1
|
Ottesen TD, Wickersham JA, Lawrence JC, Antoniak S, Zezuilin O, Polonsky M, Antonyak S, Rozanova J, Dvoriak S, Pykalo I, Filippovych M, Altice FL. High rates of deferring antiretroviral treatment for patients with HIV and substance use disorders: Results from a national sample of HIV physicians in Ukraine. PLoS One 2024; 19:e0305086. [PMID: 39028735 PMCID: PMC11259278 DOI: 10.1371/journal.pone.0305086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/23/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND HIV incidence and mortality are increasing in Ukraine despite their reductions globally, in part due to suboptimal antiretroviral therapy (ART) coverage in key populations of people with HIV (PWH) where the epidemic is concentrated. As physicians are gatekeepers to ART prescription, stigma and discrimination barriers are understudied as a key to meeting HIV treatment targets in key populations. METHODS A national sample (N = 204) of ART-prescribing physicians in Ukraine were surveyed between August and November 2019. Participants underwent a series of randomized, hypothetical HIV clinical scenarios and decided whether to initiate or defer (or withhold) ART. Scenarios varied based on 5 distinct CD4 counts (CD4: 17, 176, 305, 470, or 520 cells/mL) and 10 different PWH key populations. Z scores and McNemar's test for paired samples were used to assess differences between key populations and CD4 count. Feeling thermometers were used to assess stigma-related measures toward key populations among physicians. RESULTS Physicians were highly experienced (mean = 19 years) HIV treaters, female (80.4%), and trained in infectious diseases (76.5%). Patients who drink alcohol (range: 21.6%-23.5%) or use (PWUD range: 16.7%-20.1%) or inject (PWID range: 15.5%-20.1%) drugs were most likely to have ART deferred, even at AIDS-defining CD4 counts. PWID maintained on methadone, however, were significantly (p<0.001) less likely to have ART deferred compared with those who were not (range: 7.8%-12.7%) on methadone. Men who have sex with men (range: 5.4%-10.8%), transgender women (range: 4.9%-11.3%), sex workers (range: 3.9%-10.3%),and having an HIV-uninfected sex partner (range: 3.9%-9.3%) had the lowest likelihood of ART deferral. Increasing levels of stigma (i.e., feeling thermometers) towards a key population was correlated with ART deferral (i.e., discrimination). CONCLUSIONS Despite international and Ukrainian guidelines recommending ART prescription for all PWH, irrespective of risk or CD4 count, ART deferral by experienced HIV experts remains high in certain key populations, especially in PWH and substance use disorders. Strategies that initiate ART immediately after diagnosis (i.e., rapid start antiretroviral therapy), independent of risk group, should be prioritized to truly mitigate the current epidemic.
Collapse
Affiliation(s)
- Taylor D. Ottesen
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, Connecticut, United States of America
- Harvard Combined Orthopaedic Residency Program, Boston, MA, United States of America
| | - Jeffrey A. Wickersham
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Juliana C. Lawrence
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Sergii Antoniak
- L.V. Gromashevsky Institute of Epidemiology and Infectious Diseases of the National Academy of Medical Science of Ukraine, Kyiv, Ukraine
| | | | - Maxim Polonsky
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, Connecticut, United States of America
- Keck Graduate Institute, Claremont, CA, United States of America
| | - Svitlana Antonyak
- L.V. Gromashevsky Institute of Epidemiology and Infectious Diseases of the National Academy of Medical Science of Ukraine, Kyiv, Ukraine
| | - Julia Rozanova
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Sergii Dvoriak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Iryna Pykalo
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | | | - Fredrick L. Altice
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, United States of America
- Centre of Excellence in Research on AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
2
|
Fraser H, Stone J, Facente SN, Artenie A, Patel S, Wilson EC, McFarland W, Page K, Vickerman P, Morris MD. Modeling the impact of the COVID-19 pandemic on achieving HCV elimination amongst young and unstably housed people who inject drugs in San Francisco. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024:104452. [PMID: 38910096 DOI: 10.1016/j.drugpo.2024.104452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Young adult (18-30 years) people who inject drugs (PWID) face high hepatitis C virus (HCV) prevalence. In San Francisco, where >60% of PWID lack stable housing, barriers hinder HCV treatment access. We assessed progress towards the World Health Organization's (WHO) HCV elimination goal of an 80% reduction in incidence over 2015-2030, focusing on young (YPWID) and unstably housed PWID in San Francisco. METHODS We developed a dynamic HCV transmission model among PWID, parameterized and calibrated using bio-behavioural survey datasets from San Francisco. This included 2018 estimates for the antibody-prevalence among PWID (77%) and care cascade estimates for HCV for YPWID (72% aware of their status and 33% ever initiating treatment). Based on programmatic data, we assumed a 53.8% reduction in testing and 40.7% decrease in treatment from 2020 due to the COVID-19 pandemic, which partially rebounded from April 2021 with testing rates then being 31.1% lower than pre-pandemic rates and treatment numbers being 19.5% lower. We simulated different scenarios of how services changed after the pandemic to project whether elimination goals would be met. RESULTS Continuing post-pandemic rates of testing and treatment, the model projects an 83.3% (95% credibility interval [95% CrI]:60.6-96.9%) decrease in incidence among PWID over 2015-2030 to 1.5/100pyrs (95% CrI:0.3-4.4) in 2030. The probability of achieving the elimination goal by 2030 is 62.0%. Among YPWID and unstably housed PWID, the probability of achieving the elimination goal by 2030 is 54.8 and 67.6%, respectively. Importantly, further increasing testing and treatment rates to pre-pandemic levels by 2025 only results in a small increase in the probability (67.5%) of the elimination goal being achieved among all PWID by 2030, while increased coverage of medication for opioid use disorder among YPWID and/or housing interventions results in the probability of achieving elimination increasing to over 75%. CONCLUSION The COVID-19 pandemic impeded progress toward achieving HCV elimination. Our findings indicate that existing partial rebounds in HCV testing and treatment may achieve the elimination goal by 2030, with an additional scale-up of interventions aimed at YPWID or unstably housed PWID ensuring San Francisco is likely to achieve elimination by 2030.
Collapse
Affiliation(s)
- Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Shelley N Facente
- School of Public Health, Division of Epidemiology and Biostatistics, University of California Berkeley, Berkeley, USA; Facente Consulting, Richmond, USA
| | - Adelina Artenie
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Sheena Patel
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Erin C Wilson
- San Francisco Department of Public Health, San Francisco, USA
| | - Willi McFarland
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA; San Francisco Department of Public Health, San Francisco, USA
| | - Kimberly Page
- Department of Internal Medicine, Division of Epidemiology, University of New Mexico, USA
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, UK.
| | - Meghan D Morris
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| |
Collapse
|
3
|
Luvuno ZPB, Wiafe E, Mpofana N, Urusla MM, Nxumalo CT. Fast-track interventions for HIV and AIDS epidemic control among key populations: A rapid review. Afr J Prim Health Care Fam Med 2024; 16:e1-e12. [PMID: 38708735 PMCID: PMC11079388 DOI: 10.4102/phcfm.v16i1.4088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Targeted interventions for key populations remain critical for realisation of epidemic control for human immunodeficiency virus (HIV) infection because of the causal relationship between HIV infection in the general population and among key population groups. AIM To consolidate evidence on the fast-track interventions towards achieving HIV epidemic control among key populations. METHODS A rapid scoping review was conducted using the methodological framework by Arksey and O' Malley. The Population, Intervention, Context and Outcome (PICO) framework was used to identify relevant studies using key words with Boolean operators in electronic data bases, namely CINHAL, Web of Science, Psych Info and Sabinet. Studies were extracted using a modified data extraction tool, and results were presented narratively. RESULTS A total of 19 articles were included in this review. Most articles were primary studies (n = 17), while another involved the review of existing literature and policies (n = 2) and routinely collected data (n = 1). Most studies were conducted in the United States of America (n = 6), while another were conducted in China, Kenya, Botswana, South Africa and Mozambique. All studies revealed findings on tested interventions to achieve HIV epidemic control among key populations. CONCLUSION Effective interventions for HIV epidemic control were stand-alone behavioural preventive interventions, stand-alone biomedical preventive strategies and combination prevention approaches. Furthermore, the findings suggest that effective activities to achieve HIV epidemic control among key populations should be centred around prevention.Contribution: The findings of this study have policy and practice implications for high HIV burden settings such as South Africa in terms of interventions to facilitate realisation of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets, thereby contributing to HIV epidemic control.
Collapse
Affiliation(s)
- Zamasomi P B Luvuno
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Howard Campus, Durban.
| | | | | | | | | |
Collapse
|
4
|
Cheah MH, Gan YN, Altice FL, Wickersham JA, Shrestha R, Salleh NAM, Ng KS, Azwa I, Balakrishnan V, Kamarulzaman A, Ni Z. Testing the Feasibility and Acceptability of Using an Artificial Intelligence Chatbot to Promote HIV Testing and Pre-Exposure Prophylaxis in Malaysia: Mixed Methods Study. JMIR Hum Factors 2024; 11:e52055. [PMID: 38277206 PMCID: PMC10858413 DOI: 10.2196/52055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/22/2023] [Accepted: 12/12/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The HIV epidemic continues to grow fastest among men who have sex with men (MSM) in Malaysia in the presence of stigma and discrimination. Engaging MSM on the internet using chatbots supported through artificial intelligence (AI) can potentially help HIV prevention efforts. We previously identified the benefits, limitations, and preferred features of HIV prevention AI chatbots and developed an AI chatbot prototype that is now tested for feasibility and acceptability. OBJECTIVE This study aims to test the feasibility and acceptability of an AI chatbot in promoting the uptake of HIV testing and pre-exposure prophylaxis (PrEP) in MSM. METHODS We conducted beta testing with 14 MSM from February to April 2022 using Zoom (Zoom Video Communications, Inc). Beta testing involved 3 steps: a 45-minute human-chatbot interaction using the think-aloud method, a 35-minute semistructured interview, and a 10-minute web-based survey. The first 2 steps were recorded, transcribed verbatim, and analyzed using the Unified Theory of Acceptance and Use of Technology. Emerging themes from the qualitative data were mapped on the 4 domains of the Unified Theory of Acceptance and Use of Technology: performance expectancy, effort expectancy, facilitating conditions, and social influence. RESULTS Most participants (13/14, 93%) perceived the chatbot to be useful because it provided comprehensive information on HIV testing and PrEP (performance expectancy). All participants indicated that the chatbot was easy to use because of its simple, straightforward design and quick, friendly responses (effort expectancy). Moreover, 93% (13/14) of the participants rated the overall chatbot quality as high, and all participants perceived the chatbot as a helpful tool and would refer it to others. Approximately 79% (11/14) of the participants agreed they would continue using the chatbot. They suggested adding a local language (ie, Bahasa Malaysia) to customize the chatbot to the Malaysian context (facilitating condition) and suggested that the chatbot should also incorporate more information on mental health, HIV risk assessment, and consequences of HIV. In terms of social influence, all participants perceived the chatbot as helpful in avoiding stigma-inducing interactions and thus could increase the frequency of HIV testing and PrEP uptake among MSM. CONCLUSIONS The current AI chatbot is feasible and acceptable to promote the uptake of HIV testing and PrEP. To ensure the successful implementation and dissemination of AI chatbots in Malaysia, they should be customized to communicate in Bahasa Malaysia and upgraded to provide other HIV-related information to improve usability, such as mental health support, risk assessment for sexually transmitted infections, AIDS treatment, and the consequences of contracting HIV.
Collapse
Affiliation(s)
- Min Hui Cheah
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yan Nee Gan
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Frederick L Altice
- Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
- Division of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, United States
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeffrey A Wickersham
- Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, United States
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Roman Shrestha
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, United States
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Nur Afiqah Mohd Salleh
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kee Seong Ng
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Iskandar Azwa
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Vimala Balakrishnan
- Department of Information Systems, Faculty of Computer Science and Information Technology, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Zhao Ni
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, United States
- School of Nursing, Yale University, Orange, CT, United States
| |
Collapse
|
5
|
Sukmaningrum E, Ayu AP, Wongso LV, Handayani M, Hendrianti S, Kawi NH, Kusmayanti NA, Sulaiman N, Irwanto, Law M, Wisaksana R. Motivational Interviewing as an Intervention to Improve Antiretroviral Treatment Initiation Among People who Inject Drugs (PWID): A Pilot Study in Jakarta and Bandung, Indonesia. Curr Drug Res Rev 2024; 16:228-236. [PMID: 37259929 DOI: 10.2174/2589977515666230531154629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/11/2023] [Accepted: 05/02/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Progress towards the 95-95-95 target among People Who Inject Drugs (PWID) with Human Immunodeficiency Virus (HIV) infection was considerably low. A behavioral approach, such as motivational interviewing (MI), has been recognized as an effective strategy for improving HIV treatment outcomes among PWID. OBJECTIVE This study aimed at assessing the impact of MI counselling to improve ARV initiation among HIV-positive PWID. METHODS A cohort design pilot study was performed, and participants were recruited using a convenience sampling technique. Participants were PWID with HIV who accessed healthcare facilities in two Indonesian cities. Selected participants were assigned to an intervention group and a control group. The intervention group followed MI counselling, while the control group received ART following the standard of care. The participants were assigned to each group based on their preferences. The data was collected between January 2018 and January 2019. RESULTS In total, 115 PWID with HIV participated in this study in the intervention (n = 30) and control (n = 85) groups. All but one intervention group's participants started ART, while 68/85 in the control group did so. Receiving MI counselling significantly contributed to ART initiation. In addition, the participants were followed-up until 12 months after ARV initiation. During this period, we found that similar proportions of participants in both groups discontinued the treatment, and only a small number achieved HIV viral suppression. CONCLUSION The positive effect of MI counselling on ART initiation provides insight into the possibility of its wider implementation. Further studies are needed to gain a deeper understanding of MI counselling and its effect on other outcomes of the HIV treatment cascade.
