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Affiliation(s)
- Dinh-Toi Chu
- Faculty of Biology, Hanoi National University of Education, Hanoi 100000, Vietnam.
| | - Hoang-Long Vo
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Dang-Khoa Tran
- Department of Anatomy, University of Medicine Pham Ngoc Thach, Ho Chi Minh City 700000, Vietnam.
| | - Hao Nguyen Si Anh
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Long Bao Hoang
- Institute of Gastroenterology and Hepatology, Hanoi 100000, Vietnam.
| | - Phong Tran Nhu
- Public Health Department, Nursing Faculty, Dai Nam University, Hanoi 100000, Vietnam.
| | - Khanh Nguyen Ngoc
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Trang Thu Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Quyet Pham Van
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Nguyen Le Bao Tien
- Institute of Orthopaedics and Trauma Surgery, Viet Duc Hospital, Hanoi 100000, Vietnam.
| | - Vo Van Thanh
- Institute of Orthopaedics and Trauma Surgery, Viet Duc Hospital, Hanoi 100000, Vietnam.
- Department of Surgery, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Vu Thi Nga
- Institute for Research and Development, Duy Tan University, Danang 550000, Vietnam.
| | - Thuy Luu Quang
- Center for Anesthesia and Surgical Intensive Care, Viet Duc Hospital, Hanoi 100000, Vietnam.
| | - Le Bui Minh
- NTT Hi-tech Institute, Nguyen Tat Thanh University, 300A Nguyen Tat Thanh St., Ward 13, District 4, Ho Chi Minh City 700000, Vietnam.
| | - Van Huy Pham
- AI Lab, Faculty of Information Technology, Ton Duc Thang University, Ho Chi Minh City 700000, Vietnam.
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Gebresillassie BM, Emiru YK, Erku DA, Mersha AG, Mekuria AB, Ayele AA, Tegegn HG. Utilization of Provider-Initiated HIV Testing and Counseling as an Intervention for PMTCT Services Among Pregnant Women Attending Antenatal Clinic in a Teaching Hospital in Ethiopia. Front Public Health 2019; 7:205. [PMID: 31396503 PMCID: PMC6668358 DOI: 10.3389/fpubh.2019.00205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 07/09/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose: Little is known about acceptance of provider-initiated HIV testing and counseling (PICT) as an intervention for prevention of mother to child transmission of HIV (PMTCT) in many parts of sub-Saharan Africa including Ethiopia. This study aimed at assessing the utilization and acceptance rate of PICT as an intervention for PMTCT among pregnant women attending University of Gondar referral and teaching hospital (UoGRTH), Ethiopia. Methods: A hospital-based cross-sectional study was conducted on 364 pregnant women attending antenatal care clinic at UoGRTH through an interviewer-administered questionnaire. Frequencies, means, and percentages were used to report different variables. Univariate analysis and multivariate logistic regression analysis were used to come up with factors associated with acceptance of PICT services. Results: Out of 364 respondents, 298 330 (81.7%) of them accepted provider-initiated HIV testing and counseling. Rural residency (AOR: 364, 95% CI: 2.17–6.34), higher educational status (AOR: 3.15, 95% CI: 1.86–6.82), planning of HIV test disclosure to male partners (AOR: 7.81, 95% CI: 3.17–13.14), and a higher average monthly income (AOR: 4.01, 95% CI: 2.32–7.61) were found to be strong predictors of acceptance of provider-initiated HIV testing and counseling. Conclusions: The present study revealed a higher rate of acceptance of PICT among pregnant women. Enhancing access to and consistent use of antenatal care service among pregnant women and encouraging the active involvement of male partners are recommended to further increase the uptake of provider-initiated HIV testing and counseling.
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Affiliation(s)
| | - Yohannes Kelifa Emiru
- School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Asfaw Erku
- School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amanual Getnet Mersha
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebe Basazn Mekuria
- School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asnakew Achaw Ayele
- School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Henok Getachew Tegegn
- School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Rasmussen DN, Unger HW, Bjerregaard-Andersen M, da Silva Té D, Vieira N, Oliveira I, Hønge BL, Jespersen S, Gomes MA, Aaby P, Wejse C, Sodemann M. Political instability and supply-side barriers undermine the potential for high participation in HIV testing for the prevention of mother-to-child transmission in Guinea-Bissau: A retrospective cross-sectional study. PLoS One 2018; 13:e0199819. [PMID: 30067793 PMCID: PMC6070169 DOI: 10.1371/journal.pone.0199819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/14/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The World Health Organization recommends HIV testing is included in routine screening tests for all pregnant women in order to prevent mother-to-child-transmission of HIV and reduce maternal morbidity and mortality. OBJECTIVES To assess the proportion of women approached and tested for HIV at delivery and factors associated with non-testing at the maternity ward of the Simão Mendes National Hospital (HNSM) in Bissau, Guinea-Bissau. METHODS We conducted a retrospective cross-sectional study among women presenting for delivery from June 2008 until May 2013. During the study period, national policy included opt-out HIV-testing at delivery. Modified Poisson regression models were used to examine the association of maternal characteristics with HIV testing. Time trends were determined using Pearson's χ2 test. RESULTS Seventy-seven percent (24,217/31,443) of women presenting for delivery were counselled regarding PMTCT, of whom 99.6% (24,107/24,217) proceeded with HIV testing. The provision of opt-out HIV testing at labour increased from 38.1% (1,514/3973) in 2008 to 95.7% (2,021/2,113) in 2013, p<0.001. There were four distinct periods (two or more consecutive calendar months) when less than 50% of women delivering at HNSM were tested. Periods of political instability were significantly associated with not testing for HIV (adjusted prevalence ratio [APR] 1.79; 95% CI 1.73-1.84), as was a lower educational status (APR 1.05; 95% CI 1.00-1.10), admission during evenings/nights (APR 1.05; 95% CI 1.01-1.09) and on Sundays (APR 1.14; 95% CI 1.07-1.22) and Mondays (APR 1.12; 95% CI 1.05-1.19). CONCLUSIONS Rapid scale-up of PMTCT HIV testing services and high testing coverage was possible in this resource-limited setting but suffered from regular interruptions, most likely because of test stock-outs. Establishing proper stock management systems and back-up plans for periods of political instability is required to ensure the maintenance of health system core functions and increase health system resilience.
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Affiliation(s)
- Dlama Nggida Rasmussen
- Center for Global Health, University of Southern Denmark, Odense, Denmark
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- * E-mail:
| | - Holger Werner Unger
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Department of Obstetrics and Gynaecology, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
- Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Australia
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
- Department of Endocrinology, Hospital of South West Denmark, Esbjerg, Denmark
| | - David da Silva Té
- National HIV Programme, Secretariado Nacional de Luta Contra Sida, Ministry of Health, Bissau, Guinea-Bissau
| | - Noel Vieira
- Association Ceu e Terras, Bissau, Guinea-Bissau
| | - Inés Oliveira
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Bo Langhoff Hønge
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Sanne Jespersen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | | | - Peter Aaby
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
| | - Christian Wejse
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Morten Sodemann
- Center for Global Health, University of Southern Denmark, Odense, Denmark
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
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Hansoti B, Stead D, Parrish A, Reynolds SJ, Redd AD, Whalen MM, Mvandaba N, Quinn TC. HIV testing in a South African Emergency Department: A missed opportunity. PLoS One 2018; 13:e0193858. [PMID: 29534077 PMCID: PMC5849282 DOI: 10.1371/journal.pone.0193858] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 02/20/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND South Africa has the largest HIV epidemic in the world, with 19% of the global number of people living with HIV, 15% of new infections and 11% of AIDS-related deaths. Even though HIV testing is mandated in all hospital-based facilities in South Africa (SA), it is rarely implemented in the Emergency Department (ED). The ED provides episodic care to large volumes of undifferentiated who present with unplanned injury or illness. Thus, the ED may provide an opportunity to capture patients with undiagnosed HIV infection missed by clinic-based screening programs. METHODS AND FINDINGS In this prospective exploratory study, we implemented the National South African HIV testing guidelines (counselor initiated non-targeted universal screening with rapid point of care testing) for 24-hours a day at Frere Hospital in the Eastern Cape from September 1st to November 30th, 2016. The purpose of our study was to quantify the burden of undiagnosed HIV infection in a South African ED setting. Furthermore, we sought to evaluate the effectiveness of the nationally recommended HIV testing strategy in the ED. All patients who presented for care in the ED during the study period, and who were clinically stable and fully conscious, were eligible to be approached by HIV counseling and testing (HCT) staff to receive a rapid point-of-care HIV test. A total of 2355 of the 9583 (24.6%) patients who presented to the ED for care during the study period were approached by the HCT staff, of whom 1714 (72.8%) accepted HIV testing. There was a high uptake of HIV testing (78.6%) among a predominantly male (58%) patient group who mostly presented with traumatic injuries (70.8%). Four hundred (21.6%) patients were HIV positive, including 115 (6.2%) with newly diagnosed HIV infection. The overall prevalence of HIV infection was twice as high in females (29.8%) compared to males (15.4%). Both sexes had a similar prevalence of newly diagnosed HIV infection (6.0% for all females and 6.4% for all males) in the ED. CONCLUSIONS Overall there was high HIV testing acceptance by ED patients. A non-targeted testing approached revealed a high HIV prevalence with a significant burden of undiagnosed HIV infection in the ED. Unfortunately, a counselor-driven HIV testing approach fell short of meeting the testing needs in this setting, with over 75% of ED patients not approached by HCT staff.
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Affiliation(s)
- Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - David Stead
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
- Department of Internal Medicine, Frere and Cecilia Makiwane Hospitals, East London, Eastern Cape, South Africa
| | - Andy Parrish
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
- Department of Internal Medicine, Frere and Cecilia Makiwane Hospitals, East London, Eastern Cape, South Africa
| | - Steven J. Reynolds
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States of America
| | - Andrew D. Redd
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States of America
| | - Madeleine M. Whalen
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Nomzamo Mvandaba
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Thomas C. Quinn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States of America
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Kaufman MR, Mooney A, Gebretsadik LA, Sudhakar MN, Rieder R, Limaye RJ, Girma E, Rimal RN. The Differential Effects of an Opt-Out HIV Testing Policy for Pregnant Women in Ethiopia When Accounting for Stigma: Secondary Analysis of DHS Data. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2017; 18:245-252. [PMID: 27981447 DOI: 10.1007/s11121-016-0740-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Individual factors associated with HIV testing have been studied across multiple populations; however, testing is not just an individual-level phenomenon. This secondary analysis of 2005 and 2011 Ethiopia Demographic and Health Survey data was conducted to determine the extent to which the 2007 institution of an opt-out policy of HIV testing during antenatal care increased testing among women, and whether effects differed by women's stigmatizing beliefs about HIV. A logit model with interaction between pre-/post-policy year and policy exposure (birth in the past year) was used to estimate the increased probability of past-year testing, which may be attributable to the policy. Results suggested the policy contributed to a nine-point increase in the probability of testing (95% CI 0.06-0.13, p < 0.0001). A three-way interaction was used to compare the effects of exposure to the policy among women holding higher and lower HIV stigmatizing beliefs. The increase in the probability of past-year testing was 16 percentage points greater among women with lower stigmatizing beliefs (95% CI 0.06-0.27, p = 0.002). Women with higher stigmatizing beliefs were less likely to report attending antenatal care (ANC), testing at their last ANC visit, or being offered a test at their last ANC visit. We encourage researchers and practitioners to explore interventions that operate at multiple levels of socio-ecological spheres of influence, addressing both stigma and structural barriers to testing, in order to achieve the greatest results in preventing HIV.
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Affiliation(s)
- Michelle R Kaufman
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 255, Baltimore, MD, 21205, USA.
| | | | | | | | - Rachel Rieder
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 255, Baltimore, MD, 21205, USA
| | - Rupali J Limaye
- Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA
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11
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Vieira N, Rasmussen DN, Oliveira I, Gomes A, Aaby P, Wejse C, Sodemann M, Reynolds L, Unger HW. Awareness, attitudes and perceptions regarding HIV and PMTCT amongst pregnant women in Guinea-Bissau- a qualitative study. BMC WOMENS HEALTH 2017; 17:71. [PMID: 28870180 PMCID: PMC5584044 DOI: 10.1186/s12905-017-0427-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 08/18/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND The human immunodeficiency virus (HIV) continues to be a major cause of maternal and infant mortality and morbidity in sub-Saharan Africa. Prevention of mother-to-child transmission of HIV (PMTCT) strategies have proven effective in decreasing the number of children infected in utero, intrapartum and during the breastfeeding period. This qualitative study explores knowledge and perceptions of HIV amongst pregnant women, healthcare workers' experiences of the national PMTCT services, and barriers to PMTCT, during a period of programme scale-up in urban Guinea-Bissau (2010-11). METHODS In-depth interviews were undertaken amongst 27 women and 19 key informants at local antenatal clinics and the national maternity ward in Bissau, Guinea-Bissau. RESULTS Amongst women who had been tested for HIV, awareness and knowledge of HIV and PMTCT remained low. Testing without informed consent was reported in some cases, in particular when the test was performed around the time of delivery. Possible drivers of inadequate counselling included lack of confidentiality, suboptimal healthcare worker training, lack of time, and perceived occupational risk. Demand-side barriers to PMTCT included lack of HIV and PMTCT knowledge, customary and cultural beliefs associated with HIV and ill-health, HIV stigma and discrimination, and fear of partnership dissolution. CONCLUSIONS Socio-cultural and operational challenges, including HIV testing without informed consent, present significant barriers to the scale-up of PMTCT services in Bissau. Strengthening local capacity for effective counselling and testing in the antenatal setting is paramount. Further research into local customary beliefs relating to HIV is warranted.
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Affiliation(s)
- Noel Vieira
- Association Ceu e Terras, Avenida do Brasil n. 7, Apartado 1257, 1031, Bissau Codex, Guinea-Bissau.
| | - Dlama Nggida Rasmussen
- Bandim Health Project, INDEPTH Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau.,Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense, Denmark
| | - Inês Oliveira
- Bandim Health Project, INDEPTH Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau
| | - Aureliano Gomes
- Bandim Health Project, INDEPTH Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau
| | - Peter Aaby
- Bandim Health Project, INDEPTH Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau.,Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen, Denmark
| | - Christian Wejse
- Bandim Health Project, INDEPTH Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus, Denmark
| | - Morten Sodemann
- Bandim Health Project, INDEPTH Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau.,Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense, Denmark
| | - Lucy Reynolds
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Holger W Unger
- Bandim Health Project, INDEPTH Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau.,Department of Obstetrics and Gynaecology, The Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK.,Department of Medicine at the Doherty Institute, The University of Melbourne, Post Office Royal Melbourne Hospital, Parkville, Melbourne, VIC, 3050, Australia
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12
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Alemu YM, Ambaw F, Wilder-Smith A. Utilization of HIV testing services among pregnant mothers in low income primary care settings in northern Ethiopia: a cross sectional study. BMC Pregnancy Childbirth 2017. [PMID: 28646888 PMCID: PMC5483315 DOI: 10.1186/s12884-017-1389-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background HIV testing of women in child bearing age is an entry point for preventing mother-to-child transmission of HIV (MTCT). This study aims to identify the proportion of women tested for HIV and to determine factors associated with utilization of HIV testing services among pregnant mothers in primary care settings in northern Ethiopia. Methods A cross sectional study was conducted in 416 pregnant women from four primary care centers between October 2, 2012 and May 31, 2013 in East Gojjam, Ethiopia. Results The proportion of mothers who tested for HIV was 277(67%). Among mothers who were not tested for HIV, lack of HIV risk perception (n = 68, 49%) was a major self-reported barrier for HIV testing. A multivariable logistic regression analysis showed that those pregnant women who had comprehensive knowledge about MTCT had an Adjusted Odd Ratio (AOR) of 3.73 (95% CI: 1.56, 8.94), having comprehensive knowledge on prevention of mother to child transmission (PMTCT) of HIV an AOR of 2.56 (95% CI: 1.26, 5.19), and a favorable attitude towards persons living with HIV an AOR of 2.42 (95%CI, 1.20, 4.86) were more likely to be tested for HIV. Conclusion One third of pregnant women had never been tested for HIV until the time of the study. Efforts should be made to improve mother’s knowledge about MTCT and PMTCT to increase uptake of HIV testing. Enhancing mother’s HIV risk perception to scale up HIV testing in resource limited setting is highly recommended. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1389-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yihun Mulugeta Alemu
- Institute of Public Health, Heidelberg University, Heidelberg, Germany. .,School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Fentie Ambaw
- School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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13
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Hansoti B, Hill SE, Whalen M, Stead D, Parrish A, Rothman R, Hsieh YH, Quinn TC. Patient and provider attitudes to emergency department-based HIV counselling and testing in South Africa. South Afr J HIV Med 2017; 18:707. [PMID: 29568634 PMCID: PMC5843014 DOI: 10.4102/sajhivmed.v18i1.707] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/24/2017] [Indexed: 12/02/2022] Open
Abstract
Background The national South African HIV Counselling and Testing (HCT) guidelines mandate that voluntary counselling and testing (VCT) should be offered in all healthcare facilities. Emergency departments (EDs) are at the forefront of many healthcare facilities, yet VCT is not routinely implemented in this setting. Methods We conducted a cross-sectional study that surveyed patients and healthcare providers at a tertiary care ED in the spring and summer of 2016 to ascertain their attitudes to VCT in the ED. We also used two previously validated survey instruments to gather data on patients’ HIV knowledge and providers’ stigma against patients living with HIV, as we anticipated that these may have an impact on providers’ and patients’ attitudes to the provision of HIV testing within the ED, and may offer insights for future intervention development. Results A total of 104 patients and 26 providers were enrolled in the study. Overall, patients responded more favourably to ED-based HIV testing (92.3%) compared to providers (only 40% responded favourably). When asked about potential barriers to receiving or providing HIV testing, 16.4% of patients and 24% of providers felt that the subject of HIV was too sensitive and 58.7% of patients and 80% of providers indicated that privacy and confidentiality issues would pose major barriers to implementing ED-based HIV testing. Conclusion This study shows that while ED-based HIV testing is overall highly acceptable to patients, providers seem less willing to provide this service. The survey data also suggest that future development of ED-based testing strategies should take into consideration privacy and confidentiality concerns that may arise within a busy emergency care setting. Furthermore, every effort should be made to tackle HIV stigma among providers to improve overall attitudes towards HIV-positive individuals that present for care in the ED.
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Affiliation(s)
- Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University, United States
| | - Sarah E Hill
- Kriegler School of Arts and Sciences, Johns Hopkins University, United States
| | - Madeleine Whalen
- Department of Emergency Medicine, Johns Hopkins University, United States
| | - David Stead
- Department of Internal Medicine, Frere Hospital, South Africa.,Department of Medicine, Walter Sisulu University, South Africa
| | - Andy Parrish
- Department of Internal Medicine, Frere Hospital, South Africa.,Department of Medicine, Walter Sisulu University, South Africa
| | - Richard Rothman
- Department of Emergency Medicine, Johns Hopkins University, United States
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University, United States
| | - Thomas C Quinn
- Department of Emergency Medicine, Johns Hopkins University, United States.,Division of Intramural Research, NIAID, NIH, Bethesda, United States
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14
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Mitiku I, Addissie A, Molla M. Perceptions and experiences of pregnant women about routine HIV testing and counselling in Ghimbi town, Ethiopia: a qualitative study. BMC Res Notes 2017; 10:101. [PMID: 28209187 PMCID: PMC5314483 DOI: 10.1186/s13104-017-2423-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 02/08/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Ethiopia has implemented routine HIV testing and counselling using a provider initiated HIV testing ('opt-out' approach) to achieve high coverage of testing and prevention of mother-to-child transmission of HIV. However, women's perceptions and experiences with this approach have not been well studied. We conducted a qualitative study to explore pregnant women's perceptions and experiences of routine HIV testing and counselling in Ghimbi town, Ethiopia, in May 2013. In-depth interviews were held with 28 women tested for HIV at antenatal clinics (ANC), as well as four health workers involved in routine HIV testing and counselling. Data were analyzed using the content analysis approach. RESULTS We found that most women perceived routine HIV testing and counselling beneficial for women as well as unborn babies. Some women perceived HIV testing as compulsory and a prerequisite to receive delivery care services. On the other hand, health workers reported that they try to emphasise the importance HIV testing during pre-test counselling in order to gain women's acceptance. However, both health workers and ANC clients perceived that the pre-test counselling was limited. CONCLUSIONS Routine HIV testing and counselling during pregnancy is well acceptable among pregnant women in the study setting. However, there is a sense of obligation as women felt the HIV testing is a pre-requisite for delivery services. This may be related to the limited pre-test counselling. There is a need to strengthen pre-test counselling to ensure that HIV testing is implemented in a way that ensures pregnant women's autonomy and maximize opportunities for primary prevention of HIV.
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Affiliation(s)
- Israel Mitiku
- Department of Public Health, College of Medicine and Health Sciences, Wollo University, P. O. Box 1145, Dessie, Ethiopia
| | - Adamu Addissie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mitike Molla
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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15
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Jacobs C, Moshabela M, Maswenyeho S, Lambo N, Michelo C. Predictors of Antenatal Care, Skilled Birth Attendance, and Postnatal Care Utilization among the Remote and Poorest Rural Communities of Zambia: A Multilevel Analysis. Front Public Health 2017; 5:11. [PMID: 28239604 PMCID: PMC5299018 DOI: 10.3389/fpubh.2017.00011] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 01/20/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Optimal utilization of maternal health-care services is associated with reduction of mortality and morbidity for both mothers and their neonates. However, deficiencies and disparity in the use of key maternal health services within most developing countries still persist. We examined patterns and predictors associated with the utilization of specific indicators for maternal health services among mothers living in the poorest and remote district populations of Zambia. Methods A cross-sectional baseline household survey was conducted in May 2012. A total of 551 mothers with children between the ages 0 and 5 months were sampled from 29 catchment areas in four rural and remote districts of Zambia using the lot quality assurance sampling method. Using multilevel modeling, we accounted for individual- and community-level factors associated with utilization of maternal health-care services, with a focus on antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). Results Utilization rates of focused ANC, SBA, and PNC within 48 h were 30, 37, and 28%, respectively. The mother’s ability to take an HIV test and receiving test results and uptake of intermittent preventive treatment for malaria were positive predictors of focused ANC. Receiving ANC at least once from skilled personnel was a significant predictor of SBA and PNC within 48 h after delivery. Women who live in centralized rural areas were more likely to use SBA than those living in remote rural areas. Conclusion Utilization of maternal health services by mothers living among the remote and poor marginalized populations of Zambia is much lower than the national averages. Finding that women that receive ANC once from a skilled attendant among the remote and poorest populations are more likely to have a SBA and PNC, suggests the importance of contact with a skilled health worker even if it is just once, in influencing use of services. Therefore, it appears that in order for women in these marginalized communities to benefit from SBA and PNC, it is important for them to have at least one ANC provided by a skilled personnel, rather than non-skilled health-care providers.