Collapse
Affiliation(s)
- Evi Sukmaningrum
- University Centre of Excellence-AIDS Research Centre Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
- Faculty of Psychology, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Astri Parawita Ayu
- University Centre of Excellence-AIDS Research Centre Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Lydia Verina Wongso
- University Centre of Excellence-AIDS Research Centre Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Miasari Handayani
- Research Center for Care and Control of Infectious Diseases, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Sarahsita Hendrianti
- University Centre of Excellence-AIDS Research Centre Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | | | - Nur Aini Kusmayanti
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Nurjannah Sulaiman
- Subdirectorate HIV&AIDS, Ministry of Health of the Republic of Indonesia, Surabaya, East Java, Indonesia
| | - Irwanto
- University Centre of Excellence-AIDS Research Centre Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Matthew Law
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Rudi Wisaksana
- Research Center for Care and Control of Infectious Diseases, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| |
Collapse
|
6
|
Hudrudchai S, Suwanwong C, Prasittichok P, Mohan KP, Janeaim N. Pre-exposure Prophylaxis Adherence Among Men Who Have Sex With Men: A Systematic Review and Meta-analysis. J Prev Med Public Health 2024; 57:8-17. [PMID: 38147821 PMCID: PMC10861324 DOI: 10.3961/jpmph.23.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVES The effectiveness and efficiency of pre-exposure prophylaxis (PrEP) in reducing the transmission of human immunodeficiency virus (HIV) among men who have sex with men (MSM) relies on how widely it is adopted and adhered to, particularly among high-risk groups of MSM. The meta-analysis aimed to collect and analyze existing evidence on various factors related to PrEP adherence in MSM, including demographic characteristics, sexual behaviors, substance use, and psychosocial factors. METHODS The meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search included articles published between January 2018 and December 2022, obtained from the PubMed, ScienceDirect, and Scopus databases. The studies that were included in the analysis reported the proportion of MSM who demonstrated adherence to PrEP and underwent quality appraisal using the Newcastle-Ottawa Scale. RESULTS Of the 268 studies initially identified, only 12 met the inclusion criteria and were included in the final meta-analysis. The findings indicated that education (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.12 to 2.40), number of sexual partners (OR, 1.16; 95% CI, 1.02 to 1.31), engaging in sexual activities with an human immunodeficiency virus-positive partner (OR, 1.59; 95% CI, 1.16 to 2.26), substance use (OR, 0.83; 95% CI, 0.70 to 0.99), and lower levels of depression (OR, 0.55; 95% CI, 0.37 to 0.82) were associated with higher rates of PrEP adherence among MSM. CONCLUSIONS Despite these findings, further research is necessary to investigate PrEP adherence more comprehensively. The findings of this meta-analysis can be utilized to inform interventions aimed at improving PrEP adherence among MSM and provide directions for future research in this area.
Collapse
Affiliation(s)
- Suchitra Hudrudchai
- Faculty of Nursing, Rajamangala University of Technology Thanyaburi, Pathum Thani, Thailand
- Behavioral Science Research Institute, Srinakharinwirot University, Bangkok, Thailand
| | - Charin Suwanwong
- Behavioral Science Research Institute, Srinakharinwirot University, Bangkok, Thailand
| | - Pitchada Prasittichok
- Behavioral Science Research Institute, Srinakharinwirot University, Bangkok, Thailand
| | - Kanu Priya Mohan
- Behavioral Science Research Institute, Srinakharinwirot University, Bangkok, Thailand
| | - Nopphadol Janeaim
- Behavioral Science Research Institute, Srinakharinwirot University, Bangkok, Thailand
| |
Collapse
|
7
|
McClarty LM, Becker ML, García PJ, Garnett GP, Dallabetta GA, Ward H, Aral SO, Blanchard JF. Programme science: a route to effective coverage and population-level impact for HIV and sexually transmitted infection prevention. Lancet HIV 2023; 10:e825-e834. [PMID: 37944547 DOI: 10.1016/s2352-3018(23)00224-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 11/12/2023]
Abstract
Improvements in context-specific programming are essential to address HIV and other sexually transmitted and blood-borne infection epidemics globally. A programme science approach emphasises the need for context-specific evidence and knowledge, generated on an ongoing basis, to inform timely and appropriate programmatic decisions. We aim to accelerate and improve the use of embedded research, inquiry, and learning to optimise population-level impact of public health programmes and to introduce an effective programme coverage framework as one tool to facilitate this goal. The framework was developed in partnership with public health experts in HIV and sexually transmitted and blood-borne infections through several workshops and meetings. The framework is a practice-based tool that centres on the use of data from iterative cycles of programme-embedded research and learning, as well as routine programme monitoring, to refine the strategy and implementation of a programme. This programme science approach aims to reduce programme coverage gaps, to optimise impact at the population level, and to achieve effective coverage. This framework should facilitate the generation of programme-embedded research and learning agendas to inform resource allocation, optimise population-level impact, and achieve equitable and effective programme coverage.
Collapse
Affiliation(s)
- Leigh M McClarty
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Marissa L Becker
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Patricia J García
- School of Public Health, Universidad Peruana Cayetano Heredia, San Martin de Porres, Lima, Peru
| | | | | | - Helen Ward
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Sevgi O Aral
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James F Blanchard
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| |
Collapse
|
8
|
Emanuel E, Slater L, Croxford S, Edmundson C, Ibitoye A, Njoroge J, Ijaz S, Hope V, Platt L, Phipps E, Desai M. Adverse health outcomes among people who inject drugs who engaged in recent sex work: findings from a national survey. Public Health 2023; 225:79-86. [PMID: 37922590 DOI: 10.1016/j.puhe.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES This study explores trends in sex work among people who inject drugs (PWID) by gender and the relationship between sex work and adverse health outcomes including overdose, injection-site, and blood-borne virus (BBV) infections. STUDY DESIGN The Unlinked Anonymous Monitoring Survey of PWID is an annual cross-sectional survey that monitors BBV prevalence and behaviours, including transactional sex, among PWID recruited through specialist services in England, Wales, and Northern Ireland. METHODS Trends in sex work among PWID (2011-2021) were described. Data were analysed to assess differences between PWID who engaged in sex work in the past year (sex workers [SWs]) and those who did not (non-SWs) by gender (Pearson Chi2 tests) (2018-2021). Associations between sex work in the past year and adverse health outcomes were investigated using logistic regression. RESULTS Between 2011 and 2021, sex work among PWID remained stable, with 31% of women and 6.3% of men who inject, reporting having ever engaged in sex work, and 14% of women and 2.2% of men engaging in sex work in the past year. Between 2018 and 2021, SWs had greater odds of reporting symptoms of an injection-site infection (adjusted odds ratio (aOR): 1.68 [95% confidence interval {CI}: 1.31-2.16], P < 0.001) and reporting overdose (aOR: 2.21 [CI: 1.74-2.80], P < 0.001) than non-SWs had in the past year. Among men, SWs had 243% greater odds of having HIV than non-SWs (aOR: 3.43 [CI: 1.03-11.33], P = 0.043). CONCLUSIONS Our findings highlight disproportionate vulnerability and intersection of overlapping risk factors experienced by PWID SWs and a need for tailored interventions which are inclusive and low-threshold.
Collapse
Affiliation(s)
- E Emanuel
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - L Slater
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom.
| | - S Croxford
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom; St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, United Kingdom
| | - C Edmundson
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - A Ibitoye
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - J Njoroge
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - S Ijaz
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - V Hope
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom; Liverpool John Moores University, Liverpool, United Kingdom
| | - L Platt
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - E Phipps
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - M Desai
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| |
Collapse
|
9
|
Prata Menezes NS, Solomon SS, McFall AM, Srikrishnan AK, Vasudevan CK, Kumar MS, Celentano DD, Mehta SH, Lucas GM. Changes in HIV care continuum indicators among community-based samples of HIV-infected people who inject drugs and men who have sex with men across 21 cities in India. AIDS Care 2023; 35:1570-1579. [PMID: 36120904 PMCID: PMC10020120 DOI: 10.1080/09540121.2022.2119470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
Monitoring key populations' progress towards UNAIDS 90-90-90 targets is essential to achieving HIV/AIDS epidemic control. Using serial cross-sectional data, we evaluated changes in HIV care continuum among people who inject drugs(PWID) and men who have sex with men(MSM) in India. Cross-sectional baseline (2012/2013) and follow-up (2016/2017) samples were recruited using respondent-driven sampling across 21 cities. All participants were tested for HIV and RNA measured in HIV-positive participants. Linear regression was used to model temporal site-level changes in continuum indicators in MSM versus PWID. At baseline, we recruited 2,544 HIV-infected PWID and 1,086 HIV-infected MSM. At follow-up, we recruited 2,517 HIV-infected PWID and 1,763 HIV-infected MSM. At baseline, there were no significant differences in continuum indicators between MSM and PWID. At follow-up, compared to PWID, the proportion of MSM reaching each care continuum indicator-awareness of status, receipt of care, ART use, viral suppression-increased by 15-33 percentage points: 78% of MSM versus 49% of PWID were aware of their status (p < 0.01); 56% of MSM versus 32% of PWID were virologically suppressed (p = 0.05). MSM showed marked improvements across the care continuum, whereas PWID lagged and may require additional intervention. Differential improvement in HIV engagement may necessitate population-specific interventions and routine surveillance to facilitate HIV elimination.
Collapse
Affiliation(s)
- Neia S Prata Menezes
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sunil S Solomon
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - M Suresh Kumar
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gregory M Lucas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
10
|
McFall AM, Solomon SS, Lau B, Latkin C, Srikrishnan AK, Anand S, Vasudevan CK, Kumar MS, Lucas GM, H Mehta S. Respondent-driven sampling is more efficient than facility-based strategies at identifying undiagnosed people who inject drugs living with HIV in India. Drug Alcohol Depend 2023; 249:110834. [PMID: 37352733 PMCID: PMC10330670 DOI: 10.1016/j.drugalcdep.2023.110834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Injection drug use drives HIV epidemics in many low-resource settings, yet many people who inject drugs (PWID) living with HIV are not diagnosed. We assessed the ability of respondent-driven sampling (RDS) - which uses peer network connections - to identify undiagnosed PWID living with HIV compared to a facility-based strategy in India. METHODS In six Indian cities from 2014 to 2017, integrated care centers (ICCs) provided HIV testing. From 2016 to 2017, RDS samples of PWID in these same cities were conducted. Using biometric matching, characteristics associated with identification by RDS only and both RDS and ICC, compared to ICC only were explored. Undiagnosed individuals tested positive and did not report a prior diagnosis. The number needed to recruit (NNR) (average number recruited to find one undiagnosed PWID living with HIV) and the identification rate (average number undiagnosed PWID identified per week) assessed the efficiency of RDS vs. ICCs. RESULTS There were 10,759 ICC clients and 6012 RDS participants; 40% of RDS participants were also ICC clients resulting in 14,397 unduplicated PWID. PWID identified by RDS vs. ICC only were more likely to be male (adjusted odds ratios [aOR] RDS only: 6.8, both: 2.7) and living with HIV but undiagnosed (aOR RDS only: 2.5, both: 1.5). Overall, the RDS NNR was 11 and the ICC NNR was 26. The RDS identification rate (18.6/week) was faster than the ICC identification rate (2.7/week) overall and in all cities. CONCLUSIONS RDS required screening fewer PWID and more rapidly identified undiagnosed PWID living with HIV as compared to ICCs.
Collapse
Affiliation(s)
- Allison M McFall
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States.
| | - Sunil S Solomon
- Johns Hopkins University School of Medicine, Infectious Diseases Department, Baltimore, MD, United States
| | - Bryan Lau
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States
| | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, Baltimore, MD, United States
| | | | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | | | - Gregory M Lucas
- Johns Hopkins University School of Medicine, Infectious Diseases Department, Baltimore, MD, United States
| | - Shruti H Mehta
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States
| |
Collapse
|
11
|
Stannah J, Soni N, Lam JKS, Giguère K, Mitchell KM, Kronfli N, Larmarange J, Moh R, Nouaman M, Kouamé GM, Boily MC, Maheu-Giroux M. Trends in HIV testing, the treatment cascade, and HIV incidence among men who have sex with men in Africa: a systematic review and meta-analysis. Lancet HIV 2023; 10:e528-e542. [PMID: 37453439 DOI: 10.1016/s2352-3018(23)00111-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. In Africa, MSM face structural barriers to HIV prevention and treatment that increase their vulnerability to HIV acquisition and transmission, and undermine the HIV response. In this systematic review, we aimed to explore progress towards increases in HIV testing, improving engagement in the HIV treatment cascade, and HIV incidence reductions among MSM in Africa. METHODS We searched Embase, MEDLINE, Global Health, Scopus, and Web of Science for cross-sectional and longitudinal studies reporting HIV testing, knowledge of status, care, antiretroviral therapy (ART) use, viral suppression, and HIV incidence among MSM in Africa published between Jan 1, 1980, and March 3, 2023. We pooled surveys using Bayesian generalised linear mixed-effects models, used meta-regression to assess time trends, and compared HIV incidence estimates among MSM with those of all men. FINDINGS Of 9278 articles identified, we included 152 unique studies published in 2005-23. In 2020, we estimate that 73% (95% credible interval [CrI] 62-87) of MSM had ever tested for HIV. HIV testing in the past 12 months increased over time in central, western, eastern, and southern Africa (odds ratio per year [ORyear] 1·23, 95% CrI 1·01-1·51, n=46) and in 2020 an estimated 82% (70-91) had tested in the past 12 months, but only 51% (30-72) of MSM living with HIV knew their HIV status. Current ART use increased over time in central and western (ORyear 1·41, 1·08-1·93, n=9) and eastern and southern Africa (ORyear 1·37, 1·04-1·84, n=17). We estimated that, in 2020, 73% (47-88) of all MSM living with HIV in Africa were currently on ART. Nevertheless, we did not find strong evidence to suggest that viral suppression increased, with only 69% (38-89) of MSM living with HIV estimated to be virally suppressed in 2020. We found insufficient evidence of a decrease in HIV incidence over time (incidence ratio per year 0·96, 95% CrI 0·63-1·50, n=39), and HIV incidence remained high in 2020 (6·9 per 100 person-years, 95% CrI 3·1-27·6) and substantially higher (27-199 times higher) than among all men. INTERPRETATION HIV incidence remains high, and might not be decreasing among MSM in Africa over time, despite some increases in HIV testing and ART use. Achieving the UNAIDS 95-95-95 targets for diagnosis, treatment, and viral suppression equitably for all requires renewed focus on this key population. Combination interventions for MSM are urgently required to reduce disparities in HIV incidence and tackle the social, structural, and behavioural factors that make MSM vulnerable to HIV acquisition. FUNDING US National Institutes of Health, UK Medical Research Council, Canadian Institutes of Health Research, and Fonds de Recherche du Québec-Santé. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- James Stannah
- School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Nirali Soni
- Medical Research Council Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Jin Keng Stephen Lam
- Medical Research Council Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Katia Giguère
- Institut national de santé publique du Québec, Québec, QC, Canada
| | - Kate M Mitchell
- Medical Research Council Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Nadine Kronfli
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University Health Centre, Montréal, QC, Canada
| | - Joseph Larmarange
- Centre Population et Développement, Université Paris Cité, Institut de Recherche pour le Développement, Inserm, Paris, France
| | - Raoul Moh
- Pedagogical Unit of Dermatology and Infectiology, RTU Medical Science, Abidjan, Côte d'Ivoire; Programme PAC-CI, CHU de Treichville, Site ANRS, Abidjan, Côte d'Ivoire
| | - Marcellin Nouaman
- Programme PAC-CI, CHU de Treichville, Site ANRS, Abidjan, Côte d'Ivoire
| | | | - Marie-Claude Boily
- Medical Research Council Centre for Global Infectious Disease Analysis, Imperial College London, London, UK.