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Affiliation(s)
- Choolwe Jacobs
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; Africa Centre for Population Health, Mtubatuba, South Africa
| | | | | | - Charles Michelo
- Department of Public Health, School of Medicine, University of Zambia , Lusaka , Zambia
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16
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Luseno WK, Zhang L, Iritani BJ, Hartman S, Rusakaniko S, Hallfors DD. Influence of school support on early marriage experiences and health services utilization among young orphaned women in Zimbabwe. Health Care Women Int 2016; 38:283-299. [PMID: 27211856 DOI: 10.1080/07399332.2016.1191494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
School support programs reduce school dropout, early marriage, and early pregnancy for a majority of young orphaned women. We used a mixed-methods approach to examine why these programs are less effective for a significant minority by exploring their influence on marriage and health services utilization. Participants were from a randomized controlled trial testing school support as HIV prevention. Half as many intervention as control participants had been married; married intervention participants had 1 more year of education compared with married control participants. Receiving school support did not appear to improve health-related factors. Pregnancy was among the most common reasons for marriage across both groups. The greatest benefit of school support appears to be in delaying marriage and pregnancy while increasing educational attainment.
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Affiliation(s)
| | - Lei Zhang
- a Pacific Institute for Research and Evaluation , Chapel Hill , North Carolina , USA
| | - Bonita J Iritani
- a Pacific Institute for Research and Evaluation , Chapel Hill , North Carolina , USA
| | - Shane Hartman
- a Pacific Institute for Research and Evaluation , Chapel Hill , North Carolina , USA
| | | | - Denise Dion Hallfors
- a Pacific Institute for Research and Evaluation , Chapel Hill , North Carolina , USA
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17
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Schnall R, John RM, Carballo-Dieguez A. Do High-Risk Young Adults Use the HIV Self-Test Appropriately? Observations from a Think-Aloud Study. AIDS Behav 2016; 20:939-48. [PMID: 26518679 DOI: 10.1007/s10461-015-1240-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to understand high-risk young adults' use of the rapid human immunodeficiency virus (HIV) self-test. The highest rate of new HIV infections occurs in people between 15 and 24 years. Improving identification of young people infected with HIV is a critical public health priority. The first rapid HIV self-testing kit was approved in the US in 2012. Despite the product's promise, its use by untrained young adults is not well-understood. We conducted a mixed methods study using surveys, a think-aloud protocol, observations, and in-depth interviews. A systematic checklist was developed to assess participants' use of the test. A total of 21 racial and/or ethnic minority young adults aged 18-24 participated in this study. Analysis of our interview data was guided by the theory of reasoned action (TRA). Participants completed the initial procedures of the test with a mean time of 8:36 min (range of 2:04'-16:33'). On a 14-point checklist, participants had a mean score of 10.8 (SD 2.26, range 3-14). In the qualitative analysis of the participants' interviews, guided by the theoretical constructs of the TRA, the following themes emerged: "Did I use it correctly?", "Can I trust the results?" (attitude); "How will my partner react?!", "What will people think?" (subjective norm); "Quick, easy and blood free," and "Avoids the hassle of dealing with the healthcare system" (behavioral intention). This study provided evidence of the usefulness of the test perceived by young adults, especially in light of their concerns about lack of privacy in medical settings. Since many participants did not follow all of the instructions while using the test, it is not evident that young adults can correctly use the HIV self-test. Development of instructions manuals that are understandable and guide proper use of medical devices is a great need, especially in the context of home testing technology.
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Affiliation(s)
- Rebecca Schnall
- Columbia University, School of Nursing, 617 W. 168th Street, New York, NY, 10032, USA.
| | - Rita Marie John
- Columbia University, School of Nursing, 617 W. 168th Street, New York, NY, 10032, USA
| | - Alex Carballo-Dieguez
- Columbia University Medical Center, HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute, Unit 15, 1051 Riverside Drive, New York, NY, 10032, USA
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18
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Ahmed S, Schwarz M, Flick RJ, Rees CA, Harawa M, Simon K, Robison JA, Kazembe PN, Kim MH. Lost opportunities to identify and treat HIV-positive patients: results from a baseline assessment of provider-initiated HIV testing and counselling (PITC) in Malawi. Trop Med Int Health 2016; 21:479-85. [PMID: 26806378 PMCID: PMC4881304 DOI: 10.1111/tmi.12671] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To assess implementation of provider-initiated testing and counselling (PITC) for HIV in Malawi. METHODS A review of PITC practices within 118 departments in 12 Ministry of Health (MoH) facilities across Malawi was conducted. Information on PITC practices was collected via a health facility survey. Data describing patient visits and HIV tests were abstracted from routinely collected programme data. RESULTS Reported PITC practices were highly variable. Most providers practiced symptom-based PITC. Antenatal clinics and maternity wards reported widespread use of routine opt-out PITC. In 2014, there was approximately 1 HIV test for every 15 clinic visits. HIV status was ascertained in 94.3% (5293/5615) of patients at tuberculosis clinics, 92.6% (30,675/33,142) of patients at antenatal clinics and 49.4% (6871/13,914) of patients at sexually transmitted infection clinics. Reported challenges to delivering PITC included test kit shortages (71/71 providers), insufficient physical space (58/71) and inadequate number of HIV counsellors (32/71) while providers from inpatient units cited the inability to test on weekends. CONCLUSIONS Various models of PITC currently exist at MoH facilities in Malawi. Only antenatal and maternity clinics demonstrated high rates of routine opt-out PITC. The low ratio of facility visits to HIV tests suggests missed opportunities for HIV testing. However, the high proportion of patients at TB and antenatal clinics with known HIV status suggests that routine PITC is feasible. These results underscore the need to develop clear, standardised PITC policy and protocols, and to address obstacles of limited health commodities, infrastructure and human resources.
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Affiliation(s)
- Saeed Ahmed
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Monica Schwarz
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Robert J Flick
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,University of Colorado School of Medicine, Denver, CO, USA.,University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Chris A Rees
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Mwelura Harawa
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Katie Simon
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Jeff A Robison
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Peter N Kazembe
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Maria H Kim
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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19
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Takarinda KC, Madyira LK, Mhangara M, Makaza V, Maphosa-Mutsaka M, Rusakaniko S, Kilmarx PH, Mutasa-Apollo T, Ncube G, Harries AD. Factors Associated with Ever Being HIV-Tested in Zimbabwe: An Extended Analysis of the Zimbabwe Demographic and Health Survey (2010-2011). PLoS One 2016; 11:e0147828. [PMID: 26808547 PMCID: PMC4726692 DOI: 10.1371/journal.pone.0147828] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 01/08/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Zimbabwe has a high human immunodeficiency virus (HIV) burden. It is therefore important to scale up HIV-testing and counseling (HTC) as a gateway to HIV prevention, treatment and care. OBJECTIVE To determine factors associated with being HIV-tested among adult men and women in Zimbabwe. METHODS Secondary analysis was done using data from 7,313 women and 6,584 men who completed interviewer-administered questionnaires and provided blood specimens for HIV testing during the Zimbabwe Demographic and Health Survey (ZDHS) 2010-11. Factors associated with ever being HIV-tested were determined using multivariate logistic regression. RESULTS HIV-testing was higher among women compared to men (61% versus 39%). HIV-infected respondents were more likely to be tested compared to those who were HIV-negative for both men [adjusted odds ratio (AOR) = 1.53; 95% confidence interval (CI) (1.27-1.84)] and women [AOR = 1.42; 95% CI (1.20-1.69)]. However, only 55% and 74% of these HIV-infected men and women respectively had ever been tested. Among women, visiting antenatal care (ANC) [AOR = 5.48, 95% CI (4.08-7.36)] was the most significant predictor of being tested whilst a novel finding for men was higher odds of testing among those reporting a sexually transmitted infection (STI) in the past 12 months [AOR = 1.86, 95%CI (1.26-2.74)]. Among men, the odds of ever being tested increased with age ≥ 20 years, particularly those 45-49 years [AOR = 4.21; 95% CI (2.74-6.48)] whilst for women testing was highest among those aged 25-29 years [AOR = 2.01; 95% CI (1.63-2.48)]. Other significant factors for both sexes were increasing education level, higher wealth status and currently/formerly being in union. CONCLUSIONS There remains a high proportion of undiagnosed HIV-infected persons and hence there is a need for innovative strategies aimed at increasing HIV-testing, particularly for men and in lower-income and lower-educated populations. Promotion of STI services can be an important gateway for testing more men whilst ANC still remains an important option for HIV-testing among pregnant women.
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Affiliation(s)
- Kudakwashe Collin Takarinda
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
- International Union Against Tuberculosis and Lung Disease, Paris, France
- * E-mail:
| | | | - Mutsa Mhangara
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | | | - Simbarashe Rusakaniko
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- Centre for Research and Training in Clinical Epidemiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Peter H. Kilmarx
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Harare, Zimbabwe
| | | | - Getrude Ncube
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Anthony David Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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20
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Chikovore J, Gillespie N, McGrath N, Orne-Gliemann J, Zuma T. Men, masculinity, and engagement with treatment as prevention in KwaZulu-Natal, South Africa. AIDS Care 2016; 28 Suppl 3:74-82. [PMID: 27421054 PMCID: PMC5096677 DOI: 10.1080/09540121.2016.1178953] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Men's poorer engagement with healthcare generally and HIV care specifically, compared to women, is well-described. Within the HIV public health domain, interest is growing in universal test and treat (UTT) strategies. UTT strategies refer to the expansion of antiretroviral therapy (ART) in order to reduce onward transmission and incidence of HIV in a population, through a "treatment as prevention" (TasP). This paper focuses on how masculinity influences engagement with HIV care in the context of an on-going TasP trial. Data were collected in January-November 2013 using 20 in-depth interviews, 10 of them repeated thrice, and 4 focus group discussions, each repeated four times. Analysis combined inductive and deductive approaches for coding and the review and consolidation of emerging themes. The accounts detailed men's unwillingness to engage with HIV testing and care, seemingly tied to their pursuit of valued masculinity constructs such as having strength and control, being sexually competent, and earning income. Articulated through fears regarding getting an HIV-positive diagnosis, observations that men preferred traditional medicine and that primary health centres were not welcoming to men, descriptions that men used lay measures to ascertain HIV status, and insinuations by men that they were removed from HIV risk, the indisposition to HIV care contrasted markedly with an apparent readiness to test among women. Gendered tensions thus emerged which were amplified in the context where valued masculinity representations were constantly threatened. Amid the tensions, men struggled with disclosing their HIV status, and used various strategies to avoid or postpone disclosing, or disclose indirectly, while women's ability to access care readily, use condoms, or communicate about HIV appeared similarly curtailed. UTT and TasP promotion should heed and incorporate into policy and health service delivery models the intrapersonal tensions, and the conflict, and poor and indirect communication at the micro-relational levels of couples and families.
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Affiliation(s)
- Jeremiah Chikovore
- HIV/AIDS, STIs and TB Programme, Human Sciences Research Council (HSRC), Durban, South Africa
| | | | - Nuala McGrath
- Faculty of Medicine, University of Southampton, Southampton, UK
- Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, UK
- Africa Centre for Population Health, University of KwaZulu Natal, Mtubatuba, South Africa
- Research Department of Infection and Population Health, University College London, London, UK
| | - Joanna Orne-Gliemann
- INSERM, ISPED, Centre INSERM U1219 - Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
| | - Thembelihle Zuma
- Africa Centre for Population Health, University of KwaZulu Natal, Mtubatuba, South Africa
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Dzangare J, Takarinda KC, Harries AD, Tayler-Smith K, Mhangara M, Apollo TM, Mushavi A, Chimwaza A, Sithole N, Magure T, Mpofu A, Dube F, Mugurungi O. HIV testing uptake and retention in care of HIV-infected pregnant and breastfeeding women initiated on 'Option B+' in rural Zimbabwe. Trop Med Int Health 2015; 21:202-9. [PMID: 26555353 DOI: 10.1111/tmi.12637] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Zimbabwe has started to scale up Option B+ for the prevention of mother-to-child transmission of HIV, but there is little published information about uptake or retention in care. This study determined the number and proportion of pregnant and lactating women in rural districts diagnosed with HIV infection and started on Option B+ along with six-month antiretroviral treatment (ART) outcomes. METHODS This was a retrospective record review of women presenting to antenatal care or maternal and child health services at 34 health facilities in Chikomba and Gutu rural districts, Zimbabwe, between January and March 2014. RESULTS A total of 2728 women presented to care of whom 2598 were eligible for HIV testing: 76% presented to antenatal care, 20% during labour and delivery and 4% while breastfeeding. Of 2097 (81%) HIV-tested women, 7% were HIV positive. Lower HIV testing uptake was found with increasing parity, late presentation to antenatal care, health centre attendance and in women tested during labour. Ninety-one per cent of the HIV-positive women were started on Option B+. Six-month ART retention in care, including transfers, was 83%. Loss to follow-up was the main cause of attrition. Increasing age and gravida status ≥2 were associated with higher six-month attrition. CONCLUSION The uptake of HIV testing and Option B+ is high in women attending antenatal and post-natal clinics in rural Zimbabwe, suggesting that the strategy is feasible for national scale-up in the country.
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Affiliation(s)
- Janet Dzangare
- National AIDS and Tuberculosis Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Kudakwashe C Takarinda
- National AIDS and Tuberculosis Unit, Ministry of Health and Child Care, Harare, Zimbabwe.,International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - Katie Tayler-Smith
- Operational Centre Brussels, Medecins Sans Frontieres, 68 Rue de Gasperich, Luxembourg
| | - Mutsa Mhangara
- National AIDS and Tuberculosis Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Tsitsi Mutasa Apollo
- National AIDS and Tuberculosis Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Angela Mushavi
- National AIDS and Tuberculosis Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Anesu Chimwaza
- National AIDS and Tuberculosis Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Ngwarai Sithole
- National AIDS and Tuberculosis Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | | | | | - Owen Mugurungi
- National AIDS and Tuberculosis Unit, Ministry of Health and Child Care, Harare, Zimbabwe
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Abtew S, Awoke W, Asrat A. Acceptability of provider-initiated HIV testing as an intervention for prevention of mother to child transmission of HIV and associated factors among pregnant women attending at Public Health Facilities in Assosa town, Northwest Ethiopia. BMC Res Notes 2015; 8:661. [PMID: 26553035 PMCID: PMC4638027 DOI: 10.1186/s13104-015-1652-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/29/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite more efforts for prevention of mother to child HIV transmission, still there are problems with provider-initiated HIV testing. This study was done to assess the acceptance rate of provider-initiated HIV testing among antenatal care attendants and its associated factors. METHODS Institutions based cross sectional study with a sample size of 398 was conducted from February to March 2014 in two health facilities in Assosa town. Proportional allocation of the sample size of health facilities followed by systematic sampling method was done; data were collected using an interviewer administered questionnaire. Bivariate and multivariate regression analysis was employed using SPSS version 20. RESULTS A total of 386 pregnant women participated with response rate 97 % and 312 (80.8 %) of them accepted provider-initiated HIV testing. The odds of acceptance of provider-initiated HIV testing was higher among rural residents (AOR 4.04; 95 % CI 1.24-13.11) than urban. It was also higher among students (AOR 6.00; 95 % CI 1.45-24.75), merchants (AOR 4.43; 95 % CI 1.18-16.68) and employed women (AOR 2.15; 95 % CI 1.08-4.30) than housewives. Pregnant women who had no stigmatized attitude towards people living with HIV/AIDS were more likely to accept testing (AOR 3.54; 95 % CI 1.23-10.16) than who had a strong stigmatized attitude. In addition, those who planned to disclose their test results from their husbands were higher odd of acceptance (AOR 14.85; 95 % CI 4.60-47.94) than who secreted. CONCLUSION Acceptance of provider-initiated HIV testing among pregnant women attending for antenatal care services was relatively high. Mothers from urban residence, occupational satus being housewives, stigmatization and not having a plan to disclose the status of test results were negatively affect the acceptance of provider-initiated HIV testing. During counselling sessions, antenatal care providers should focus on barriers of provider-initiated HIV testing such as residence, occupational status, stigmatized attitudes and disclosure status of results of HIV tests.
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Affiliation(s)
- Solomon Abtew
- College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 693, Bahir Dar, Ethiopia.
| | - Worku Awoke
- College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 693, Bahir Dar, Ethiopia.
| | - Anemaw Asrat
- College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 693, Bahir Dar, Ethiopia.
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Tenthani L, Haas AD, Egger M, van Oosterhout JJ, Jahn A, Chimbwandira F, Tal K, Myer L, Estill J, Keiser O. Brief Report: HIV Testing Among Pregnant Women Who Attend Antenatal Care in Malawi. J Acquir Immune Defic Syndr 2015; 69:610-4. [PMID: 25950205 PMCID: PMC4501862 DOI: 10.1097/qai.0000000000000669] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Malawi adopted the Option B+ strategy in 2011. Its success in reducing mother-to-child transmission depends on coverage and timing of HIV testing. We assessed HIV status ascertainment and its predictors during pregnancy. HIV status ascertainment was 82.3% (95% confidence interval: 80.2 to 85.9) in the pre-Option B+ period and 85.7% (95% confidence interval: 83.4 to 88.0) in the Option B+ period. Higher HIV ascertainment was independently associated with higher age, attending antenatal care more than once, and registration in 2010. The observed high variability of HIV ascertainment between sites (50.6%-97.7%) and over time suggests that HIV test kit shortages and insufficient numbers of staff posed major barriers to reducing mother-to-child transmission.
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Affiliation(s)
- Lyson Tenthani
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
- International Training and Education Centre for Health/Department for Global Health, University of Washington, Seattle, USA
| | - Andreas D. Haas
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa
| | - Joep J van Oosterhout
- Dignitas International, Zomba, Malawi
- Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Andreas Jahn
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
- International Training and Education Centre for Health Malawi, Lilongwe, Malawi
| | | | - Kali Tal
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa
| | - Janne Estill
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Olivia Keiser
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
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Ben-Natan M, Hazanov Y. Women's willingness to be tested for human immunodeficiency virus during pregnancy: A review. World J Virol 2015; 4:245-54. [PMID: 26279985 PMCID: PMC4534815 DOI: 10.5501/wjv.v4.i3.245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 05/28/2015] [Accepted: 07/21/2015] [Indexed: 02/05/2023] Open
Abstract
Mother-to-child-transmission of human immunodeficiency virus (HIV) is a primary cause of pediatric infections with HIV. Many of these infections involve women who were not tested early enough in pregnancy, or who did not receive prevention services. HIV testing of pregnant women is considered to be one of the key strategies for preventing mother-to-child-transmission of HIV, but HIV testing rates among pregnant women in various countries remain suboptimal. Understanding the factors relating to women's willingness to be tested for HIV during pregnancy is critical for developing strategies to increase HIV testing rates among pregnant women. Extensive research points to various factors relating to women's willingness to be tested for HIV during pregnancy, and various recommendations aimed at improving testing rates among pregnant women have been suggested based on the research. In light of the goals set by the United Nations to reduce the rate of infants infected with HIV, it is necessary to summarize what is currently known regarding factors related to women's willingness to be tested for HIV during pregnancy. The purpose of this review is therefore to examine factors related to women's willingness to be tested for HIV during pregnancy, and to summarize recommendations for practice and further research.
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Ettarh RR, Kimani J, Kyobutungi C, Wekesah F. Correlates of HIV-status awareness among adults in Nairobi slum areas. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 11:337-42. [PMID: 25860192 DOI: 10.2989/16085906.2012.754833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The prevalence of HIV in the adult population in slum areas in Nairobi, Kenya, is higher than for residents in the city as a whole. This disparity suggests that the characteristics of slum areas may adversely influence the HIV-prevention strategies directed at reducing the national prevalence of HIV. The objective of the study was to identify some of the sociodemographic and behavioural correlates of HIV-status awareness among the adult population of two slums in Nairobi. In a household-based survey conducted by the African Population and Health Research Center (APHRC), 4 767 men and women aged between 15 and 54 years were randomly sampled from two slums (Korogocho and Viwandani) in Nairobi and data were collected on the social and health context of HIV and AIDS in these settlements. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with HIV-status awareness. The proportion of respondents that had ever been tested and knew their HIV status was 53%, with the women having greater awareness of their HIV status (62%) than the men (38%). Awareness of HIV status was significantly associated with age, sex, level of education, marital status and slum of residence. The lower level of HIV-status awareness among the men compared with the women in the slums suggests a poor uptake of HIV-testing services by males. Innovative strategies are needed to ensure greater access and uptake of HIV-testing services by the younger and less-educated residents of these slums if the barriers to HIV-status awareness are to be overcome.
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Affiliation(s)
- Remare Renner Ettarh
- a African Population and Health Research Center (APHRC) , Manga Close, PO Box 10787 , Nairobi , 00100 , Kenya
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Ameh D, Uchendu UO, Adeyemi OA, Ideh RC, Ebruke BE, Mackenzie G, Howie S, Corrah T. Is the absolute requirement for informed consent before HIV testing a barrier to public health? A case report and management challenges. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 13:93-8. [PMID: 25174520 DOI: 10.2989/16085906.2014.901978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Clinicians in sub-Saharan Africa are faced with a major challenge of parental refusal to test their children for HIV. We present a case of a nine-month-old child with a clinical presentation suggestive of HIV infection whose mother persistently declined HIV testing of the child or herself. The case illustrates the difficulties faced by the clinicians caring for the child in an isolated location in West Africa. While not eliminating these difficulties, an opt-out approach to paediatric HIV testing in sub-Saharan Africa may increase the proportion of children who access treatment when they need it, particularly when this is backed by the development of more effective national and regional clinical and legislative frameworks for HIV testing in children.