| | | |
Collapse
|
12
|
Loeb TA, McFall AM, Srikrishnan AK, Anand S, Vasudevan CK, Mehta SH, Solomon SS. Integration of a geospatially targeted community-based testing approach with respondent-driven sampling to identify people who inject drugs living with HIV and HCV in Patti and Gorakhpur, India. Drug Alcohol Depend 2023; 247:109874. [PMID: 37087926 PMCID: PMC10612114 DOI: 10.1016/j.drugalcdep.2023.109874] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/21/2023] [Accepted: 04/07/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Respondent-driven sampling (RDS), a network recruitment approach, is effective at reaching people who inject drugs (PWID), but other strategies may be needed to reach PWID at risk or living with HIV and/or Hepatitis C (HCV). We examined the impact of integrating geospatially targeted community-based HIV/HCV testing with an RDS survey. METHODS PWID were recruited between 2019 and 2021 in Patti and Gorakhpur, India, in a two-phased approach for identifying PWID living with HIV/HCV. Phase 1 was an RDS survey, in which participants reported injection venues. Venues with the highest prevalence of HIV/HCV viremia were selected for Phase 2: community-based testing. All participants underwent rapid HIV and HCV testing and viral load quantification. Using Pearson's chi-squared test, two-sided exact significance tests, and t-tests, we compared prevalence and identification rates for each of the primary outcomes: the number of PWID 1) living with HIV/HCV, 2) undiagnosed, and 3) viremic. RESULTS Both approaches identified large numbers of PWID (n∼500 each; N=2011) who were living with HIV/HCV and had transmission potential (i.e., detectable viremia). The community-based approach identified a higher proportion of individuals living with HCV (76.4% vs. 69.6% in Gorakhpur and 36.3% vs. 29.0% in Patti). Community-based testing was also faster at identifying PWID with detectable HIV viremia. Both approaches identified PWID with varying demographic characteristics. CONCLUSIONS Community-based testing was more efficient than RDS overall, but both may be required to reach PWID of varying characteristics. Surveillance should collect data on injection venues to facilitate community-based testing and maximize case identification.
Collapse
Affiliation(s)
- Talia A Loeb
- The Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States
| | - Allison M McFall
- The Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States
| | | | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | - Shruti H Mehta
- The Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States
| | - Sunil S Solomon
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| |
Collapse
|
13
|
Ghalekhani N, Mirzazadeh A, Tavakoli F, Mousavian G, Khezri M, Zamani O, Mehmandoost S, Haghdoost AA, Sharifi H. HIV Continuum of Care Among People Who Inject Drugs in Iran: A Cross-sectional Study. J Assoc Nurses AIDS Care 2023; 34:182-187. [PMID: 36728048 DOI: 10.1097/jnc.0000000000000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT People living with HIV who inject drugs may have lower access to treatment services. We aimed to assess the HIV continuum of care among people who inject drugs (PWID) in Iran. Data were collected from 2,663 PWID who were recruited via respondent-driven sampling from 11 cities of Iran between June 2019 and March 2020. Participants who tested positive for HIV infection were asked questions to calculate the status of HIV cascade of care. Of 95 PWID living with HIV, 67% were aware of their HIV status, 57% were linked to care service and initiated ART, 49% retained on ART, and only 15% had viral load less than 1,000 copies/ml. About half of the PWID diagnosed with HIV ever started ART and less than one in six were virally suppressed. Strategies to improve linkage to ART programs and ART retention may improve HIV care outcomes among PWID in Iran.
Collapse
Affiliation(s)
- Nima Ghalekhani
- Nima Ghalekhani, PhD, is a Research vice chancellor of HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. Ali Mirzazadeh, PhD, is an Assistant Professor of Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA, and HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. Fatemeh Tavakoli, MSc, is a PhD Candidate, who is a Research Assistant at HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. Ghazal Mousavian MSc, is a PhD Candidate, who is a Research Assistant at HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. Mehrdad Kherzi, MSc, is a PhD Candidate, who is a Research Assistant at HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. Omid Zamani, MD, MPH, is a Research assistant at HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. Soheil Mehmandoost, MSc, is a PhD Candidate, who is a Research Assistant at HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. Ali Akbar Haghdoost, PhD, is a Professor of Epidemiology, Head of the Institute for Futures Studies in Health Kerman University of Medical Sciences, HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Kerman, Iran. Hamid Sharifi, PhD, is a Professor of Epidemiology, Head of HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Aroke H, Buchanan A, Katenka N, Crawford FW, Lee T, Halloran ME, Latkin C. Evaluating the Mediating Role of Recall of Intervention Knowledge in the Relationship Between a Peer-Driven Intervention and HIV Risk Behaviors Among People Who Inject Drugs. AIDS Behav 2023; 27:578-590. [PMID: 35932359 PMCID: PMC10408304 DOI: 10.1007/s10461-022-03792-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/01/2022]
Abstract
Peer-driven interventions can be effective in reducing HIV injection risk behaviors among people who inject drugs (PWID). We employed a causal mediation framework to examine the mediating role of recall of intervention knowledge in the relationship between a peer-driven intervention and subsequent self-reported HIV injection-related risk behavior among PWID in the HIV Prevention Trials Network (HPTN) 037 study. For each intervention network, the index participant received training at baseline to become a peer educator, while non-index participants and all participants in the control networks received only HIV testing and counseling; recall of intervention knowledge was measured at the 6-month visit for each participant, and each participant was followed to ascertain HIV injection-related risk behaviors at the 12-month visit. We used inverse probability weighting to fit marginal structural models to estimate the total effect (TE) and controlled direct effect (CDE) of the intervention on the outcome. The proportion eliminated (PE) by intervening to remove mediation by the recall of intervention knowledge was computed. There were 385 participants (47% in intervention networks) included in the analysis. The TE and CDE risk ratios for the intervention were 0.47 [95% confidence interval (CI): 0.28, 0.78] and 0.73 (95% CI: 0.26, 2.06) and the PE was 49%. Compared to participants in the control networks, the peer-driven intervention reduced the risk of HIV injection-related risk behavior by 53%. The mediating role of recall of intervention knowledge accounted for less than 50% of the total effect of the intervention, suggesting that other potential causal pathways between the intervention and the outcome, such as motivation and skill, self-efficacy, social norms and behavior modeling, should be considered in future studies.
Collapse
Affiliation(s)
- Hilary Aroke
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI, 02881, USA.
| | - Ashley Buchanan
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI, 02881, USA
- Department of Computer Science and Statistics, College of Arts & Science, University of Rhode Island, Kingston, RI, 02281, USA
| | - Natallia Katenka
- Department of Computer Science and Statistics, College of Arts & Science, University of Rhode Island, Kingston, RI, 02281, USA
| | - Forrest W Crawford
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, 06510, USA
- Department of Statistics & Data Science, Yale University, New Haven, CT, 06510, USA
- Department of Ecology & Evolutionary Biology, Yale University, New Haven, CT, 06510, USA
- Yale School of Management, Yale University, New Haven, CT, 06510, USA
| | - TingFang Lee
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI, 02881, USA
| | - M Elizabeth Halloran
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seatle, WA, 98109, USA
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, 98195, USA
| | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| |
Collapse
|
15
|
Medeiros P, Warren L, Kazemi M, Massaquoi N, Smith S, Tharao W, Serghides L, Logie CH, Kroch A, Burchell AN, de Pokomandy A, Kaida A, Loutfy M. HIV care cascade for women living with HIV in the Greater Toronto Area versus the rest of Ontario and Canada. Int J STD AIDS 2023; 34:4-17. [PMID: 36411243 PMCID: PMC9806481 DOI: 10.1177/09564624221108034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Greater Toronto Area (GTA) is home to 39% of Canada's population living with HIV. To identify gaps in access and engagement in care and treatment, we assessed the care cascade of women living with HIV (WLWH) in the GTA versus the rest of Ontario and Canada (in this case: Quebec and British Columbia). METHODS We analyzed 2013-2015 self-reported baseline data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study for six care cascade stages: linked to care, retained in care, initiated antiretroviral therapy (ART), currently on ART, ART adherence (≥90%), and undetectable (<50 copies/mL). Multivariable logistic regression was used to reveal associations with being undetectable. RESULTS Comparing the GTA to the rest of Ontario and Canada, respectively: 96%, 98%, 100% were linked to care; 92%, 94%, 98% retained in care; 72%, 89%, 96% initiated ART; 67%, 81%, 90% were currently using ART; 53%, 66%, 77% were adherent; 59%, 69%, 81% were undetectable. Factors associated with viral suppression in the multivariable model included: living outside of the GTA (Ontario: aOR = 1.72, 95% CI: 1.09-2.72; Canada: aOR = 2.42, 95% CI: 1.62-3.62), non-Canadian citizenship (landed immigrant/permanent resident: aOR = 3.23, 95% CI: 1.66-6.26; refugee/protected person/other status: aOR = 4.77, 95% CI: 1.96-11.64), completed high school (aOR = 1.77, 95% CI: 1.15-2.73), stable housing (aOR = 2.13, 95% CI: 1.33-3.39), income of ≥$20,000 (aOR = 1.52, 95% CI: 1.00-2.31), HIV diagnosis <6 years (6-14 years: aOR = 1.75, 95% CI: 1.16-2.63; >14 years: aOR = 1.87, 95% CI: 1.19-2.96), and higher resilience (aOR = 1.02, 95% CI: 1.00-1.04). CONCLUSION WLWH living in the GTA had lower rates of viral suppression compared to the rest of Ontario and Canada even after adjustment of age, ethnicity, and HIV diagnosis duration. High-impact programming for WLWH in the GTA to improve HIV outcomes are greatly needed.
Collapse
Affiliation(s)
- Priscilla Medeiros
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Priscilla Medeiros, PhD, Women’s College
Research Institute, Women’s College Hospital, 76 Grenville Street, Room 6415,
Toronto, ON M5G 1N8, Canada. E-mail:
| | - Laura Warren
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mina Kazemi
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada
| | | | - Stephanie Smith
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands
Community Health, Toronto, ON, Canada
| | - Lena Serghides
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Toronto General Hospital Research
Institute, University Health
Network, Toronto, ON, Canada,Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Carmen H Logie
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | - Ann N Burchell
- Department of Family and Community
Medicine, St. Michael’s Hospital, Toronto, ON, Canada,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health
Centre, Montreal, QC, Canada,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Mona Loutfy
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | |
Collapse
|
16
|
El-Bassel N, McCrimmon T, Wu E, Chang M, Terlikbayeva A, Hunt T, Darisheva M, Primbetova S, Davis A, Metsch LR, Feaster DJ, Baiserkin B, Abishev A, Denebayeva A, Sagimbayev B, Kurmetova K, Mashirov K, Gilbert L. Effectiveness of an Intervention to Improve HIV Service Delivery for People Who Inject Drugs in Kazakhstan: A Cluster Trial. JAMA Netw Open 2022; 5:e2244734. [PMID: 36454567 PMCID: PMC9716389 DOI: 10.1001/jamanetworkopen.2022.44734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE The increasing HIV incidence rates and suboptimal rates of testing, engagement, and retention in care for people who inject drugs (PWID) in Kazakhstan underscore the need for effective HIV care continuum interventions for PWID. OBJECTIVE To determine the effectiveness of the Bridge HIV care continuum intervention implemented in needle and syringe programs (NSPs) in Kazakhstan. DESIGN, SETTING, AND PARTICIPANTS This stepped-wedge cluster trial was conducted from February 2017 to May 2020, with implementation beginning sequentially across 3 cities (Almaty, Karaganda-Temirtau, and Shymkent) in August 2017, January 2018, and May 2019. Intervention effect sizes were estimated via population-averaged models, and hypothesis testing relied on a permutation testing approach. The primary unit of analysis was an NSP. Data analysis was performed from October 2020 to April 2022. INTERVENTIONS The intervention addresses the full HIV care continuum: identification, testing, referral to services, and linkage to HIV care. The 3 intervention components were (1) a social network strategy, a peer-driven recruitment approach for HIV testing; (2) HIV counseling, rapid testing, and referral following international and national guidelines and protocols; and (3) enhanced antiretroviral treatment and access to services. MAIN OUTCOMES AND MEASURES The primary outcomes were the effectiveness of implementing Bridge's enhanced service integration approach in increasing the number of PWID served at NSPs, increasing the number of PWID who are tested for HIV in NSPs, and improving linking HIV-positive PWID with HIV care. Secondary outcomes included numbers of clients registered for HIV care, initiation of antiretroviral therapy, and viral suppression. RESULTS Twenty-four NSPs (8 in each city) served a total of 1225 PWID (369 in Almaty, 618 in Karaganda-Temirtau, and 238 in Shymkent) at the preimplementation study step; 1015 clients (82.9%) were male, and the mean (SD) age was 36.7 (7.1) years. Compared with preimplementation study steps, during Bridge intervention implementation steps, NSPs experienced a significant increase in the number of PWID clients registered (incidence rate ratio, 2.37; 95% CI, 1.48-3.78) and the number of PWID who received rapid HIV tests (incidence rate ratio, 3.98; 95% CI, 2.30-6.90). No significant increase in referral to HIV care was observed. The study also found significant support for secondary outcomes of antiretroviral therapy initiation and the number of clients who achieved viral suppression. CONCLUSIONS AND RELEVANCE In this stepped-wedge cluster trial, the findings suggest that implementation of the Bridge intervention was associated with significant improvement in several steps in the continuum of HIV care for PWID in Kazakhstan. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02796027.