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Affiliation(s)
- David Ameh
- a Medical Research Council Unit , Fajara and Basse Stations , The Gambia
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27
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Awungafac G, Njukeng PA, Ndasi JA, Mbuagbaw LT. Prevention of mother-to-child transmission of the Human Immunodeficiency Virus: investigating the uptake and utilization of maternal and child health services in Tiko health district, Cameroon. Pan Afr Med J 2015; 20:20. [PMID: 25995817 PMCID: PMC4431405 DOI: 10.11604/pamj.2015.20.20.5137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 01/05/2015] [Indexed: 11/11/2022] Open
Abstract
Introduction Despite evidence that interventions to prevent mother-to-child transmission (PMTCT) of HIV are effective in ensuring a healthy child and keeping mothers alive, there are many challenges to achieving successful interventions in Cameroon. The study was conducted to investigate factors that affect access to and utilization of maternal and child health (MCH) and PMTCT services among women in Tiko health district in Cameroon. Methods We conducted a cross-sectional, descriptive study on women of reproductive age who had experienced a pregnancy using a self-administered, structured questionnaire, in health facilities offering PMTCT services and in communities within the district. Results Four hundred and thirteen women were interviewed. The majority, 98.4%, of them attended antenatal care (ANC) during their most recent pregnancy. Of these women, 87.4% of them made at least four ANC visits. HIV testing during the first visit among the ANC attendees was 85.5%. Approximately, 92.1% of women who tested for HIV received their results on the same day. All participants reported to have given birth in a health facility during their most recent pregnancy. No education (Odds Ratio [OR] 0.11; 95% CI 0.01-0.83) and acquisition of primary education (OR 0.25; 95% CI 0.06-0.88) was associated with better male partner involvement in PMTCT. Conclusion The uptake of MCH/PMTCT services was high in this study. Further exploration of these levels is warranted so that this model of care and engagement can be replicated in other parts of the country where uptake is low.
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Affiliation(s)
- George Awungafac
- Global Health Systems Solutions (GHSS), SONARA Road, Limbe, Cameroon
| | - Patrick Achiangia Njukeng
- Global Health Systems Solutions (GHSS), SONARA Road, Limbe, Cameroon ; University of Dschang, Dschang, Cameroon
| | - Juliana Ajoache Ndasi
- Global Health Systems Solutions (GHSS), SONARA Road, Limbe, Cameroon ; Faculty of Health Sciences, University of Buea, Buea, Cameroon
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Conroy AA. The influence of relationship power dynamics on HIV testing in rural Malawi. JOURNAL OF SEX RESEARCH 2015; 52:347-59. [PMID: 24670263 PMCID: PMC4177026 DOI: 10.1080/00224499.2014.883590] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Using the theory of gender and power (TGP) and data from the Tsogolo la Thanzi (TLT) study, we examined how relationship power shapes young people's decisions to test for HIV in rural Malawi (N=932), a high-HIV prevalence setting undergoing rapid expansions in testing services. We used generalized estimating equations (GEE) to examine associations among five constructs of relationship power (socioeconomic inequalities, relationship dominance, relationship violence, relationship unity, and mistrust), perceived risk, and receiving an HIV test over a 16-month period. The results indicate that young Malawians are testing for HIV at relatively high rates, repeatedly, and not just during pregnancy. Over the study period, 47.3% of respondents received at least one HIV test outside of TLT (range: 0-4). The GEE analysis revealed that men and women with higher levels of relationship unity were less likely to test for HIV. For men, being a victim of sexual coercion was an additional barrier to testing. Women's testing decisions were more strongly influenced by perceptions of a partner's risk for HIV than their own, whereas men relied more on self-assessments. The results highlight that testing decisions are deeply embedded within the relationship context, which should be considered in future HIV testing interventions.
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Affiliation(s)
- Amy A Conroy
- a Center for AIDS Prevention Studies , University of California , San Francisco
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Knight L, McGrath N, van Rooyen H, Humphries H, van Heerden A, Richter L. Characteristics of sexually experienced HIV testers aged 18 to 32 in rural South Africa: baseline results from a community-based trial, NIMH Project Accept (HPTN 043). BMC Public Health 2014; 14:1164. [PMID: 25392204 PMCID: PMC4234824 DOI: 10.1186/1471-2458-14-1164] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/17/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Young people in South Africa are at high risk of HIV infection and yet may have more limited access to prevention and treatment services than others in the population. Testing facilitates the sharing of prevention messages but also enables the linkage to care and treatment of those who test positive and therefore has wider public health implications. METHODS This baseline survey conducted in 2005 for a community randomized trial in rural KwaZulu-Natal explored factors associated with a history of ever, repeat and recent testing amongst sexually debuted men and women aged 18 to 32 years. RESULTS Over 35% of this rural population ever tested for HIV, with men less likely to ever (unadjusted OR 0.26, 95% CI: 0.21-0.32) and repeatedly test than women (adjusted OR (aOR) 0.68, 95% CI: 0.48-0.97). Men aged 24-28 years (aOR 2.02, 95% CI: 1.10-3.71) and 29-32 years (aOR 2.69, 95% CI: 1.46-4.94) were more likely to ever test than those <20 years. Those who reported having discussed HIV with others had significantly greater odds of reporting ever (men's aOR 2.83, 95% CI: 1.63-4.89; women's aOR 3.36, 95% CI: 2.50-4.53), recent (irrespective of sex, aOR 2.87, 95% CI: 2.02-4.09) and repeat testing (aOR 2.02, 95% CI: 1.28-3.19). CONCLUSION These findings highlight the need for novel youth- and men-friendly testing services and emphasises the importance of discussions about HIV in the home and community to encourage testing.
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Affiliation(s)
- Lucia Knight
- />School of Public Health, University of the Western Cape, P Bag X17, Bellville, 7535 South Africa
| | - Nuala McGrath
- />Academic Unit of Primary Care and Population Sciences, and Department of Social Statistics and Demography, Mailpoint 805, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD UK
- />Africa Centre for Health and Population Studies, University of KwaZulu-Natal, PO Box 198, Mtubatuba, KZN 3935 South Africa
| | - Heidi van Rooyen
- />HIV/AIDS STIs and TB Programme, Human Sciences Research Council, P.O Box 90, Msunduzi, 3200 South Africa
| | - Hilton Humphries
- />HIV/AIDS STIs and TB Programme, Human Sciences Research Council, P.O Box 90, Msunduzi, 3200 South Africa
| | - Alastair van Heerden
- />HIV/AIDS STIs and TB Programme, Human Sciences Research Council, P.O Box 90, Msunduzi, 3200 South Africa
- />Developmental Pathways of Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda Richter
- />Developmental Pathways of Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- />HIV/AIDS STIs and TB Programme, Human Sciences Research Council, 750 Francois Road, Cato Manor, Durban, 4001 South Africa
- />DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
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Stenehjem E, Shlay JC. Sex-specific differences in treatment outcomes for patients with HIV and AIDS. Expert Rev Pharmacoecon Outcomes Res 2014; 8:51-63. [DOI: 10.1586/14737167.8.1.51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Mohammed S, Hussen A, Tamiru D. Determinant factors for provider-initiated HIV counselling and testing among pregnant women in Cheha district, southern Ethiopia. ACTA ACUST UNITED AC 2013. [DOI: 10.12968/ajmw.2013.7.4.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shikur Mohammed
- Department of Public Health at Arba Minch University, Ethiopia
| | | | - Dessalegn Tamiru
- Department of Population and Family Health at Jimma University Ethiopia
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Ndondoki C, Brou H, Timite-Konan M, Oga M, Amani-Bosse C, Menan H, Ekouévi D, Leroy V. Universal HIV screening at postnatal points of care: which public health approach for early infant diagnosis in Côte d'Ivoire? PLoS One 2013; 8:e67996. [PMID: 23990870 PMCID: PMC3749176 DOI: 10.1371/journal.pone.0067996] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 05/29/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Universal HIV pediatric screening offered at postnatal points of care (PPOC) is an entry point for early infant diagnosis (EID). We assessed the parents' acceptability of this approach in Abidjan, Côte d'Ivoire. METHODS In this cross-sectional study, trained counselors offered systematic HIV screening to all children aged 6-26 weeks attending PPOC in three community health centers with existing access to HAART during 2008, as well as their parents/caregivers. HIV-testing acceptability was measured for parents and children; rapid HIV tests were used for parents. Both parents' consent was required according to the Ivorian Ethical Committee to perform a HIV test on HIV-exposed children. Free HIV care was offered to those who were diagnosed HIV-infected. FINDINGS We provided 3,013 HIV tests for infants and their 2,986 mothers. While 1,731 mothers (58%) accepted the principle of EID, only 447 infants had formal parental consent 15%; 95% confidence interval (CI): [14%-16%]. Overall, 1,817 mothers (61%) accepted to test for HIV, of whom 81 were HIV-infected (4.5%; 95% CI: [3.5%-5.4%]). Among the 81 HIV-exposed children, 42 (52%) had provided parental consent and were tested: five were HIV-infected (11.9%; 95% CI: [2.1%-21.7%]). Only 46 fathers (2%) came to diagnose their child. Parental acceptance of EID was strongly correlated with prenatal self-reported HIV status: HIV-infected mothers were six times more likely to provide EID parental acceptance than mothers reporting unknown or negative prenatal HIV status (aOR: 5.9; 95% CI: [3.3-10.6], p = 0.0001). CONCLUSIONS Although the principle of EID was moderately accepted by mothers, fathers' acceptance rate remained very low. Routine HIV screening of all infants was inefficient for EID at a community level in Abidjan in 2008. Our results suggest the need of focusing on increasing the PMTCT coverage, involving fathers and tracing children issued from PMTCT programs in low HIV prevalence countries.
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Affiliation(s)
- Camille Ndondoki
- Inserm, U897, Centre de Recherche Epidémiologie et Biostatistique, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Bordeaux Victor Segalen, Bordeaux, France
| | - Hermann Brou
- Programme PACCI, Projet Pedi-Test ANRS 12165, Abidjan, Côte d'Ivoire
| | - Marguerite Timite-Konan
- Programme PACCI, Projet Pedi-Test ANRS 12165, Abidjan, Côte d'Ivoire
- Service de Pédiatrie, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | - Maxime Oga
- Programme PACCI, Projet Pedi-Test ANRS 12165, Abidjan, Côte d'Ivoire
| | | | - Hervé Menan
- Programme PACCI, Projet Pedi-Test ANRS 12165, Abidjan, Côte d'Ivoire
- Laboratoire de Virologie du CeDRes, Abidjan, Côte d'Ivoire
| | - Didier Ekouévi
- Inserm, U897, Centre de Recherche Epidémiologie et Biostatistique, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Bordeaux Victor Segalen, Bordeaux, France
- Programme PACCI, Projet Pedi-Test ANRS 12165, Abidjan, Côte d'Ivoire
| | - Valériane Leroy
- Inserm, U897, Centre de Recherche Epidémiologie et Biostatistique, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Bordeaux Victor Segalen, Bordeaux, France
- * E-mail:
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Sarin E, Nayak H, Das M, Nanda P. HIV testing among pregnant wives of migrant men in a rural district of India: urgent call for scale up. Women Health 2013; 53:369-83. [PMID: 23751091 DOI: 10.1080/03630242.2013.796306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In India, despite the fact that more pregnant women are being tested for HIV under the purview of the Prevention of Parent-to-Child HIV Transmission program, official figures indicate low rates of HIV testing, evidencing missed opportunities for HIV prevention. The present study examined the prevalence of HIV testing and the barriers to testing among pregnant women, whose vulnerability to HIV is enhanced by their spouses' risky behaviors. A cross-sectional study was conducted from November 2010 to January 2011 among 357 women who had given birth in the last two years in a district in Orissa. Only one-third of women had been tested for HIV during pregnancy. Women with more than six years of education (OR: 2.39, 95% CI: 1.06-5.39), having knowledge of sexually transmitted infections (OR: 12.37, 95% CI: 5.55-27.58), having discussions with spouses about HIV (OR: 3.56, 95% CI: 1.61-7.86), and seeking antenatal care in government district hospitals and private clinics as opposed to peripheral community health centers, were more likely to receive HIV testing during pregnancy. The findings point to the need to widen HIV testing to community-based services, increase coverage of HIV/sexually transmitted infection awareness and prevention programs, and encourage spousal communication through quality counseling.