Collapse
Affiliation(s)
- Nabila El-Bassel
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University School of Social Work, New York, New York
| | - Tara McCrimmon
- Columbia University Mailman School of Public Health, New York, New York
| | - Elwin Wu
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University School of Social Work, New York, New York
| | - Mingway Chang
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University School of Social Work, New York, New York
| | | | - Timothy Hunt
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University School of Social Work, New York, New York
| | | | | | - Alissa Davis
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University School of Social Work, New York, New York
| | - Lisa R Metsch
- Columbia University Mailman School of Public Health, New York, New York
| | - Daniel J Feaster
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Baurzhan Baiserkin
- Medical and Pharmaceutical Control Committee of the Ministry of Health of the Republic of Kazakhstan, Almaty, Kazakhstan
| | - Asylkhan Abishev
- Kazakh Scientific Center of Dermatology and Infectious Diseases, Almaty, Kazakhstan
| | - Alfiya Denebayeva
- Center for Prevention and Control of AIDS of the Almaty Health Department, Almaty, Kazakhstan
| | - Beibit Sagimbayev
- Karaganda Oblast Center for Prevention and Control of AIDS of the Health Department of Karaganda Oblast, Karaganda, Kazakhstan
| | - Kulpan Kurmetova
- Karaganda Oblast Center for Prevention and Control of AIDS of the Health Department of Karaganda Oblast, Karaganda, Kazakhstan
| | - Kozhakhmet Mashirov
- Center for Prevention and Control of AIDS of the Shymkent Health Department, Shymkent, Kazakhstan
| | - Louisa Gilbert
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University School of Social Work, New York, New York
| |
Collapse
|
17
|
Lindsay BR, Mwango L, Toeque M, Malupande SL, Nkhuwa E, Moonga CN, Chilambe A, Sakala H, Kafunda I, Olowski P, Olufunso A, Okuku J, Kancheya N, Mumba D, Hachaambwa L, Sheneberger R, Blanco N, Lavoie M, Claassen CW. Peer community health workers improve HIV testing and ART linkage among key populations in Zambia: retrospective observational results from the Z-CHECK project, 2019-2020. J Int AIDS Soc 2022; 25:e26030. [PMID: 36317821 PMCID: PMC9624072 DOI: 10.1002/jia2.26030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Zambia has made tremendous progress towards HIV epidemic control; however, gaps remain among key populations (KPs), such as female sex workers (FSWs), men who have sex with men (MSM), people who inject drugs (PWID) and people in prisons and enclosed settings due to cultural, social and legal barriers. The University of Maryland, Baltimore Zambia Community HIV Epidemic Control for Key Populations (Z-CHECK) project aimed to improve HIV case-finding, linkage and treatment adherence at the community level for KPs in Zambia. We describe Z-CHECK strategies and examine HIV positivity yield and antiretroviral therapy (ART) linkage among KPs to inform ongoing programme improvement. METHODS Z-CHECK recruited, trained and deployed peer community health workers (CHWs) for KP groups, with ongoing mentorship in community engagement. CHWs offered HIV testing in safe spaces and escorted newly HIV-diagnosed clients for same-day ART initiation. Z-CHECK also reached out to KP community leaders and gatekeepers for KP mobilization and trained healthcare workers (HCWs) on KP services and sensitivity. We conducted a retrospective observational review of routinely collected aggregate data for KPs aged ≥15 years at high risk for HIV transmission across five districts in Zambia from January 2019 to December 2020. RESULTS Z-CHECK provided HIV testing for 9211 KPs, of whom 2227 were HIV positive (positivity yield, 24%). Among these, 1901 (85%) were linked to ART; linkage for MSM, FSW, PWID and people in prisons and enclosed settings was 95%, 89%, 86% and 65%, respectively. Programme strategies that contributed to high positivity yield and linkage included the use of peer KP CHWs, social network testing strategies and opportunities for same-day ART initiation. Challenges to programme implementation included stigma and discrimination among HCWs, as well as KP CHW attrition, which may be explained by high mobility. CONCLUSIONS Peer CHWs were highly effective at reaching KP communities, identifying persons living with HIV and linking them to care. Engaging KP community gatekeepers resulted in high diffusion of health messages and increased access to health resources. The mobility of CHWs and HCWs is a challenge for programme implementation. Innovative interventions are needed to support PWID and people in prisons and enclosed settings.
Collapse
Affiliation(s)
- Brianna R. Lindsay
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia,Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | | | - Mona‐Gekanju Toeque
- Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | | | | | | | | | - Henry Sakala
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia
| | - Ina Kafunda
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia
| | - Pawel Olowski
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia
| | - Adebayo Olufunso
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia
| | - Jackson Okuku
- U.S. Centers for Disease Control and Prevention ZambiaLusakaZambia
| | - Nzali Kancheya
- U.S. Centers for Disease Control and Prevention ZambiaLusakaZambia
| | | | - Lottie Hachaambwa
- Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA,Ciheb ZambiaLusakaZambia
| | - Robb Sheneberger
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia,Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Natalia Blanco
- Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Marie‐Claude Lavoie
- Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Cassidy W. Claassen
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia,Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| |
Collapse
|
18
|
Durosinmi-Etti O, Nwala EK, Oki F, Ikpeazu A, Godwin E, Umoh P, Shaibu A, Ogundipe A, Kalaiwo A. Willingness to Pay for HIV Prevention Commodities Among Key Population Groups in Nigeria. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00303. [PMID: 36316139 PMCID: PMC9622283 DOI: 10.9745/ghsp-d-21-00303] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/02/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Key population (KP) groups, such as female sex workers and men who have sex with men, in Nigeria rely on free HIV prevention commodities, including pre-exposure prophylaxis (PrEP) and HIV self-testing (HIVST) kits, provided through foreign aid. We investigated the willingness of KP groups to use and pay for HIV prevention commodities to support improved sustainable HIV prevention programming. METHODS In 2020, we conducted a cross-sectional survey in 3 states with KP groups. The survey covered sociodemographic characteristics and willingness to use and pay for PrEP, HIVST, and condoms, and we used a bidding game iteration process to collect data on factors that influence willingness to use and pay for the commodities. We performed bivariate and multivariable regression analyses to explore factors that may determine willingness to pay and the maximum amount willing to pay. RESULTS Of the participants surveyed, 73% were willing to pay for PrEP services, 81% were willing to pay for HIVST, and 87% were willing to pay for condoms. Willingness to pay varied between the commodities and was associated with, among other variables: age, KP group, marital status, level of education, employment status, place of residence, average monthly income, and familiarity with the commodity in question. CONCLUSION We demonstrate that KP groups are willing to pay for HIV prevention commodities, but there is a need to bridge the gap between the maximum amount they are willing to pay and retail prices. If prices are reduced, the willingness to pay may result in high consumption and positive returns for the private sector.
Collapse
Affiliation(s)
| | | | - Funke Oki
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Akudo Ikpeazu
- National AIDS and STIs Control Program, Federal Ministry of Health, Abuja, Nigeria
| | | | - Paul Umoh
- Heartland Alliance Nigeria, Abuja, Nigeria
| | - Arome Shaibu
- JSI Research and Training Institute Inc, Abuja, Nigeria
| | - Alex Ogundipe
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Abiye Kalaiwo
- U.S. Agency for International Development Nigeria, Abuja, Nigeria
| |
Collapse
|
19
|
Nyashanu M, Lekalakala-Mokgele E. Exploring the impacts of and reactions to HIV diagnosis in older adults: narratives from Ga-Rankuwa, South Africa. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2022; 21:213-220. [PMID: 36102041 DOI: 10.2989/16085906.2022.2042339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 06/15/2023]
Abstract
There is an increase in prevalence of human immunodeficiency virus (HIV) infection among older adults. This new emerging social group is being overlooked, owing to the focus on groups that have traditionally been regarded as "high risk". This article set out to explore the impact of and reaction to HIV infection among older adults at the point of diagnosis. This study used a qualitative exploratory design that included a purposive sample of older adults currently receiving HIV treatment. The researchers recruited 12 participants who met the study's inclusion criteria. Face-to-face interviews were used to collect data. A thematic approach was used to analyse the data. The study found that the impact on and reaction of older adults following HIV diagnosis included anger and shock, feeling suicidal, blaming others, fear of stigma and discrimination, loss of trust and intimacy, fear of disclosure to new partners and denial. The study concluded that there is a need to improve sexual health and HIV services that cater for the needs of older adults as a new emerging group affected by HIV. Furthermore, HIV testing and prevention counselling should be offered to older adults just as it is to younger patients.
Collapse
Affiliation(s)
- Mathew Nyashanu
- Institute of Health & Allied Professions, Nottingham Trent University, Nottingham, United Kingdom
| | | |
Collapse
|
20
|
Patel EU, Solomon SS, McFall AM, Prata Menezes N, Tomori C, Srikrishnan AK, Kumar MS, Celentano DD, Lucas GM, Mehta SH. Drug use stigma, antiretroviral therapy use, and HIV viral suppression in a community-based sample of people with HIV who inject drugs. AIDS 2022; 36:1583-1589. [PMID: 35730390 PMCID: PMC9391282 DOI: 10.1097/qad.0000000000003297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the association of drug use stigma with antiretroviral therapy (ART) use and HIV viral suppression among people with HIV who inject drugs in India. DESIGN Cross-sectional biobehavioral survey. METHODS Between August 2016 and May 2017, persons aged at least 18 years who reported injection drug use in the past 2 years were recruited via respondent-driven sampling (RDS) in 12 Indian cities (approximately 1000 per city). The analysis was restricted to participants with laboratory-confirmed HIV infection who self-reported a prior HIV diagnosis and were eligible for ART per concurrent national HIV treatment guidelines. Enacted and internalized drug use stigma were each measured by five to six-item subscales. The study outcomes were HIV viral suppression (<150 copies/ml) and self-reported past 30-day ART use. RDS-II weighted multivariable logistic regression with a city-level random-intercept was used to estimate adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CIs). RESULTS Among 971 ART-eligible participants previously diagnosed with HIV, 65.1% reported ART use and 56.1% were virally suppressed. Reporting any enacted stigma (vs. none) was associated with lower odds of ART use [aOR = 0.26 (95% CI = 0.15-0.44)] and viral suppression [aOR = 0.49 (95% CI = 0.31-0.78)]. High internalized stigma scores (>median vs. ≤median) were associated with lower odds of viral suppression among participants aged at least 35 years [aOR = 0.51 (95% CI = 0.27-0.97)] but not among participants aged less than 35 years [aOR = 1.22 (95% CI = 0.57-2.60)]. Similar associations were observed in analyses restricted to participants ever linked to HIV care. CONCLUSION Drug use stigma may be a barrier to HIV viral suppression among people with HIV who inject drugs, thereby hindering efforts to achieve HIV control.
Collapse
Affiliation(s)
- Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Neia Prata Menezes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Cecília Tomori
- Johns Hopkins University School of Nursing
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gregory M Lucas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| |
Collapse
|
21
|
Jones HS, Hensen B, Musemburi S, Chinyanganya L, Takaruza A, Chabata ST, Matambanadzo P, Rice B, Cowan FM, Hargreaves JR. Interpreting declines in HIV test positivity: an analysis of routine data from Zimbabwe's national sex work programme, 2009–2019. J Int AIDS Soc 2022; 25:e25943. [PMID: 35773959 PMCID: PMC9247303 DOI: 10.1002/jia2.25943] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 05/19/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction Methods Results Conclusions
Collapse
Affiliation(s)
- Harriet S. Jones
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine London UK
| | - Bernadette Hensen
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine London UK
| | - Sithembile Musemburi
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe Harare Zimbabwe
| | - Lilian Chinyanganya
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe Harare Zimbabwe
| | - Albert Takaruza
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe Harare Zimbabwe
| | - Sungai T. Chabata
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe Harare Zimbabwe
| | | | - Brian Rice
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine London UK
| | - Frances M. Cowan
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe Harare Zimbabwe
- Faculty of Global Health, Liverpool School of Tropical Medicine Liverpool UK
| | - James R. Hargreaves
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine London UK
| |
Collapse
|
22
|
Reaching the 90–90–90 UNAIDS treatment target for people who inject drugs receiving integrated clinical care at a drug-use outpatient treatment facility. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01298-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
23
|
Mulholland GE, Markiewicz M, Arimi P, Ssengooba F, Weir S, Edwards JK. HIV Prevalence and the HIV Treatment Cascade Among Female Sex Workers in Cross-Border Areas in East Africa. AIDS Behav 2022; 26:556-568. [PMID: 34379274 DOI: 10.1007/s10461-021-03411-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/14/2022]
Abstract
In cross-border areas of East Africa, sexual networks include partnerships across resident, migrant, and mobile populations, and risky behaviors can coincide with fragmented health services given the challenges of cross-border coordination. Among those most at risk are female sex workers (FSWs). We map HIV prevalence among FSWs in 14 cross-border areas, estimate associations between FSW characteristics and HIV and undiagnosed HIV, and estimate progress towards the UNAIDS 90-90-90 targets. The 2016-2017 East Africa Cross-Border Integrated Health Study recruited 4040 women; 786 were classified as FSWs. Overall HIV prevalence among FSWs was 10.8% (95% CI 8.2%, 13.3%), though area-specific estimates varied considerably. Among FSWs living with HIV, 46.1% (95% CI 33.2%, 59.0%) knew their status, 80.6% (95% CI 66.3%, 94.9%) of FSWs who knew their status were on ART, and 84.8% (95% CI 66.1%, 100.0%) of FSWs on ART were virally suppressed. Results indicate a need for expanded HIV testing.
Collapse
Affiliation(s)
- Grace E Mulholland
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB 7435, Chapel Hill, NC, 27599-7435, USA.
| | - Milissa Markiewicz
- MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Peter Arimi
- Centre for Research, Innovation and Grants Advancement, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Freddie Ssengooba
- Department of Health Policy Planning and Management, Makerere School of Public Health, Kampala, Uganda
| | - Sharon Weir
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB 7435, Chapel Hill, NC, 27599-7435, USA
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB 7435, Chapel Hill, NC, 27599-7435, USA
| |
Collapse
|
24
|
GLICK JL, RUSSO RG, HUANG AKH, JIVAPONG B, RAMASAMY V, ROSMAN LM, PELAEZ DL, SHERMAN SG. ART uptake and adherence among female sex workers (FSW) globally: A scoping review. Glob Public Health 2022; 17:254-284. [PMID: 33301704 PMCID: PMC8190161 DOI: 10.1080/17441692.2020.1858137] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We conducted the first scoping literature review on ART uptake and adherence among Female Sex Workers (FSW), following PRISMA-ScR guidelines. Searches were conducted in PubMed, Embase, CINAHL, PsycInfo, and Sociological Abstracts. Eligibility criteria included: reporting an ART uptake or adherence result among FSW aged 18 or older; peer-reviewed; published in English between 1996 and 2018. Our search identified 6,735 studies; 30 met eligibility requirements. ART uptake ranges from 0 to 100% and adherence ranges from 50-90%, depending on measurement methods. Uptake and adherence influencing factors are mapped onto a social ecological model (SEM). Knowledge and beliefs, substance use, food insecurity and sex-work engagement were negatively associated, while older age, relationships and social support were positively associated with ART uptake and adherence. Standardised methods to measure uptake and adherence prevalence must be established for data comparison. Evidence regarding ART uptake and adherence barriers and facilitators span multiple SEM levels, although more research is needed regarding structural and occupational level influencers. Results suggest that the multi-level ART uptake and adherence barriers faced by FSW require complex multi-level evidence-based interventions. Study findings can inform ART interventions, future research, and offer guidance to other support services with FSW, such as PrEP interventions.
Collapse
Affiliation(s)
- Jennifer L. GLICK
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Rienna G. RUSSO
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Aimee Kao-Hsuan HUANG
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Belinda JIVAPONG
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | | | - Lori M. ROSMAN
- Welch Medical Library, Johns Hopkins University, Baltimore MD, USA
| | - Danielle L PELAEZ
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Susan G. SHERMAN
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| |
Collapse
|
25
|
Smith AD, Fearon E, Kabuti R, Irungu E, Kungu M, Babu H, Nyabuto C, Muthoga P, Weatherburn P, Bourne A, Kimani J. Disparities in HIV/STI burden and care coverage among men and transgender persons who have sex with men in Nairobi, Kenya: a cross-sectional study. BMJ Open 2021. [PMCID: PMC8719220 DOI: 10.1136/bmjopen-2021-055783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ObjectivesThe study aimed to estimate the prevalence of, and associations, with HIV and metrics of HIV care engagement in a representative population of gay, bisexual and other men who have sex with men (GBMSM) and transgender persons (TP) who have sex with men (GBMSM/TP)SettingUrban districts of Nairobi, Kenya.DesignCross-sectional.Participants608 eligible participants were identified through respondent-driven sampling over 19 waves of recruitment arising from ten seeds between May and December 2017. Inclusion criteria were: age >18 years; Nairobi residence; male sex assignment at birth or current identification as male, and recent consensual sex with male partners. Exclusion criteria were: missing or invalid recruitment coupon; repeat registration; intoxication at study visit.Primary and secondary outcome measuresHIV status measured using Determine Alere HIV 1/2 and First Response HIV 1–2.0 and GeneXpert HIV-1 Qual. Self-reported metrics of HIV status awareness, antiretroviral use and objective quantification of viral suppression using GeneXpert HIV-1 VL.Results26.4% (286/618) were HIV positive of whom 76.6% were status aware, 65.3% were on antiretroviral therapy (ART), and 47.4% were virally suppressed (<50 copies/mL). Participants 18–22 years were less likely to be status aware, be receiving ART or to have achieved viral suppression. Mean log viral load was 3.14 log higher in 18–22 years compared with older participants. Bacterial sexually transmitted infections were common at both urethral and rectal sites and most infections were asymptomatic by self-report (rectal 82.2%, urethral 82.3%).ConclusionsEngagement in the HIV diagnosis and care cascade among GBMSM/TP in Nairobi is markedly better than in most sub-Saharan African countries, yet falls short of achievements for the general population in Kenya and for GBMSM in high income settings. Young GBMSM/TP are least well served by the current configuration of adult key population services, and programmes should identify and address the sexual, social and developmental needs of adolescent and young key populations.
Collapse
Affiliation(s)
- Adrian D Smith
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elizabeth Fearon
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Rhoda Kabuti
- Partners for Health and Development, Nairobi, Kenya
| | | | - Mary Kungu
- Partners for Health and Development, Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development, Nairobi, Kenya
| | | | - Peter Muthoga
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Weatherburn
- Sigma Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Joshua Kimani
- Department of Global Health & Development, Partners for Health and Development, Nairobi, Kenya
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
26
|
Durosinmi-Etti O, Nwala EK, Oki F, Ikpeazu A, Godwin E, Umoh P, Shaibu A, Ogundipe A, Kalaiwo A. Communication needs for improved uptake of PrEP and HIVST services among key populations in Nigeria: a mixed-method study. AIDS Res Ther 2021; 18:88. [PMID: 34801037 PMCID: PMC8605890 DOI: 10.1186/s12981-021-00411-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/03/2021] [Indexed: 11/21/2022] Open
Abstract
Background World Health Organization (WHO) reports that people who indulge in risky behaviours such as penile-anal sex, unprotected intercourse, multiple sex partners, and alcohol and illicit drugs are at risk of HIV/AIDS and classified as Key Populations (KPs). Since the introduction of PrEP and HIVST for the key population groups in Nigeria, government entities and implementing partners have used a range of channels in messaging these essential services across to the target groups—ranging from in-person, social media, television, and radio adverts. Yet, few successes have been documented, thereby necessitating the need to understand the enabling facilitators, barriers to, and communication needs of the KP groups in messaging PrEP and HIVST services in Nigeria. Communicating PrEP and HIVST services will empower the key populations to seek available HIV prevention services and help to increase access to HIV testing services in Nigeria. Methods This study was a mixed-method cross-sectional design; involving 1169 participants from the key populations in Nigeria. The study used a survey and qualitative exploratory methods (interviews and focus group discussion), to collect data from the participants—MSM, FSWs, and key influencers of the KP groups (health providers, peer educators, HIV program officers). In August 2020, data collection was conducted using an open data kit (ODK). Quantitative data were analyzed using SPSS version 20 for descriptive statistics, while qualitative data were analyzed using deductive and thematic analysis based on the codebook. Results The KPs were mainly urban dwellers (77.7%), and the majority of the participants were between 18 to 28 years (89.3%). However, the MSM group was of a younger population compared to the FSWs. A majority completed secondary education (56.1% FSWs and 43.5% MSM). The MSM group showed more tendency to acquire higher education compared to the FSWs. For example, about 51.3% of the MSM group were undergraduates compared to 9.5% of the FSWs. The majority of the KPs were self-employed (56.4% FSWs and 40% MSM). Only about 51% of the KPs were aware of PrEP, with typological variations (39.9% FSWs and 62.3% MSM). MSM group in Lagos (82.5%) were more aware of PrEP services, than 53.1% and 54.5% in A/Ibom (53.1%) and C/River (54.5%). Among the enablers to acquiring PrEP information was the ability of the KPs to network within their communities and on personal relationships. Evidence shows that no single approach influenced the acquisition and use of PrEP information by KPs. Although this proportion varied across the geographic locations, only about 50% of the KPs were aware of HIVST services (40% FSWs and 60% MSM). The factors that enabled the acquisition and use of the prevention commodities were cross-cutting, including a previous or current role as a peer educator, integration of the messages, peer networking, multi-lingual and multi-channel presentation, job aids, and reminders. KPs expressed the need for information on how to take PrEP, eligibility, clarification on differences between PrEP and PEP, clarification on any side effects, for PrEP, price, efficacy, sales point, dosage, available brands. A scale-up of the research across all geopolitical zones and a survey to quantify the prevalence would help understand the dynamics and prioritization of interventions for scaling up PrEP and HIVST services in Nigeria. Conclusions The study documented barriers and facilitators to the uptake of PrEP and HIVST among key populations in Nigeria. It highlighted that KPs are willing to receive PrEP and HIVST messages. The policy actors should consider the preferences of the KPs and the key influencers in reducing barriers to communication and increasing the uptake of PrEP and HIVST services; ensure it reflects in a tailored communication strategy. Since multi-linguistics and multi-channels of presentation were enablers to acquiring PrEP and HIVST messages, the communications strategy for HIV prevention should incorporate these recommendations and adapt to context-specific approaches for effective messaging.
Collapse
|
27
|
Rocha-Jiménez T, Pitpitan EV, Cazares R, Smith LR. "He is the Same as Me ": Key Populations' Acceptability and Experience of a Community-Based Peer Navigator Intervention to Support Engagement in HIV Care in Tijuana, Mexico. AIDS Patient Care STDS 2021; 35:449-456. [PMID: 34665000 PMCID: PMC8817705 DOI: 10.1089/apc.2021.0069] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Engagement in the HIV care continuum among people living with HIV is essential to prevent ongoing transmission. Although there is evidence for the need for comprehensive approaches (e.g., peer navigation) to improve the HIV care continuum, there is limited knowledge of how the peer navigation model might work to improve the HIV care continuum in low resource settings among Latinx key populations (e.g., persons who inject drugs, female sex workers, men who have sex with men, and transgender women). Therefore, this article aims to qualitatively assess members of key populations' acceptability of Conexiones Saludables (Healthy Connections), a community-based peer navigation intervention implemented in Tijuana, Mexico. This analysis draws upon the postintervention survey data from 34 participants and data from qualitative interviews with 10 participants. Participants found the intervention to be acceptable and discussed the ways in which peer navigators were influential in educating participants about HIV, antiretroviral therapy (ART), linking participants to existing HIV care and ancillary services in Tijuana, and in providing emotional and instrumental support to facilitate engagement in HIV treatment and ART adherence. The intervention emphasized the use of peer navigators who had a deep understanding of the sociostructural barriers (e.g., substance use, homelessness) that HIV-positive key populations face in Tijuana. Findings from this study may inform programs with highly vulnerable populations in similar settings.
Collapse
Affiliation(s)
- Teresita Rocha-Jiménez
- Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, California, USA
| | - Eileen V. Pitpitan
- School of Social Work, San Diego State University, San Diego, California, USA
| | | | - Laramie R. Smith
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, California, USA
| |
Collapse
|
28
|
Firkey M, Sheinfil A, Ramos J, Woolf-King SE. Cannabis and Alcohol Co-Use and Condomless Anal Sex Among Men Who have Sex with Men Living with HIV: An Event-Level Analysis. AIDS Behav 2021; 25:3770-3781. [PMID: 33733310 DOI: 10.1007/s10461-021-03228-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Men who have sex with men (MSM) account for more than two thirds of new HIV diagnoses annually. Sexual behavior that increases risk for onward transmission of HIV is associated with both alcohol and cannabis use. However, little is known about the influence of cannabis and alcohol co-use on engagement in condomless anal sex (CAS). The current study explored daily associations between substance use and CAS among HIV-positive MSM using a 42-day timeline followback interview (N = 101). Generalized estimating equation (GEE) logistic regression models were used to examine the association between cannabis and alcohol co-use and CAS at the sexual event while controlling for study site, condition, adherence to antiretroviral therapy, sex-related alcohol expectancies, and partner type. Participants provided data for 1052 sexual activity days, 60.7% of which involved CAS. Of 638 CAS days, 9.1% involved no substances, 72.0% involved either cannabis or alcohol use, and 18.9% involved cannabis and alcohol co-use. Results indicated that the odds of engaging in CAS were higher for sexual events in which cannabis and alcohol co-use occurred (aOR 2.98; 95% CI 1.27, 6.97) compared to events in which no substance use occurred (p = 0.012), but this relationship was no longer significant when cannabis and alcohol co-use was compared to single substance use (aOR 1.57; 95% CI 0.85, 2.90; p = 0.15). Future research should identify specific substance use (e.g., quantity) and partner characteristics (e.g., level of intoxication) that may uniquely influence the relationship between cannabis and alcohol co-use and condomless sex.
Collapse
|
29
|
Dunbar W, Alcide Jean-Pierre MC, Pétion JS, Labat A, Maulet N, Coppieters Y. A realist evaluation of the continuum of HIV services for men who have sex with men. AIDS Res Ther 2021; 18:67. [PMID: 34627315 PMCID: PMC8502381 DOI: 10.1186/s12981-021-00396-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022] Open
Abstract
Background Men who have Sex with Men (MSM) represent the risk group that are disproportionately most affected by the human immunodeficiency virus (HIV) and continue to drop-off from the steps of the continuum of HIV services that have been adopted to overcome poor engagement and retention in care. This realist evaluation aimed at: (1) describing the evaluation carried out in Haiti aiming to ascertain why, how and under which circumstances MSM are linked and retained along the continuum, (2) assessing the outcomes of this approach and (3) exploring the motivators and facilitators for the HIV continuum of services through mechanisms and pathways. Methods Guided by a realist approach, first, an initial program theory (IPT) was developed based on literature and frameworks review, participant observations and discussions with stakeholders. Then, the IPT was tested using a mixed method explanatory study: a quantitative phase to build the continuum from a cross-sectional analysis, and a qualitative phase to explore the motivators and facilitators related to proper linkages along the continuum. Finally, the IPT was refined by eliciting the mechanisms and pathways for outcomes improvement. Results The results showed that the current service delivery model is suboptimal in identifying, engaging, linking and retaining MSM, resulting in loss to follow-up at every step of the continuum and failure to fully realize the health and prevention benefits of antiretroviral. However, the mechanisms through which linkages across the continuum can be improved are: self-acceptance, sense of community support and sense of comprehensive and tailored HIV services. These mechanisms are based on 10 different pathways: self-esteem, awareness and pride, perception of HIV risk, pcceptance and HIV status, addressing community stigma, strengthening of MSM organizations and community networks, societal acceptation and tolerance, stigma reduction training for healthcare providers, engagement of peers as educators and navigators and, adapted services delivery through drug dispensing points and mobile technology and financial assistance. Conclusions The study findings show that engagement, adherence and retention to the continuum of HIV service for MSM are affected by a multi-layer of factors, thus highlighting the importance of taking a comprehensive approach to improve the program.