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Huang YK, Chen SCC, Yu JKL, Chen PF, Chiang MH, Khosa B, Chiang HC. Voluntary Counseling and Testing in the Pediatric Ward of Mzuzu Central Hospital, Northern Malawi. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.jecm.2013.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Soares MDL, Oliveira MICD, Fonseca VM, Brito ADS, Silva KSD. Preditores do desconhecimento do status sorológico de HIV entre puérperas submetidas ao teste rápido anti-HIV na internação para o parto. CIENCIA & SAUDE COLETIVA 2013. [DOI: 10.1590/s1413-81232013000500016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste artigo é analisar fatores associados ao desconhecimento do status sorológico de HIV do pré-natal na internação ao parto. Estudo transversal realizado em 2006 em Hospitais Amigos da Criança do Sistema de Gestação de Alto Risco do SUS no município do Rio de Janeiro. Foram entrevistadas no alojamento conjunto 873 mães submetidas ao teste rápido anti-HIV no hospital. Razões de prevalência (RP) do desconhecimento do status de HIV foram obtidas por regressão de Poisson com variância robusta, com ajuste por características sociodemográficas maternas e familiares, da gravidez e de assistência pré-natal. A prevalência de status ignorado de HIV foi 32,2%. Baixa escolaridade materna, baixa renda materna, ter tido mais de um relacionamento no último ano, início tardio do pré-natal e baixo número de consultas pré-natais mostraram-se associados ao desfecho. O mais importante preditor do desconhecimento do status de HIV na internação para o parto foi o baixo número de consultas pré-natais. Recomenda-se a expansão da cobertura da testagem anti-HIV no pré-natal e a entrega de resultados em tempo hábil, com captação precoce da gestante e incremento no número de consultas, enfocando a clientela de baixo nível socioeconômico.
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Nyuzaghl J, Ohene S, Odoi-Agyarko K. Acceptability of routine offer of HIV Testing (opt-out approach) among pregnant women in the Wa municipality. Ghana Med J 2013; 45:10-5. [PMID: 21572819 DOI: 10.4314/gmj.v45i1.68916] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND With the introduction of the opt out HIV testing policy in Ghana, the HIV test is offered routinely to all pregnant women unless they decline testing. OBJECTIVE To assess acceptability of the routine offer of HIV testing antenatal clinic (ANC) clients in the Wa municipality, Ghana. DESIGN Cross-sectional study of 270 randomly selected ANC attendees. RESULTS More than 90% of respondents were in favour of the opt-out policy. The most commonly cited reasons were that it would help pregnant women know their status and facilitate prevention of mother to child transmission of HIV (PMTCT). About 60% of respondents had tested for HIV in the current pregnancy with more than 90% reporting that the test was offered them in a manner in which they could have refused the test. HIV testing in the current pregnancy was associated with having heard of the opt-out policy (p <0.001) and awareness that the test was offered at the facility (p < 0.001), but there was no relationship with educational level. Out of the 112 clients who had not had HIV test in the current pregnancy, 61.8% claimed the test had not been offered to them while 82.4% expressed willingness to have the test done if offered. CONCLUSION The opt-out HIV testing policy is acceptable to the pregnant women surveyed in the Wa municipality. A well laid out process to ensure that all pregnant women are routinely offered HIV testing at the ANC may help minimize missed opportunities for utilizing PMTCT services.
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Affiliation(s)
- J Nyuzaghl
- Bole District Hospital, Ghana Health Service, Bole, Ghana
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Malaju MT, Alene GD. Women's expectation of partner's violence on HIV disclosure for prevention of mother to child transmission of HIV in North West Ethiopia. BMC Res Notes 2013; 6:96. [PMID: 23497642 PMCID: PMC3601008 DOI: 10.1186/1756-0500-6-96] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 03/07/2013] [Indexed: 12/03/2022] Open
Abstract
Background All violence against women has serious consequences for their mental, physical wellbeing, reproductive and sexual health including HIV infection and no study was conducted in this regard in Ethiopia and particularly in the present study area. Findings A cross-sectional study was conducted in Gondar town from 22 July–18 August 2011. Of the 400 pregnant women who actively participated in this study, 314 (78.50%) expected a negative reaction for HIV positive test result from their partners. A positive reaction from the partner was associated with women having their own income (Adjusted odds ratio (AOR) (95% CI) =2.18 (1.21, 3.92)), residing in the urban areas (AOR (95% CI) =2.26 (1.21, 4.22)), having education level of secondary level and above (AOR (95% CI) = 6.05 (3.12, 11.72)), not having a stigmatizing attitude towards people living with HIV (AOR (95% CI) = 2.15 (1.24, 3.73)), having a positive attitude towards counselors (AOR (95% CI) = 2.46 (1.42, 4.25)) and being able to access health facilities (AOR (95% CI) = 2.35(1.22, 4.50)). Conclusion Most of the participants in this study expected their partner to react negatively towards a positive HIV test result. Since women’s having their own income is strongly associated with a positive partner’s reaction on HIV test disclosure for prevention of mother to child transmission of HIV services, emphasis should be given for education and economic empowerment of women. A well functioning and accessible health facility with prevention of mother to child transmission of HIV service is important, especially in rural areas.
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Affiliation(s)
- Marelign Tilahun Malaju
- Department of Public Health, College of Medicine and Health Sciences, Arba-Minch University, P,O, Box 21, Arba-Minch, Ethiopia.
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Mwembo-Tambwe ANK, Kalenga MK, Donnen P, Humblet P, Chenge M, Dramaix M, Buekens P. [HIV testing among women in delivery rooms in Lubumbashi, Democratic Republic of the Congo: a catch-up strategy for prevention of mother-to-child transmission]. Rev Epidemiol Sante Publique 2013; 61:21-7. [PMID: 23337841 DOI: 10.1016/j.respe.2012.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 04/24/2012] [Accepted: 05/07/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Although HIV testing is offered during antenatal care, the proportion of women giving birth without knowing their HIV status is still important in DR Congo. The objective of this study was to determine the acceptability of rapid HIV testing among parturients in labor room, and to identify factors that are associated with the acceptability of HIV testing. METHODS Intervention including rapid HIV testing among pregnant women in labor rooms in Lubumbashi for 5 months, from September 2010 to February 2011. Pregnant women who tested HIV positive were attended by prevention of mother-to-child transmission service. Descriptive statistical analysis and logistic regression were performed. RESULTS Among 474 pregnant women who enter the labor room, 433 (91.4%; confidence interval [CI]: 95%: 88.4-93.7%) had voluntary testing for HIV in the labor room after counseling. The acceptance of rapid testing for HIV was significantly higher when the duration of counseling was less or equal to 5 minutes (adjusted Odds ratio [aOR]=5.8; [CI] 95%: 2.6-13); among those who did not report having this screening test during antenatal care (aOR=3.8; [CI] 95%: 2-7.8), among those who were in early labor (aOR=2.3; [CI] 95%: 1.2-4.7) and lower in adolescents than in adults (aOR=0.1; [CI] 95%: 0.0-0.7). CONCLUSION Counseling and voluntary HIV testing are accepted in our labor rooms. Consistently offering this service in the labor room could be a catch-up strategy to be combined with antenatal care testing.
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Affiliation(s)
- A N K Mwembo-Tambwe
- Département de gynécologie et obstétrique, faculté de médecine, université de Lubumbashi, Lubumbashi, République démocratique du Congo.
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Obermeyer CM, Neuman M, Desclaux A, Wanyenze R, Ky-Zerbo O, Cherutich P, Namakhoma I, Hardon A. Associations between mode of HIV testing and consent, confidentiality, and referral: a comparative analysis in four African countries. PLoS Med 2012; 9:e1001329. [PMID: 23109914 PMCID: PMC3479110 DOI: 10.1371/journal.pmed.1001329] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 09/10/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recommendations about scaling up HIV testing and counseling highlight the need to provide key services and to protect clients' rights, but it is unclear to what extent different modes of testing differ in this respect. This paper examines whether practices regarding consent, confidentiality, and referral vary depending on whether testing is provided through voluntary counseling and testing (VCT) or provider-initiated testing. METHODS AND FINDINGS The MATCH (Multi-Country African Testing and Counseling for HIV) study was carried out in Burkina Faso, Kenya, Malawi, and Uganda. Surveys were conducted at selected facilities. We defined eight outcome measures related to pre- and post-test counseling, consent, confidentiality, satisfactory interactions with providers, and (for HIV-positive respondents) referral for care. These were compared across three types of facilities: integrated facilities, where testing is provided along with medical care; stand-alone VCT facilities; and prevention of mother-to-child transmission (PMTCT) facilities, where testing is part of PMTCT services. Tests of bivariate associations and modified Poisson regression were used to assess significance and estimate the unadjusted and adjusted associations between modes of testing and outcome measures. In total, 2,116 respondents tested in 2007 or later reported on their testing experience. High percentages of clients across countries and modes of testing reported receiving recommended services and being satisfied. In the unadjusted analyses, integrated testers were less likely to meet with a counselor before testing (83% compared with 95% of VCT testers; p<0.001), but those who had a pre-test meeting were more likely to have completed consent procedures (89% compared with 83% among VCT testers; p<0.001) and pre-test counseling (78% compared with 73% among VCT testers; p = 0.015). Both integrated and PMTCT testers were more likely to receive complete post-test counseling than were VCT testers (59% among both PMTCT and integrated testers compared with 36% among VCT testers; p<0.001). Adjusted analyses by country show few significant differences by mode of testing: only lower satisfaction among integrated testers in Burkina Faso and Uganda, and lower frequency of referral among PMTCT testers in Malawi. Adjusted analyses of pooled data across countries show a higher likelihood of pre-test meeting for those testing at VCT facilities (adjusted prevalence ratio: 1.22, 95% CI: 1.07-1.38) and higher satisfaction for stand-alone VCT facilities (adjusted prevalence ratio: 1.15; 95% CI: 1.06-1.25), compared to integrated testing, but no other associations were statistically significant. CONCLUSIONS Overall, in this study most respondents reported favorable outcomes for consent, confidentiality, and referral. Provider-initiated ways of delivering testing and counseling do not appear to be associated with less favorable outcomes for clients than traditional, client-initiated VCT, suggesting that testing can be scaled up through multiple modes without detriment to clients' rights. Please see later in the article for the Editors' Summary.
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Affiliation(s)
| | - Melissa Neuman
- Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Alice Desclaux
- Institut de Recherche pour le Développement, Dakar, Sénégal
| | - Rhoda Wanyenze
- Makerere University School of Public Health, Kampala, Uganda
| | - Odette Ky-Zerbo
- Programme d'Appui au Monde Associatif et Communautaire, Ouagadougou, Burkina Faso
| | - Peter Cherutich
- National AIDS/STD Control Program, Ministry of Health, Nairobi, Kenya
| | | | - Anita Hardon
- Anthropology of Care and Health, University of Amsterdam, Amsterdam, The Netherlands
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Vogel TR, Dombrovskiy VY, Lowry SF. Impact of infectious complications after elective surgery on hospital readmission and late deaths in the U.S. Medicare population. Surg Infect (Larchmt) 2012; 13:307-11. [PMID: 23082877 DOI: 10.1089/sur.2012.116] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Whereas the negative impact of infectious complications (IC) during the index hospitalization after elective surgery is well established, the long-term ramifications of hospital-acquired post-operative infections are not well studied. This analysis evaluated the impact of a hospital-acquired IC after open abdominal vascular surgery on the readmission rate and the mortality rates 30 and 90 days after initial discharge. METHODS Data from all hospitals in the United States that performed elective open abdominal vascular operations in the Medicare population from 2005 to 2007 were extracted from the national Medicare Provider Analysis and Review database. The cohort consisted of all patients undergoing open abdominal vascular operations, including aortic, iliac, and visceral procedures. The ICs evaluated were pneumonia, urinary tract infection (UTI), postoperative sepsis (sepsis), surgical site infection (SSI), and Clostridium difficile infection (CDI). Patients were categorized as either developing an IC during their initial hospitalization (Index+INF) or not developing an IC (No INF). The rates of 30-day readmission, 30-day IC, and 30- and 90-day mortality after the initial discharge were evaluated longitudinally and compared in patients with and without an IC. RESULTS A total of 29,549 open abdominal vascular procedures were identified, and 4,016 patients (13.6%) developed an IC during their index hospitalization: Pneumonia (5.1% of the total), UTI (2.7%), sepsis (1.6%), SSI (1.4%), and CDI (0.6%). Additionally, 1.13% of patients developed pneumonia, UTI, SSI, or CDI complicated by sepsis. The hospital mortality rate during the initial hospitalization was 13.7% (Index+INF) versus 4.0% (No INF) (p<0.0002). Infectious processes (pneumonia, UTI, SSI, and CDI) complicated by sepsis had an in-hospital mortality rate significantly higher than patients having an IC alone (50.9% vs. 13.7%; p<0.002). The mortality rate 30 and 90 days after the initial discharge was significantly higher for Index+INF than for No INF (4.4% vs. 1.2% and 8.6% vs. 2.6%, respectively; p<0.0002). The highest 30-day mortality rates after discharge were found after CDI+sepsis (30%), pneumonia+sepsis (12.6%), and postoperative sepsis alone (8.6%). The same rank was found for the 90-day mortality rate: 30%, 22.5%, and 13.8%. Overall, readmission was more likely for Index+INF than for No INF (33.7% vs. 21.5%; p<0.0002). Rates of 30-day readmission after an index IC ranged from 32% to 50%. CONCLUSION For Medicare beneficiaries undergoing elective open abdominal vascular procedures, the development of any IC significantly increased not only the in-hospital mortality rate but also the mortality rates 30 and 90 days after discharge from the hospital. Index ICs also were associated with a higher 30-day readmission rate. Hospital-acquired infections have a profound late effect on outcomes after discharge. Future programs targeting high-risk patients may improve long-term survival and minimize readmissions.
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Affiliation(s)
- Todd R Vogel
- Department of Surgery, Division of Vascular Surgery, University of Missouri Hospital and Clinics, Columbia, MO 65212, USA.
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Saito S, Wu Y, Nankabirwa V, Nash D. The contribution of antenatal care to the coverage and correlates of HIV testing among adults in Zimbabwe 2005-06. Int J STD AIDS 2012; 23:308-15. [PMID: 22648882 DOI: 10.1258/ijsa.2011.011274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Expanding the availability, utilization and coverage of HIV testing services is a critical step towards primary prevention and successful delivery of antiretroviral therapy (ART) in Zimbabwe. We used data from the Zimbabwe Demographic and Health Survey (2005-2006) to examine the coverage and correlates of recent HIV testing (HIV testing <24 months preceding the survey) among HIV-positive and HIV-negative adults. We estimated the relative contribution of HIV testing in both the antenatal care (ANC) setting and non-ANC settings. Uptake of recent HIV testing was 14.4% among women and 11.1% among men, with HIV testing in ANC accounting for 42.3% and 10.3% of all recent testing among women and men, respectively. In the multivariate analyses, recent pregnancies and being aware of ART were independent correlates after controlling for demographic and socioeconomic variables. HIV testing in ANC was an important contributor to HIV testing coverage in Zimbabwe by reaching not only pregnant women but also their partners.
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Affiliation(s)
- S Saito
- International Center for AIDS Care and Treatment Programs (ICAP), Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA.
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Larsson EC, Thorson AE, Pariyo G, Waiswa P, Kadobera D, Marrone G, Ekström AM. Missed Opportunities: barriers to HIV testing during pregnancy from a population based cohort study in rural Uganda. PLoS One 2012; 7:e37590. [PMID: 22916089 PMCID: PMC3420922 DOI: 10.1371/journal.pone.0037590] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 04/21/2012] [Indexed: 02/07/2023] Open
Abstract
The aim was to assess population-level HIV-testing uptake among pregnant women, key for access to prevention-of mother to child transmission (PMTCT) services, and to identify risk factors for not being HIV tested,The study was conducted May 2008-May 2010 in the Iganga/Mayuge Health and Demographic Surveillance Site (HDSS), Eastern Uganda, during regular surveillance of 68,000 individuals. All women identified to be pregnant May-July 2008 (n=881) were interviewed about pregnancy-related issues and linked to the HDSS database for socio-demographic data. Women were followed-up via antenatal care (ANC) register reviews at the health facilities to collect data related to ANC services received, including HIV testing. Adjusted relative risk (aRR), and 95% confidence intervals (CI) for not being HIV tested were calculated using multivariable binomial regression among the 544 women who remained after record review.Despite high ANC attendance (96%), the coverage of HIV testing was 64%. Only 6% of pregnant women who sought ANC at a facility without HIV testing services were referred for testing and only 20% received counseling regarding HIV. At ANC facilities with HIV testing services, 85% were tested. Only 4% of the women tested had been couple tested for HIV. Living more than three kilometers away from a health facility with HIV testing services was associated with not being tested both among the poorest (aRR,CI; 1.44,1.02-2.04) and the least poor women (aRR,CI;1.72,1.12-2.63).The lack of on site HIV testing services and distant ANC facilities lead to missed opportunities for PMTCT, especially for the poorest women. Referral systems for HIV testing need to be improved and testing should be expanded to lower level health facilities. This is in order to ensure that the policy of HIV testing during pregnancy is implemented more effectively and that testing is accessible for all.
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Affiliation(s)
- Elin C Larsson
- Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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Jean K, Anglaret X, Moh R, Lert F, Dray-Spira R. Barriers to HIV testing in Côte d'Ivoire: the role of individual characteristics and testing modalities. PLoS One 2012; 7:e41353. [PMID: 22815995 PMCID: PMC3399867 DOI: 10.1371/journal.pone.0041353] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 06/20/2012] [Indexed: 11/19/2022] Open
Abstract
Background Expanding HIV testing requires a better understanding of barriers to its uptake. We investigated barriers to HIV testing in Côte d'Ivoire, taking into account test circumstances (client vs. provider-initiated). Methods We used data from the 2005 nationally representative Demographic and Health Survey conducted in Côte d'Ivoire. Socio-demographic characteristics, sexual behaviour and knowledge and attitudes toward HIV/AIDS associated with recent (<2 years) HIV testing were identified using gender-specific univariate and multivariate logistic regressions. Among women, differential effects of barriers to testing according to test circumstance (whether they have been offered for a prenatal test or not) were assessed through interaction tests. Results Recent HIV testing was reported by 6.1% of men and 9.5% of women (including 4.6% as part of antenatal care). Among men, having a low socioeconomic status, having a low HIV-related knowledge level and being employed [compared to those inactive: adjusted Odds Ratio (aOR) 0.46; 95% confidence interval (CI) 0.25–0.87] were associated with lower proportions of recent HIV testing. Among women without a prenatal HIV testing offer, living outside the capital (aOR 0.38; CI 0.19–0.77) and reporting a unique lifetime sexual partner constituted additional barriers to HIV testing. By contrast, among women recently offered to be tested in prenatal care, none of these variables was found to be associated with recent HIV testing. Conclusions Various dimensions of individuals' characteristics constituted significant barriers to HIV testing in Côte d'Ivoire in 2005, with gender specificities. Such barriers are substantially reduced when testing was proposed in the framework of antenatal care. This suggests that provider-initiated testing strategies may help overcome individual barriers to HIV testing.
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Affiliation(s)
- Kévin Jean
- Epidemiology of Occupational and Social Determinants of Health-Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.
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Baggaley R, Hensen B, Ajose O, Grabbe KL, Wong VJ, Schilsky A, Lo YR, Lule F, Granich R, Hargreaves J. From caution to urgency: the evolution of HIV testing and counselling in Africa. Bull World Health Organ 2012; 90:652-658B. [PMID: 22984309 DOI: 10.2471/blt.11.100818] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 05/09/2012] [Accepted: 05/11/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe recent changes in policy on provider-initiated testing and counselling (PITC) for human immunodeficiency virus (HIV) infection in African countries and to investigate patients' experiences of and views about PITC. METHODS A review of the published literature and of national HIV testing policies, strategic frameworks, plans and other relevant documents was carried out. FINDINGS Of the African countries reviewed, 42 (79.2%) had adopted a PITC policy. Of the 42, all recommended PITC for the prevention of mother-to-child HIV transmission, 66.7% recommended it for tuberculosis clinics and patients, and 45.2% for sexually transmitted infection clinics. Moreover, 43.6% adopted PITC in 2005 or 2006. The literature search identified 11 studies on patients' experiences of and views about PITC in clinical settings in Africa. The clear majority regarded PITC as acceptable. However, women in antenatal clinics were not always aware that they had the right to decline an HIV test. CONCLUSION Policy and practice on HIV testing and counselling in Africa has shifted from a cautious approach that emphasizes confidentiality to greater acceptance of the routine offer of HIV testing. The introduction of PITC in clinical settings has contributed to increased HIV testing in several of these settings. Most patients regard PITC as acceptable. However, other approaches are needed to reach people who do not consult health-care services.