Collapse
|
30
|
Morin L, Béhanzin L, Guédou FA, Kêkê RK, Bushman L, Anderson PL, Gangbo F, Diabaté S, Nagot N, Alary M. HIV Prevention and Treatment Cascades Among Female Sex Workers in Benin, West Africa. Sex Transm Dis 2021; 48:654-662. [PMID: 33633072 DOI: 10.1097/olq.0000000000001399] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Benin has a long-standing history of HIV prevention programs aimed at female sex workers (FSWs). We used data from a national survey among FSWs (2017) to assess the prevention and care cascades in this population. METHODS Female sex workers were recruited through cluster sampling of sex work sites. A questionnaire was administered, and HIV tested. HIV-positive participants were asked to provide dried blood spots and were tested for antiretroviral and viral load. We assessed 2 prevention cascades (HIV testing and safer sex) and the treatment cascade, using a combination of self-reported and biological variables. RESULTS Mean age of the 1086 FSWs was 30 years. Half of them were Beninese, and two-thirds had a primary school education level or less. Almost all FSWs had ever heard of HIV/AIDS. More than half (79.1%) had ever been tested, and 84.1% of the latter had been tested in the last year. In the previous 6 months, 90.1% were exposed to prevention messages. Women exposed to any HIV prevention message reported a higher level of consistent condom use in the last month (69.0%) than those who were not (48.5%, P < 0.0001). HIV prevalence was 7.7%. Among HIV-positive women, 60.6% knew their status; among those, 90.5% were on antiretroviral and 81.8% of them had a suppressed viral load. CONCLUSIONS Despite long-standing HIV prevention programs for FSWs, the prevention indicators were often low. Linkage to care was good, viral suppression was suboptimal, but knowledge of HIV-positive status was low. Exposing women to prevention messages is necessary, as to increase HIV testing.
Collapse
Affiliation(s)
| | | | | | | | - Lane Bushman
- University of Colorado Anschutz Medical Campus-Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO
| | - Peter L Anderson
- University of Colorado Anschutz Medical Campus-Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO
| | | | | | - Nicolas Nagot
- CHU de Montpellier et INSERM UMR 1058, Montpellier, France
| | | |
Collapse
|
31
|
Smyth HL, Pitpitan EV, MacKinnon DP, Booth RE. Assessing Potential Outcomes Mediation in HIV Interventions. AIDS Behav 2021; 25:2441-2454. [PMID: 33740215 DOI: 10.1007/s10461-021-03207-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2021] [Indexed: 10/21/2022]
Abstract
Knowledge of causal processes through mediation analysis can help improve the effectiveness and reduce costs of public health programs, like HIV prevention and treatment interventions. Advancements in mediation using the potential outcomes framework provide a method for estimating the causal effect of interventions on outcomes via a mediating variable. The purpose of this paper is to provide practical information about mediation and the potential outcomes framework that can enhance data analysis and causal inference for intervention studies. Causal mediation effects are defined and then estimated using data from an HIV intervention randomized trial among people who inject drugs (PWID) in Ukraine. Results from a potential outcomes mediation analysis show that the intervention had a total causal effect on incident HIV infection such that participants in the experimental group were 36% less likely to become infected during the 12-month study than those in the control arm, but that neither self-efficacy nor network communication mediated this effect. Because neither putative mediator was significant, measurement and confounding issues should be investigated to rule out these mediators. Other putative mediators, such as injection frequency, route of administration, or HIV knowledge can be considered. Future research is underway to examine additional, multiple mediators explaining efficacy of the current intervention and sensitivity to confounding effects.
Collapse
|
32
|
Maatouk I, Jaspal R. Barriers to HIV treatment as prevention (TasP) in men who have sex with men in the Eastern Mediterranean Region. J Public Health (Oxf) 2021; 42:e513-e515. [PMID: 31915825 DOI: 10.1093/pubmed/fdz186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/14/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ismael Maatouk
- Dermatology Department, Clemenceau Medical Center, Johns Hopkins International, Beirut, Lebanon.,Faculty of Health and Life Sciences, De Montfort University, Leicester LE1-9BH, UK
| | - Rusi Jaspal
- Faculty of Health and Life Sciences, De Montfort University, Leicester LE1-9BH, UK
| |
Collapse
|
33
|
Khanna AS, Edali M, Ozik J, Collier N, Hotton A, Skwara A, Ardestani BM, Brewer R, Fujimoto K, Harawa N, Schneider JA. Projecting the number of new HIV infections to formulate the "Getting to Zero" strategy in Illinois, USA. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:3922-3938. [PMID: 34198418 PMCID: PMC8281377 DOI: 10.3934/mbe.2021196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Getting to Zero (GTZ) initiatives focus on expanding use of antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) to eliminate new HIV infections. Computational models help inform policies for implementation of ART and PrEP continuums. Such models, however, vary in their design, and may yield inconsistent predictions. Using multiple approaches can help assess the consistency in results obtained from varied modeling frameworks, and can inform optimal implementation strategies. METHODS A study using three different modeling approaches is conducted. Two approaches use statistical time series analysis techniques that incorporate temporal HIV incidence data. A third approach uses stochastic stimulation, conducted using an agent-based network model (ABNM). All three approaches are used to project HIV incidence among a key population, young Black MSM (YBMSM), over the course of the GTZ implementation period (2016-2030). RESULTS All three approaches suggest that simultaneously increasing PrEP and ART uptake is likely to be more effective than increasing only one, but increasing ART and PrEP by 20% points may not eliminate new HIV infections among YBMSM. The results further suggest that a 20% increase in ART is likely to be more effective than a 20% increase in PrEP. All three methods consistently project that increasing ART and PrEP by 30% simultaneously can help reach GTZ goals. CONCLUSIONS Increasing PrEP and ART uptake by about 30% might be necessary to accomplish GTZ goals. Such scale-up may require addressing psychosocial and structural barriers to engagement in HIV and PrEP care continuums. ABNMs and other flexible modeling approaches can be extended to examine specific interventions that address these barriers and may provide important data to guide the successful intervention implementation.
Collapse
Affiliation(s)
- Aditya Subhash Khanna
- Center for Alcohol and Addiction Studies, Brown University, Providence RI USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence RI USA
| | - Mert Edali
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
- Department of Industrial Engineering, Yildiz Technical University, Besiktas, Istanbul 34349, Turkey
| | - Jonathan Ozik
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, IL, USA
| | - Nicholson Collier
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, IL, USA
| | - Anna Hotton
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Abigail Skwara
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Babak Mahdavi Ardestani
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Russell Brewer
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Kayo Fujimoto
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Nina Harawa
- Department of Psychiatry and Human Behavior, Charles R. Drew University, Los Angeles, CA, USA
- Department of Epidemiology, University of California, Los Angeles, CA, USA
| | - John A. Schneider
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| |
Collapse
|
34
|
Vourli G, Noori T, Pharris A, Porter K, Axelsson M, Begovac J, Cazein F, Costagliola D, Cowan S, Croxford S, d'Arminio Monforte A, Delpech V, Díaz A, Girardi E, Gunsenheimer-Bartmeyer B, Hernando V, Leierer G, Lot F, Nunez O, Obel N, Op de Coul E, Paraskeva D, Patrinos S, Reiss P, Schmid D, Sonnerborg A, Suligoi B, Supervie V, van Sighem A, Zangerle R, Touloumi G. Human Immunodeficiency Virus Continuum of Care in 11 European Union Countries at the End of 2016 Overall and by Key Population: Have We Made Progress? Clin Infect Dis 2021; 71:2905-2916. [PMID: 32960957 PMCID: PMC7778352 DOI: 10.1093/cid/ciaa696] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 08/21/2020] [Indexed: 12/18/2022] Open
Abstract
Background High uptake of antiretroviral treatment (ART) is essential to reduce human immunodeficiency virus (HIV) transmission and related mortality; however, gaps in care exist. We aimed to construct the continuum of HIV care (CoC) in 2016 in 11 European Union (EU) countries, overall and by key population and sex. To estimate progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target, we compared 2016 to 2013 estimates for the same countries, representing 73% of the population in the region. Methods A CoC with the following 4 stages was constructed: number of people living with HIV (PLHIV); proportion of PLHIV diagnosed; proportion of those diagnosed who ever initiated ART; and proportion of those ever treated who achieved viral suppression at their last visit. Results We estimated that 87% of PLHIV were diagnosed; 92% of those diagnosed had ever initiated ART; and 91% of those ever on ART, or 73% of all PLHIV, were virally suppressed. Corresponding figures for men having sex with men were: 86%, 93%, 93%, 74%; for people who inject drugs: 94%, 88%, 85%, 70%; and for heterosexuals: 86%, 92%, 91%, 72%. The proportion suppressed of all PLHIV ranged from 59% to 86% across countries. Conclusions The EU is close to the 90-90-90 target and achieved the UNAIDS target of 73% of all PLHIV virally suppressed, significant progress since 2013 when 60% of all PLHIV were virally suppressed. Strengthening of testing programs and treatment support, along with prevention interventions, are needed to achieve HIV epidemic control.
Collapse
Affiliation(s)
- Georgia Vourli
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Solna, Sweden
| | | | | | | | - Josip Begovac
- Department of Infectious Diseases, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Francoise Cazein
- Santé publique France, the French national public health agency, Saint-Maurice, France
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | | | | | | | | | - Asunción Díaz
- Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain
| | - Enrico Girardi
- Istituto Nazionale Malattie Infettive 'L. Spallanzani, Roma, Italy
| | | | - Victoria Hernando
- Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Florence Lot
- Santé publique France, the French national public health agency, Saint-Maurice, France
| | - Olivier Nunez
- Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain
| | - Niels Obel
- Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Eline Op de Coul
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Dimitra Paraskeva
- Hellenic Center for Disease Control and Prevention, Amarousio, Greece
| | - Stavros Patrinos
- Hellenic Center for Disease Control and Prevention, Amarousio, Greece
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, The Netherlands.,Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniela Schmid
- Austrian Agency for Health and Food Safety, Vienna, Austria
| | - Anders Sonnerborg
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Barbara Suligoi
- National AIDS Unit, Istituto Superiore di Sanita, Rome, Italy
| | - Virginie Supervie
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | | | | | - Giota Touloumi
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | |
Collapse
|
35
|
Maragh-Bass AC, Gamble T, El-Sadr WM, Hanscom B, Tolley EE. Examining stigma, social support, and gender differences in unsuppressed HIV viral load among participants in HPTN 065. J Behav Med 2021; 44:159-171. [PMID: 33161564 PMCID: PMC11068030 DOI: 10.1007/s10865-020-00186-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/17/2020] [Indexed: 01/13/2023]
Abstract
Successful navigation of the HIV care continuum is necessary to maintain viral suppression. We explored gender-stratified correlates of being virally unsuppressed in the Prevention for Positives (P4P) component of HPTN 065. The outcome of interest was unsuppressed viral load (> 40 copies/mL) among individuals already living with HIV. Correlates included medication adherence factors, social support and stigma. Logistic regression models were stratified by gender (N = 673). Men-specific correlates of being virally unsuppressed included opposite-sex partners, older age and HIV disclosure stigma. Women-specific correlates included time since diagnosis, and personal-level barriers to medication adherence. When more individuals knew about their HIV status, women had over twice the likelihood of being virally unsuppressed; no such association was seen among men. Additionally, higher levels of social support were not associated with viral suppression among women. Interventions should consider gender-specific approaches to engaging social support in de-stigmatization of HIV and promotion of medication adherence and subsequent viral suppression.
Collapse
Affiliation(s)
| | | | - Wafaa M El-Sadr
- International Center for AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Brett Hanscom
- HIV Prevention Trials Network Statistical Center for HIV AIDS Research and Prevention, University of Washington Seattle, Seattle, WA, USA
| | - Elizabeth E Tolley
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences, Durham, NC, USA
| |
Collapse
|
36
|
The HIV Care Continuum in Small Cities of Southern New England: Perspectives of People Living with HIV/AIDS, Public Health Experts, and HIV Service Providers. AIDS Behav 2021; 25:897-907. [PMID: 33001353 DOI: 10.1007/s10461-020-03049-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
The HIV care continuum (HCC), comprised of five steps (screening, linkage to care, treatment initiation, retention, and viral suppression), is used to monitor treatment delivery to people living with HIV (PLWH). The HCC has primarily focused on large urban or metropolitan areas where the situation may differ from that in smaller cities. Three themes (i.e., knowledge, stigma, stability) that shaped HCC outcomes were identified from analysis of two qualitative studies involving HIV service providers, public health experts, and PLWH in smaller cities of southern New England. The findings suggest that enhancing HCC outcomes require a multiprong approach that targets both the individual and organizational levels and includes interventions to increase health literacy, staff communication skills, universal screening to assess patients' religiosity/spirituality and supplemental service needs. Interventions that further ensure patient confidentiality and the co-location and coordination of HIV and other healthcare services are particularly important in smaller cities.
Collapse
|
37
|
Eustaquio PC, Docken SS, Leyritana KT, Wulandari LPL. HIV care cascade among cisgender men who have sex with men in a key population-led community center in the Philippines. Int J STD AIDS 2021; 32:718-728. [PMID: 33533689 DOI: 10.1177/0956462420987435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The HIV epidemic in the Philippines is the fastest growing globally, and disproportionately affects cisgender men who have sex with men (cis-MSM) demanding effective strategies for this key population (KP) group. KP-specific and community-based (CB) interventions have improved the HIV response elsewhere, but these have yet to be evaluated locally. We analyzed the HIV care cascade outcomes in a KP-led, CB HIV test-and-treat center and determined factors that affect these by performing a retrospective study of medical records of 3137 patients diagnosed from January 2016 to March 2019 in LoveYourself in Manila, Philippines. Multivariate logistic regression was performed to determine predictors affecting the likelihood of antiretroviral therapy (ART) initiation and viral load (VL) suppression. As to UNAIDS 90-90-90 targets, LoveYourself had higher rates than national outcomes with 78% initiated ART and 84% achieved VL suppression. Such satisfactory performance is consistent with other studies exploring CB, KP-led approaches among cis-MSM. Patients who presented with WHO Stages 2-4 and those with sexually transmitted infections were less likely to initiate ART. Patients who presented with WHO Stages 2-4 and those whose ART was started late were less likely to be virally suppressed. These findings suggest the need to develop responsive interventions to reach the UNAIDS targets.
Collapse
Affiliation(s)
| | - Steffen S Docken
- Kirby Institute, 2786University of New South Wales, Sydney, Australia
| | - Katerina T Leyritana
- Sustained Health Initiatives of the Philippines, Inc., Metro Manila, Philippines
| | - Luh Putu Lila Wulandari
- Kirby Institute, 2786University of New South Wales, Sydney, Australia.,Department of Faculty of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| |
Collapse
|
38
|
Boothe MAS, Sathane I, Baltazar CS, Chicuecue N, Horth R, Fazito E, Raymond HF. Low engagement in HIV services and progress through the treatment cascade among key populations living with HIV in Mozambique: alarming gaps in knowledge of status. BMC Public Health 2021; 21:146. [PMID: 33451344 PMCID: PMC7811257 DOI: 10.1186/s12889-020-10039-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Mozambique has a generalized HIV epidemic of 13.5% among the general population. Early modeling exercises in Mozambique estimate that key populations (KP), defined as men who have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID), along with their partners account for about one third of all new infections. There is limited data describing the engagement of KP living with HIV in testing, care and treatment services. Methods We conducted a secondary data analysis of HIV-positive participants in the first Bio-behavioral Surveillance (BBS) surveys in Mozambique conducted 2011–2014 in order to assess service uptake and progress though the HIV treatment cascade among MSM, FSW, and PWID. Unweighted pooled estimates were calculated for each key population group. Results Among HIV-positive MSM, 63.2% of participants had ever received an HIV test, 8.8% were aware of their status, 6.1% reported having been linked to care, while 3.5% initiated ART and were currently on treatment. Of the HIV-infected FSW participants, 76.5% reported a previous HIV test and 22.4% were previously aware of their status. Linkage to care was reported by 20.1%, while 12.7% reported having initiated ART and 11.8% reported being on treatment at the time of the survey. Among HIV-infected PWID participants, 79.9% had previously received an HIV test, 63.2% were aware of their HIV status, and 49.0% reported being linked to care for their HIV infection. ART initiation was reported by 42.7% of participants, while 29.4% were on ART at the time of the survey. Conclusion Among the three high risk populations in Mozambique, losses occurred throughout critical areas of service uptake with the most alarming breakpoint occurring at knowledge of HIV status. Special attention should be given to increasing HIV testing and linkage to ART treatment. Future surveys will provide the opportunity to monitor improvements across the cascade in line with global targets and should include viral load testing to guarantee a more complete picture of the treatment cascade.
Collapse
Affiliation(s)
- Makini A S Boothe
- Institute for Global Health Sciences, University of California (UCSF), San Francisco, USA. .,Ghent University, Faculty of Medicine and Health Sciences, Ghent, Belgium.
| | - Isabel Sathane
- The National Program of the Control of STIs and HIV/AIDS, Ministry of Health, Maputo, Mozambique
| | - Cynthia Semá Baltazar
- Ghent University, Faculty of Medicine and Health Sciences, Ghent, Belgium.,National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Noela Chicuecue
- Ghent University, Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Roberta Horth
- Institute for Global Health Sciences, University of California (UCSF), San Francisco, USA
| | - Erika Fazito
- ICAP, Columbia University, Pretoria, South Africa
| | - Henry F Raymond
- Institute for Global Health Sciences, University of California (UCSF), San Francisco, USA.,School of Public Health, Rutgers University, New Brunswick, USA
| |
Collapse
|
39
|
Salleh NAM, Voon P, Karamouzian M, Milloy MJ, Richardson L. Methadone maintenance therapy service components linked to improvements in HIV care cascade outcomes: A systematic review of trials and observational studies. Drug Alcohol Depend 2021; 218:108342. [PMID: 33097340 PMCID: PMC7750271 DOI: 10.1016/j.drugalcdep.2020.108342] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/17/2020] [Accepted: 10/04/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The beneficial links between engagement in methadone maintenance therapy (MMT) and HIV treatment outcomes have been extensively described. Nevertheless, people who use drugs (PWUD) continue to experience suboptimal HIV treatment outcomes. In this systematic review, we sought to identify components of MMT service provision that are associated with improvements in HIV care outcomes across the HIV care cascade. METHODS We searched for peer-reviewed studies in online databases. To be eligible for inclusion in this review, studies must have involved a population or sub-population of PWUD engaged in MMT; report improved uptake of HIV testing, exposure to ART, or HIV-1 RNA plasma viral load suppression; provide details on MMT services; and be published in English between 1 January 2006 until 31 December 2018. RESULTS Out of the 5594 identified records, 22 studies were eligible for this systematic review. Components of MMT services associated with HIV care cascade outcomes described in the studies were classified in three categories of care models: 1) standard MMT care with adequate doses, 2) standard MMT care and alongside additional medical component(s), and 3) standard MMT care, additional medical component(s) as well as informational or instrumental social support. CONCLUSION The few studies identified reflect a scarcity of evidence on the role of social support to increase the benefits of MMT for PWUD who are living with HIV. Further research is needed to assess the role of medical and social service components in MMT care delivery in advancing PWUD along the HIV care cascade.
Collapse
Affiliation(s)
- NA Mohd Salleh
- Interdisciplinary Studies Graduate Program, University of
British Columbia, Vancouver, BC, Canada,British Columbia Centre on Substance Use, Vancouver, BC,
Canada,Department of Social and Preventive Medicine, Faculty of
Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pauline Voon
- British Columbia Centre on Substance Use, Vancouver, BC,
Canada,School of Population and Public Health, University of
British Columbia, Vancouver, BC, Canada
| | - Mohammad Karamouzian
- British Columbia Centre on Substance Use, Vancouver, BC,
Canada,School of Population and Public Health, University of
British Columbia, Vancouver, BC, Canada,HIV/STI Research Center, and WHO Collaborating Center for
HIV Surveillance, Kerman University of Medical Sciences, Kerman, Iran
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, BC,
Canada,Department of Medicine, University of British Columbia,
Vancouver, BC, Canada
| | - Lindsey Richardson
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Sociology, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
40
|
Sazonova Y, Kulchynska R, Sereda Y, Azarskova M, Novak Y, Saliuk T, Kornilova M, Liulchuk M, Vitek C, Dumchev K. HIV treatment cascade among people who inject drugs in Ukraine. PLoS One 2020; 15:e0244572. [PMID: 33382768 PMCID: PMC7775055 DOI: 10.1371/journal.pone.0244572] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/10/2020] [Indexed: 12/15/2022] Open
Abstract
The HIV treatment cascade is an effective tool to track progress and gaps in the HIV response among key populations. People who inject drugs (PWID) remain the most affected key population in Ukraine with HIV prevalence of 22% in 2015. We performed secondary analysis of the 2017 Integrated Bio-Behavioral Surveillance (IBBS) survey data to construct the HIV treatment cascade for PWID and identify correlates of each indicator achievement. The biggest gap in the cascade was found in the first "90", HIV status awareness: only 58% [95% CI: 56%-61%] of HIV-positive PWID reported being aware of their HIV-positive status. Almost 70% [67%-72%] of all HIV-infected PWID who were aware of their status reported that they currently received antiretroviral therapy (ART). Almost three quarters (74% [71%-77%]) of all HIV-infected PWID on ART were virally suppressed. Access to harm reduction services in the past 12 months and lifetime receipt of opioid agonist treatment (OAT) had the strongest association with HIV status awareness. Additionally, OAT patients who were aware of HIV-positive status had 1.7 [1.2-2.3] times the odds of receiving ART. Being on ART for the last 6 months or longer increased odds to be virally suppressed; in contrast, missed recent doses of ART significantly decreased the odds of suppression. The HIV treatment cascade analysis for PWID in Ukraine revealed substantial gaps at each step and identified factors contributing to achievement of the outcomes. More intensive harm reduction outreach along with targeted case finding could help to fill the HIV awareness gap among PWID in Ukraine. Scale up of OAT and community-level linkage to care and ART adherence interventions are viable strategies to improve ART coverage and viral suppression among PWID.
Collapse
Affiliation(s)
- Yana Sazonova
- Monitoring and Evaluation Unit, ICF “Alliance for Public Health”, Kyiv, Ukraine
| | - Roksolana Kulchynska
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Kyiv, Ukraine
| | | | - Marianna Azarskova
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Kyiv, Ukraine
| | - Yulia Novak
- Monitoring and Evaluation Unit, ICF “Alliance for Public Health”, Kyiv, Ukraine
| | - Tetiana Saliuk
- Monitoring and Evaluation Unit, ICF “Alliance for Public Health”, Kyiv, Ukraine
| | - Marina Kornilova
- Monitoring and Evaluation Unit, ICF “Alliance for Public Health”, Kyiv, Ukraine
| | - Mariia Liulchuk
- State Institution “The L.V. Gromashevskij Institute of Epidemiology and Infectious Diseases of NAMS of Ukraine”, Kiev, Ukraine
| | - Charles Vitek
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | |
Collapse
|
41
|
Okoli C, Van de Velde N, Brough G, Hardy WD, Corbelli G, Allan B, Muchenje M, Castellanos E, Young B, Eremin A, Ramothwala P, de los Rios P. Differences in HIV treatment experiences, perceptions, and behaviors by gender and sexual orientation in 25 middle-income and high-income countries: Findings from the 2019 Positive Perspectives Survey. POPULATION MEDICINE 2020. [DOI: 10.18332/popmed/128600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
42
|
Maragh-Bass AC, Gamble T, El-Sadr WM, Hanscom B, Tolley EE. Exploring individual-level barriers to HIV medication adherence among men who have sex with men in the HIV Prevention Trials Network (HPTN 065) study. AIDS Care 2020; 33:1404-1413. [PMID: 33025791 DOI: 10.1080/09540121.2020.1828799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
African-American men who have sex with men (MSM) with HIV are more likely to have unsuppressed viral load than other racial/ethnic groups. HPTN 065 Study, completed in 2015, consisted of five interconnected study components conducted at clinics in Bronx, New York and Washington, D.C. Participants completed surveys with questions related to socio-demographic factors and individual-level HIV medication adherence barriers, such as forgetting doses or fear of taking medications in front of others. Descriptive analyses and ordinal logistic regression with robust standard errors were conducted. Fifty-seven per cent of participants (N = 359) were African-American (57.1%) and roughly 40% had no more than a high school education. Mean age was 48 years. Overall, MSM with viral load suppression identified fewer individual-level barriers to adherence (p < .01) and individuals with depressive symptoms identified a greater number of barriers to adherence (p < .01). Compared to African-Americans, white MSM had a lower likelihood of identifying barriers to adherence (p < .05). Findings suggest that individual-level barriers to HIV medication adherence are common among MSM, irrespective of time since diagnosis and viral suppression. Race-specific interventions which address intersectional stigma are needed to improve health outcomes among African-American MSM, who bear much of the burden of poor HIV outcomes in the United States.
Collapse
Affiliation(s)
| | | | - Wafaa M El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Brett Hanscom
- HIV Prevention Trials Network Statistical Center for HIV AIDS Research and Prevention, University of Washington Seattle, Seattle, WA, USA
| | - Elizabeth E Tolley
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences, Durham, NC, USA
| |
Collapse
|
43
|
Twahirwa Rwema JO, Lyons CE, Herbst S, Liestman B, Nyombayire J, Ketende S, Mazzei A, Olawore O, Nsanzimana S, Mugwaneza P, Kagaba A, Sullivan PS, Allen S, Karita E, Baral SD. HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross-sectional study. J Int AIDS Soc 2020; 23 Suppl 6:e25604. [PMID: 33000912 PMCID: PMC7527755 DOI: 10.1002/jia2.25604] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Given intersecting biological, network and structural risks, men who have sex with men (MSM) and transgender women (TGW) consistently have a high burden of HIV. Although MSM are a key population in Rwanda, there are limited epidemiologic data to guide programming. This study aimed to characterize HIV prevalence and care cascade among MSM and TGW in Kigali. METHODS MSM and TGW ≥ 18 years were recruited using respondent-driven sampling (RDS) from March-August 2018 in Kigali. Participants underwent a structured interview including measures of individual, network and structural determinants. HIV and sexually transmitted infections (STI) including syphilis, Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) were tested. Viral load was measured for MSM living with HIV. Robust Poisson regression was used to characterize the determinants of HIV infection and engagement in the HIV treatment cascade. RESULTS A total of 736 participants were enrolled. The mean age was 27 years (range:18 to 68) and 14% (106) were TGW. HIV prevalence was 10% (RDS-adjusted: 9.2% (95% CI: 6.4 to 12.1)). Unadjusted prevalence of any STI was 20% (147); syphilis: 5.7% (42); CT: 9.1% (67) and NG: 8.8% (65). Anticipated (41%), perceived (36%) and enacted stigmas (45%) were common and higher among TGW (p < 0.001). In multivariable RDS adjusted analysis, higher age (aPR: 1.08 (95% CI: 1.05 to 1.12)) and ever having sex with women (aPR: 3.39 (95% CI: 1.31 to 8.72)) were positively associated with prevalent HIV. Being circumcised (aPR: 0.52 (95% CI: 0.28 to 0.9)) was negatively associated with prevalent HIV infection. Overall, 61% (45/74) of respondents reported knowing their HIV-positive status. Among these, 98% (44/45) reported antiretroviral therapy use (ART); 75% (33/44) were virally suppressed using a cut-off of <200 copies/mL. Of the 29 participants who did not report any previous HIV diagnosis or ART use, 38% (11/29) were virally suppressed. Cumulatively, 59% (44/74) of all participants living with HIV were virally suppressed. CONCLUSIONS These data show a high burden of HIV among MSM/TGW in Kigali, Rwanda. Bisexual concurrency was common and associated with prevalent HIV infection, demonstrating the need of comprehensive screening for all sexual practices and preferences in the provision of comprehensive HIV prevention services in Rwanda. Viral suppression was below the UNAIDS target suggesting poor adherence and potential ART resistance. There is a need for adherence support, screening for primary and secondary ART resistance and stigma mitigation interventions to optimize HIV-related outcomes for MSM in Rwanda.