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Affiliation(s)
- R Baggaley
- HIV/AIDS Department, World Health Organization, Geneva, Switzerland
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Leta TH, Sandøy IF, Fylkesnes K. Factors affecting voluntary HIV counselling and testing among men in Ethiopia: a cross-sectional survey. BMC Public Health 2012; 12:438. [PMID: 22703550 PMCID: PMC3538522 DOI: 10.1186/1471-2458-12-438] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 05/30/2012] [Indexed: 11/13/2022] Open
Abstract
Background Voluntary HIV counselling and testing (VCT) is one of the key strategies in the HIV/AIDS prevention and control programmes in Ethiopia. However, utilization of this service among adults is very low. The aim of the present study was to investigate factors associated with VCT utilization among adult men since men are less likely than women to be offered and accept routine HIV testing. Methods The study utilized data from the Ethiopian Demographic Health Survey (EDHS) 2005, which is a cross-sectional survey conducted on a nationally representative sample. Using cluster sampling, 6,778 men aged 15–59 years were selected from all the eleven administrative regions in Ethiopia. Logistic regression was used to analyze potential factors associated with VCT utilization. Results Overall, 21.9% of urban men and 2.6% of rural men had ever tested for HIV through VCT and most of them had learned their HIV test result. Having no stigmatizing attitudes toward people living with HIV/AIDS was found to be strongly and positively associated with VCT utilization in both urban and rural strata. In rural areas HIV test rates were higher among younger men (aged ≤44 years) and those of higher socio-economic position (SEP). Among urban men, risky sexual behaviour was positively associated with VCT utilization whereas being Muslim was found to be inversely associated with utilization of VCT. Area of residence as well as SEP strongly affected men’s level of stigmatizing attitudes toward people living with HIV/AIDS. Conclusions VCT utilization among men in Ethiopia was low and affected by HIV/AIDS-related stigma and residence. In order to increase VCT acceptability, HIV/AIDS prevention and control programs in the country should focus on reducing HIV/AIDS-related stigma. Targeting rural men with low SEP should be given first priority when designing, expanding, and implementing VCT services in the country.
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Affiliation(s)
- Tesfaye H Leta
- Centre for International Health, University of Bergen, Overlege Danielsens Hus, Årstadv, 21, Postbox 7804, NO-5020 Bergen, Norway.
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Medley AM, Mugerwa GW, Kennedy C, Sweat M. Ugandan men's attitudes toward their partner's participation in antenatal HIV testing. Health Care Women Int 2012; 33:359-74. [PMID: 22420677 DOI: 10.1080/07399332.2012.655392] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Several authors have shown that women's uptake of antenatal HIV testing is influenced by fear of their partners' reactions. We conducted a qualitative study with 40 Ugandan men to examine their attitudes toward their partners' participation in antenatal HIV testing. Most men believed women should consult their husbands prior to HIV testing to avoid negative consequences and facilitate disclosure. When women tested during routine antenatal care, however, the need to obtain permission was considered less important. These findings lend support to the practice of routine antenatal HIV testing as an acceptable way for women to test independently of their partners.
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Affiliation(s)
- Amy M Medley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Malaju MT, Alene GD. Assessment of utilization of provider-initiated HIV testing and counseling as an intervention for prevention of mother to child transmission of HIV and associated factors among pregnant women in Gondar town, North West Ethiopia. BMC Public Health 2012; 12:226. [PMID: 22440018 PMCID: PMC3350437 DOI: 10.1186/1471-2458-12-226] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 03/22/2012] [Indexed: 11/18/2022] Open
Abstract
Background Detection of maternal HIV infection early in pregnancy is critical for prevention of mother to child transmission of HIV/AIDS. Most efforts have focused on VCT as the primary means of encouraging people to become aware of their HIV status. However, its uptake is low in many parts of sub-Saharan Africa including Ethiopia. Provider-initiated HIV testing and counseling provides a critical opportunity to diagnose HIV infection, to begin chronic care, and to prevent mother to child transmission. However, little is known about its acceptance and associated factors among pregnant women in the country and particularly in the present study area. Methods Health institution based cross-sectional quantitative study was conducted in Gondar town from July 22-August 18, 2010. A total of 400 pregnant women were involved in the study using stratified sampling technique and multiple logistic regression analysis was employed using SPSS version 16. Results A total of 400 pregnant women actively participated in this study and 330 (82.5%) of them accepted provider-initiated HIV testing and counseling to be tested for HIV and 70(17.5%) of them refused. Acceptance of provider-initiated HIV testing and counseling was positively associated with greater number of antenatal care visits [Adj. OR (95%CI)=2.64(1.17, 5.95)], residing in the urban areas[Adj. OR (95%CI)=2.85(1.10, 7.41)], having comprehensive knowledge on HIV [Adj. OR (95%CI)=4.30(1.72, 10.73)], positive partners reaction for HIV positive result [Adj. OR (95%CI)=8.19(3.57, 18.80)] and having knowledge on prevention of mother to child transmission of HIV[Adj. OR (95%CI)=3.27(1.34, 7.94)], but negatively associated with increased maternal age and education level. Conclusion Utilization of provider-initiated HIV testing and counseling during antenatal care was relatively high among pregnant women in Gondar town. Couple counseling and HIV testing should be strengthened to promote provider-initiated HIV testing and counseling among male partners and to reduce HIV related violence of women from their partner and access to and consistent use of antenatal care should be improved to increase the uptake of provider-initiated HIV testing and counseling service.
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Affiliation(s)
- Marelign Tilahun Malaju
- Department of Public Health, College of Medicine and Health Sciences, Arba-Minch University, PO Box: 21, Arba-Minch, Ethiopia.
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Anand A, Luman ET, O'Connor PM. Building on success--potential to improve coverage of multiple health interventions through integrated delivery with routine childhood vaccination. J Infect Dis 2012; 205 Suppl 1:S28-39. [PMID: 22315383 DOI: 10.1093/infdis/jir794] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Integrating delivery of nonvaccine interventions with childhood vaccinations has been suggested as a mechanism to accelerate progress toward Millennium Development Goals. METHODS Demographic health surveys from 28 sub-Saharan African countries were analyzed to determine potential coverage with 5 nonvaccine interventions that could be delivered to children, mothers, and families during routine infant vaccinations. Potential coverage levels were calculated among households with children aged 12-23 months, based on existing coverage of interventions and vaccinations. FINDINGS Most (>60%) children in families that had not received nonvaccine interventions had been vaccinated. If nonvaccine interventions could be delivered with vaccinations, the median percentage of households owning a bed net could increase from 46% to 92% and those with improved or treated sources of water from 55% to 91%. The median percentage of children who had received vitamin A supplementation could increase from 66% to 90%. Mothers who have been tested for human immunodeficiency virus could increase from 16% to 86%. CONCLUSIONS In Africa, vaccination programs could provide a platform to substantially increase coverage of nonvaccine interventions. Studies are needed to investigate programmatic approaches to optimize the selection, adoption, and long-term utilization of these interventions and to assess the impact on vaccination and other intervention coverage.
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Affiliation(s)
- Abhijeet Anand
- Global Immunization Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E05, Atlanta, GA 30333, USA.
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Byamugisha R, Åstrøm AN, Ndeezi G, Karamagi CAS, Tylleskär T, Tumwine JK. Male partner antenatal attendance and HIV testing in eastern Uganda: a randomized facility-based intervention trial. J Int AIDS Soc 2011; 14:43. [PMID: 21914207 PMCID: PMC3192699 DOI: 10.1186/1758-2652-14-43] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 09/13/2011] [Indexed: 11/26/2022] Open
Abstract
Background The objective of the study was to evaluate the effect of a written invitation letter to the spouses of new antenatal clinic attendees on attendance by couples and on male partner acceptance of HIV testing at subsequent antenatal clinic visits. Methods The trial was conducted with 1060 new attendees from October 2009 to February 2010 in an antenatal clinic at Mbale Regional Referral Hospital, Mbale District, eastern Uganda. The intervention comprised an invitation letter delivered to the spouses of new antenatal attendees, while the control group received an information letter, a leaflet, concerning antenatal care. The primary outcome measure was the proportion of pregnant women who attended antenatal care with their male partners during a follow-up period of four weeks. Eligible pregnant women were randomly assigned to the intervention or non-intervention groups using a randomization sequence, which was computer generated utilizing a random sequence generator (RANDOM ORG) that employed a simple randomization procedure. Respondents, health workers and research assistants were masked to group assignments. Results The trial was completed with 530 women enrolled in each group. Participants were analyzed as originally assigned (intention to treat). For the primary outcome, the percentage of trial participants who attended the antenatal clinic with their partners were 16.2% (86/530) and 14.2% (75/530) in the intervention and non-intervention groups, respectively (OR = 1.2; 95% CI: 0.8, 1.6). For the secondary outcome, most of the 161 male partners attended the antenatal clinic; 82 of 86 (95%) in the intervention group and 68 of 75 (91%) in the non-intervention group were tested for HIV (OR = 2.1; 95% CI: 0.6 to 7.5). Conclusions The effect of the intervention and the control on couple antenatal attendance was similar. In addition, the trial demonstrated that a simple intervention, such as a letter to the spouse, could increase couple antenatal clinic attendance by 10%. Significantly, the majority of male partners who attended the antenatal clinic accepted HIV testing. Therefore, to further evaluate this simple and cost-effective intervention method, adequately powered studies are required to assess its effectiveness in increasing partner participation in antenatal clinics and the programme for prevention of mother to child transmission of HIV. Trial Registration ClinicalTrials.gov Identifier: NCT01144234.
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Affiliation(s)
- Robert Byamugisha
- Department of Obstetrics and Gynaecology, Mbale Regional Referral Hospital, Mbale, Uganda.
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Mirkuzie AH, Sisay MM, Moland KM, Astrøm AN. Applying the theory of planned behaviour to explain HIV testing in antenatal settings in Addis Ababa - a cohort study. BMC Health Serv Res 2011; 11:196. [PMID: 21851613 PMCID: PMC3169463 DOI: 10.1186/1472-6963-11-196] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 08/18/2011] [Indexed: 11/10/2022] Open
Abstract
Background To facilitate access to the prevention of mother-to-child HIV transmission (PMTCT) services, HIV counselling and testing are offered routinely in antenatal care settings. Focusing a cohort of pregnant women attending public and private antenatal care facilities, this study applied an extended version of the Theory of Planned Behaviour (TPB) to explain intended- and actual HIV testing. Methods A sequential exploratory mixed methods study was conducted in Addis Ababa in 2009. The study involved first time antenatal attendees from public- and private health care facilities. Three Focus Group Discussions were conducted to inform the TPB questionnaire. A total of 3033 women completed the baseline TPB interviews, including attitudes, subjective norms, perceived behavioural control and intention with respect to HIV testing, whereas 2928 completed actual HIV testing at follow up. Data were analysed using descriptive statistics, Chi-square tests, Fisher's Exact tests, Internal consistency reliability, Pearson's correlation, Linear regression, Logistic regression and using Epidemiological indices. P-values < 0.05 was considered significant and 95% Confidence Interval (CI) was used for the odds ratio. Results The TPB explained 9.2% and 16.4% of the variance in intention among public- and private health facility attendees. Intention and perceived barriers explained 2.4% and external variables explained 7% of the total variance in HIV testing. Positive and negative predictive values of intention were 96% and 6% respectively. Across both groups, subjective norm explained a substantial amount of variance in intention, followed by attitudes. Women intended to test for HIV if they perceived social support and anticipated positive consequences following test performance. Type of counselling did not modify the link between intended and actual HIV testing. Conclusion The TPB explained substantial amount of variance in intention to test but was less sufficient in explaining actual HIV testing. This low explanatory power of TPB was mainly due to the large proportion of low intenders that ended up being tested contrary to their intention before entering the antenatal clinic. PMTCT programs should strengthen women's intention through social approval and information that testing will provide positive consequences for them. However, women's rights to opt-out should be emphasized in any attempt to improve the PMTCT programs.
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Affiliation(s)
- Alemnesh H Mirkuzie
- Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen, Overlege Danielsens Hus, Årstav. 21, Postbox 7804, Bergen 5020, Norway.
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