Collapse
Affiliation(s)
- Jean Olivier Twahirwa Rwema
- Department of EpidemiologyKey Populations ProgramCenter for Public Health and Human RightsJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Carrie E Lyons
- Department of EpidemiologyKey Populations ProgramCenter for Public Health and Human RightsJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Benjamin Liestman
- Department of EpidemiologyKey Populations ProgramCenter for Public Health and Human RightsJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Sosthenes Ketende
- Department of EpidemiologyKey Populations ProgramCenter for Public Health and Human RightsJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Oluwasolape Olawore
- Department of EpidemiologyKey Populations ProgramCenter for Public Health and Human RightsJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | | | | | | | | | | | - Stefan D Baral
- Department of EpidemiologyKey Populations ProgramCenter for Public Health and Human RightsJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| |
Collapse
|
44
|
Nguyen LH, Nguyen HLT, Larsson M, Tran BX, L Stein M, Rocha LEC, Strömdahl S. An exploratory assessment of the preference for eHealth interventions to prevent HIV and sexually transmitted infections among men who have sex with men in Hanoi, Vietnam. BMC Public Health 2020; 20:1387. [PMID: 32917157 PMCID: PMC7488431 DOI: 10.1186/s12889-020-09449-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electronic health (eHealth) interventions are promising in HIV and sexually transmitted infections (STIs) prevention among men who have sex with men (MSM), given a high rate of the Internet use in this population. This study determined the preferences for eHealth interventions to prevent HIV and STIs among MSM in Hanoi, Vietnam to guide the development of future eHealth interventions. METHODS Five focus group discussions (FGD) were conducted with 35 MSM recruited by purposive sampling in January 2018 in Hanoi, Vietnam. The FGDs addressed attitudes towards the feasibility and uptake of HIV/STI interventions via online modalities such as smartphone applications (apps, social network sites, or emails); preferences and concerns regarding an online HIV/STI intervention. FGDs were audio-recorded and transcribed verbatim. Content analysis was used to determine themes. RESULTS MSM reported that they commonly searched for information regarding HIV/STI and sexual health on Facebook and a variety of mobile apps. They perceived a lack of reliable online sources, a high need, and interest for an online intervention. Most of them preferred short and concise messages without perceived sensitive words such as "HIV" or "STI". Diversity of online modalities were preferred with information from credible sources about HIV/STI symptoms, testing and treatment, safe sex practices and testing locations with a focus on safe MSM-friendly clinics. Concerns about the need to trust the organization behind the online information and interventions, and the importance of confidentiality when participating in online interventions were raised. CONCLUSION High acceptance and perceived need for an online HIV/STI intervention were reported. The importance of establishing trust within the MSM community as a reliable source of information was emphasized, as well as the importance of confidentiality.
Collapse
Affiliation(s)
- Long Hoang Nguyen
- Department of Global Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden. .,Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.
| | | | - Mattias Larsson
- Department of Global Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Bach Xuan Tran
- Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Department of Health, Behaviours, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mart L Stein
- National Coordination Centre for Communicable Disease Control, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Luis E C Rocha
- Department of Economics & Department of Physics and Astronomy, Ghent University, Ghent, Belgium
| | - Susanne Strömdahl
- Department of Global Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
| |
Collapse
|
45
|
Vannakit R, Andreeva V, Mills S, Cassell MM, Jones MA, Murphy E, Ishikawa N, Boyd MA, Phanuphak N. Fast-tracking the end of HIV in the Asia Pacific region: domestic funding of key population-led and civil society organisations. Lancet HIV 2020; 7:e366-e372. [PMID: 32386723 DOI: 10.1016/s2352-3018(20)30077-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/17/2020] [Accepted: 03/02/2020] [Indexed: 01/26/2023]
Abstract
Ending AIDS in Asia Pacific by 2030 requires countries to give higher priority to financing community-based and key population-led service delivery. Mechanisms must be developed for civil society organisations to deliver health and HIV/AIDS services for key populations, especially men who have sex with men, and transgender people, within national health policy frameworks. Current investments in the HIV response in the Asia Pacific region reflect inadequate HIV financing for key populations, particularly for civil society and key population-led organisations that are optimally positioned to advance HIV epidemic control. These organisations are typically supported by international agencies whose investments are starting to decline. Domestic investments in key population-led organisations are often hampered by punitive laws against their communities, pervasive stigma and discrimination by policy makers, an insufficient understanding of the most effective HIV epidemic control strategies, and financing systems that limit access to funding for these organisations from the national budget. Countries in the Asia Pacific region are evolving their community-based and key population policies and programmes. We need accessible, disaggregated financial data and in-depth case studies that showcase effective key population-led programmes, to enable countries to learn from each other.
Collapse
Affiliation(s)
| | | | | | | | - Melissa A Jones
- US Agency for International Development, Regional Development Mission for Asia, Bangkok, Thailand
| | | | - Naoko Ishikawa
- WHO Regional Office for Western Pacific, Manila, Philippines
| | - Mark A Boyd
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | | |
Collapse
|
46
|
Abstract
Purpose of review To explore the comparative importance of HIV infections among key populations and their intimate partners as HIV epidemics evolve, and to review implications for guiding responses. Recent findings Even as concentrated epidemics evolve, new infections among current and former key population members and their intimate partners dominate new infections. Prevalent infections in the general population grow primarily because of key population turnover and infections among their intimate partners. In generalized epidemic settings, data and analysis on key populations are often inadequate to assess the impact of key population-focused responses, so they remain limited in coverage and under resourced. Models must incorporate downstream infections in comparing impacts of alternative responses. Summary Recognize that every epidemic is unique, moving beyond the overly simplistic concentrated/generalized epidemic paradigm that can misdirect resources. Guide HIV responses by gathering and using locally relevant data, understanding risk heterogeneity, and applying modeling at both national and sub-national levels to optimize resource allocations among different populations for greatest impact. Translate this improved understanding into clear, unequivocal advice for policymakers on where to focus for impact, breaking them free of the generalized/concentrated paradigm limiting their thinking and affecting their decisions.
Collapse
|
47
|
Pantalone DW, Nelson KM, Batchelder AW, Chiu C, Gunn HA, Horvath KJ. A Systematic Review and Meta-Analysis of Combination Behavioral Interventions Co-Targeting Psychosocial Syndemics and HIV-Related Health Behaviors for Sexual Minority Men. JOURNAL OF SEX RESEARCH 2020; 57:681-708. [PMID: 32077326 PMCID: PMC7457381 DOI: 10.1080/00224499.2020.1728514] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In the U.S., sexual minority men (SMM) are disproportionately affected by HIV. Interventions are needed to increase HIV prevention and treatment behaviors, especially among syndemically exposed SMM. In recent years, researchers have created and tested combination behavioral interventions co-targeting syndemics and HIV-related health behaviors. We evaluated that literature via systematic review and meta-analysis, identifying 44 trials targeting mental health symptoms, alcohol use, and drug use, as well as sexual risk behavior, antiretroviral adherence, and healthcare engagement. For the randomized controlled trials, we computed between-group, pre-post effect sizes and tested them via random-effects models. Results supported the efficacy of combined interventions with significant, small, positive effects for improving mental health and reducing substance use (d = .20, CIs: 0.12, .29), and reducing sexual risk behavior and improving antiretroviral adherence (d = .16, CIs: .03, .30). Stratification analyses indicate that longer (9+ sessions) and individual (vs. group) interventions resulted in stronger effects on syndemic but not health behavior outcomes. Intervention developers should attend to intervention intensity and format. More evidence is needed about the importance of additional factors, such as novel intervention targets and cultural tailoring, as well as broadening the focus to multi-level interventions to address both interpersonal and structural mechanisms of change.
Collapse
Affiliation(s)
- David W Pantalone
- Department of Psychology, University of Massachusetts Boston
- The Fenway Institute, Fenway Health
| | - Kimberly M Nelson
- Department of Community Health Sciences, Boston University School of Public Health
| | - Abigail W Batchelder
- The Fenway Institute, Fenway Health
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School
| | | | - Hamish A Gunn
- Department of Psychology, University of Massachusetts Boston
| | | |
Collapse
|
48
|
Fearon E, Tenza S, Mokoena C, Moodley K, Smith AD, Bourne A, Weatherburn P, Palanee-Phillips T. HIV testing, care and viral suppression among men who have sex with men and transgender individuals in Johannesburg, South Africa. PLoS One 2020; 15:e0234384. [PMID: 32555703 PMCID: PMC7299351 DOI: 10.1371/journal.pone.0234384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/26/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Men who have sex with men and transgender individuals (MSM/TG) carry a disproportionately high burden of HIV, including in South Africa. However, there are few empirical population-representative estimates of viral suppression and the HIV care cascade including HIV testing among this population, nor of factors associated with these outcomes. METHODS We conducted a respondent driven sampling (RDS) survey among 301 MSM/TG in Johannesburg in 2017. Participants gave blood samples for HIV testing and viral load. Participants self-completed a survey including sociodemographics, HIV testing history, and engagement in care. We calculated RDS-II weighted estimates of the percentage of HIV-negative MSM/TG reporting HIV testing in the previous 6 months, their testing experience and preferences. Among those HIV-positive, we estimated the percentage status-aware, on ART, and virally suppressed (<50 viral copies/ml plasma). We conducted RDS-weighted robust Poisson regression to obtain weighted prevalence ratios of factors associated with 1) HIV testing among those HIV-negative; and 2) viral suppression among those HIV-positive. RESULTS There were 118/300 HIV-positive MSM/TG, (37.5%). Of the HIV-negative MSM/TG, 61.5% reported that they had tested for HIV in the previous 6 months, which was associated with selling sex to men (Prevalence Ratio = 1.67, 95% CI 1.36-2.05). There were 76/118 HIV-positive MSM/TG (56.5%) who reported having previously tested positive for HIV and 39/118 (30.0%) who reported current ART. There were 58/118 HIV-positive MSM/TG with viral loads <50 copies/ml plasma (46.9%). Viral suppression was associated with older age (adjusted PR = 1.03, 95% CI 1.00-1.06 for each year), neighbourhood, and having bought sex from men (adjusted PR = 1.53, 95% CI 1.12-2.08). CONCLUSIONS HIV prevalence was very high. Viral suppression among those HIV-positive was similar to the general male population in South Africa, but remains far short of national and international targets. A majority of HIV-negative MSM/TG had HIV tested in the previous 6 months, though there is room for improvement.
Collapse
Affiliation(s)
- Elizabeth Fearon
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Siyanda Tenza
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Cecilia Mokoena
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Kerushini Moodley
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Adrian D. Smith
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, LaTrobe University, Melbourne, Australia
| | - Peter Weatherburn
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | |
Collapse
|
49
|
Barrow GJ, Fairley M, Brandeau ML. Optimizing Interventions Across the HIV Care Continuum: A Case Study Using Process Improvement Analysis. OPERATIONS RESEARCH FOR HEALTH CARE 2020; 25:100258. [PMID: 33014699 PMCID: PMC7528976 DOI: 10.1016/j.orhc.2020.100258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
UNAIDS' 90-90-90 goal for 2020 is for 90% of HIV-infected people to know their status, 90% of infected individuals to receive antiretroviral therapy (ART), and 90% of those on ART to achieve viral suppression. To achieve these ambitious goals, effective care delivery programs are needed. In this paper we present a case study showing how HIV care can be improved by viewing the patient care process as a production process and applying methods of process improvement analysis. We examine the continuum of HIV care at a hospital-based HIV clinic in Kingston, Jamaica. We perform qualitative analysis to identify key programmatic, personnel, and clinical areas for process improvement. We then perform quantitative analysis. We develop a stochastic model of the care process which we use to evaluate the effects of potential process improvements on the number of patients who receive ART and the number who achieve viral suppression. We also develop a model for optimal investment of a fixed budget among interventions aimed at improving the care cascade and we use the model to determine the optimal investment among three interventions that the clinic could invest in. By viewing the patient care process as a production process and applying qualitative and quantitative process improvement analysis, our case study illustrates how clinics can identify the best ways to maximize clinical outcomes. Our methods are generalizable to other HIV care clinics as well as to clinics that provide care for other chronic conditions (e.g., diabetes, hepatitis B, or opioid use disorder).
Collapse
Affiliation(s)
- Geoffrey J. Barrow
- Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica
| | - Michael Fairley
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Margaret L. Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| |
Collapse
|
50
|
Byonanebye DM, Semitala FC, Katende J, Bakenga A, Arinaitwe I, Kyambadde P, Musinguzi P, Biraro IA, Byakika-Kibwika P, Kamya MR. High viral suppression and low attrition in healthy HIV-infected patients initiated on ART with CD4 above 500 cells/µL in a program setting in Uganda. Afr Health Sci 2020; 20:132-141. [PMID: 33402901 PMCID: PMC7750048 DOI: 10.4314/ahs.v20i1.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The World Health Organization recommends antiretroviral therapy (ART) for all HIV-infected patients at all CD4 counts. However, there are concerns that asymptomatic patients may have poorer viral suppression and high attrition. OBJECTIVES We sought to determine attrition and viral suppression among healthy HIV-infected patients initiated on ART in program settings. METHODS This cross-sectional study enrolled ART-experienced patients attending two PEPFAR-supported, high-volume clinics in Kampala, Uganda. Eligible patients were >18 years and had completed at least six months on ART. Participants were interviewed on socio-demographics, ART history and plasma viral load (VL) determined using Abbott Real-time. Predictors of viral suppression (<75 copies/ml) were determined using multivariate logistic regression. RESULTS Overall, 267 participants were screened, 228 were eligible and 203 (89%) retained in care (visit within 90 days). Of the 203 participants, 115 (56.7%) were key-populations. Viral suppression was achieved in 173 patients (85%; 95% CI, 80.3%-90.1%). The factors associated with viral suppression were prior VL tests (AOR 6.98; p-value <0.001) and receiving care from a general clinic (AOR 5.41; p=0.009). CONCLUSION Asymptomatic patients initiated on ART with high baseline CD4 counts, achieve high viral suppression with low risk of attrition. VL monitoring and clinic type are associated with viral suppression.
Collapse
Affiliation(s)
| | - Fred C Semitala
- Makerere University College of Health Sciences, Kampala, Uganda
- Makerere University Joint AIDS Program, Kampala, Uganda
| | | | - Alex Bakenga
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Irene Arinaitwe
- Makerere University College of Computing and Information Science
| | | | | | | | | | - Moses R Kamya
- Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala Uganda
| |
Collapse
|