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Schnure MC, Kasaie P, Dowdy DW, Genberg BL, Kendall EA, Fojo AT. Forecasting the effect of HIV-targeted interventions on the age distribution of people with HIV in Kenya. AIDS 2024; 38:1375-1385. [PMID: 38537051 PMCID: PMC11211060 DOI: 10.1097/qad.0000000000003895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/27/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES To provide accurate forecasts of the age distribution of people with HIV (PWH) in Kenya from 2025 to 2040. DESIGN Development of a compartmental model of HIV in Kenya, calibrated to historical estimates of HIV epidemiology. METHODS We forecasted changes in population size and age distribution of new HIV infections and PWH under the status quo and under scale-up of HIV services. RESULTS Without scale-up, new HIV infections were forecasted to fall from 34 000 (28 000-41 000) in 2,025 to 29 000 (15 000-57 000) in 2,040; the percentage of new infections occurring among persons over 30 increased from 33% (20-50%) to 40% (24-62%). The median age of PWH increased from 39 years (38-40) in 2025 to 43 years (39-46) in 2040, and the percentage of PWH over age 50 increased from 26% (23-29%) to 34% (26-43%). Under the full intervention scenario, new infections were forecasted to fall to 6,000 (3,000-12 000) in 2,040. The percentage of new infections occurring in people over age 30 increased to 52% (34-71%) in 2,040, and there was an additional shift in the age structure of PWH [forecasted median age of 46 (43-48) and 40% (33-47%) over age 50]. CONCLUSION PWH in Kenya are forecasted to age over the next 15 years; improvements to the HIV care continuum are expected to contribute to the growing proportion of older PWH.
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Affiliation(s)
| | - Parastu Kasaie
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David W. Dowdy
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Becky L. Genberg
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Lealem EB, Zeleke EG, Andargie BA, Wagnew A. Pooled prevalence, spatial variation and associated factors of HIV testing uptake among multiple sexual partners in Sub Saharan Africa: Spatial and multilevel analysis. PLoS One 2024; 19:e0306770. [PMID: 38990916 PMCID: PMC11239050 DOI: 10.1371/journal.pone.0306770] [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: 02/19/2024] [Accepted: 06/24/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Uptake of HIV testing is vital for the early diagnosis of HIV infection and initiation of treatment, which are used to eliminate the disease's progression and reduce HIV-related mortality. Even if determining HIV testing is imperative to prevent HIV/AIDS among multiple sexual partners who are at higher risk of sexually transmitted infections, most of the countries in Sub Saharan Africa did not fulfil the global targets of UNAIDS. Moreover there is a paucity of literature on spatial variation and factors associated with HIV testing among high-risk groups in SSA. This study aimed to assess the pooled prevalence, spatial variation and determinants of HIV testing uptake among multiple sexual partners in Sub Saharan Africa. METHODS The Demographic and Health Surveys data conducted between 2011 and 2021 in 30 Sub-Saharan Africa countries was used to analyze total weighted sample of 56,210 multiple sexual partners. Exploratory spatial data analysis, with countries as the unit of analysis was conducted using ArcGIS V10.7.1 and Sat Scan V 10.1 soft wares. A multilevel binary logistic regression model was used to identify the factors associated with the HIV testing uptake. The Adjusted odds Ratio with a 95% confidence interval was reported to declare the strength of association and their statistical significance. RESULTS The spatial patterns of HIV testing uptake were found to be non-random. Primary clusters were identified around western and central sub- regions. Multiple sexual partners who were ever married, those attended primary level and above education, those from rich wealth status, aged above 24 years, having good HIV related knowledge, and exposed to media were positive association with HIV testing uptake. However, being male, having working status and living in rural area were negatively associated with HIV testing uptake. At the community-level, multiple sexual partners from communities in Eastern and southern sub regions, countries with upper middle income and countries with the survey year after 2014 were more likely to utilize HIV testing services compared with their counterparts. CONCLUSION In this study, the pooled prevalence of the HIV testing uptake among multiple sexual partners was found to be lower than the universal target and showed differences in HIV testing uptake across Sub-Saharan Africa region. Both individual and community-level factors affected HIV testing uptake among multiple sexual partners. Stakeholders should implement interventions to help increase the uptake of HIV testing among those risky groups in this region.
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Affiliation(s)
- Emebet Birhanu Lealem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ejigu Gebeye Zeleke
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Betelhem Abebe Andargie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemakef Wagnew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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3
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Islam MH, Shrestha RK, Hoch JS, Farnham PG. Estimating the Cost-Effectiveness of HIV Self-Testing in the United States Using Net Benefit Regression. J Acquir Immune Defic Syndr 2024; 95:138-143. [PMID: 37831617 DOI: 10.1097/qai.0000000000003325] [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: 05/19/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Cost-effectiveness analysis of HIV self-testing using patient-level data from a randomized clinical trial can inform HIV prevention funding decisions. Cost-effectiveness analysis using net-benefit regression addresses the sampling uncertainty in the trial data and the variability of policymakers' willingness to pay (WTP). METHODS We used published data from a 12-month longitudinal randomized clinical trial that enrolled 2665 men who had sex with men randomly assigned to the self-testing arm (participants receiving self-test kits) and control arm (participants receiving standard-of-care), and the self-testing arm identified 48 additional new HIV cases. We used net-benefit regression to investigate the cost-effectiveness of an HIV self-testing intervention, which compared the incremental cost per new HIV diagnosis with policymakers' WTP thresholds. We addressed the uncertainties in estimating the incremental cost and the policymakers' WTP per new diagnosis through the incremental net-benefit (INB) regression and cost-effectiveness acceptability curve (CEAC) analyses. RESULTS From the health care provider's perspective, the INB analysis showed a positive net benefit of HIV self-testing compared with standard-of-care when policymakers' WTP per new HIV diagnosis was $9365 (95% confidence interval: $5700 to $25,500) or higher. The CEAC showed that the probability of HIV self-testing being cost-effective compared with standard-of-care was 58% and >99% at a WTP of $10 000 and $50 000 per new HIV diagnosis, respectively. CONCLUSION The INB and CEAC analyses suggest that HIV self-testing has the potential to be cost-effective for relatively low values of policymakers' WTP.
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Affiliation(s)
- Md Hafizul Islam
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Ram K Shrestha
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, CA
| | - Paul G Farnham
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and
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Pinto PFPS, Macinko J, Silva AF, Lua I, Jesus G, Magno L, Santos CAST, Ichihara MY, Barreto ML, Moucheraud C, Souza LE, Dourado I, Rasella D. The effect of primary health care on AIDS incidence and mortality: a cohort study of 3.4 million Brazilians. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.02.23296417. [PMID: 37873240 PMCID: PMC10593023 DOI: 10.1101/2023.10.02.23296417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Primary Health Care (PHC) is essential for the health and wellbeing of people living with HIV/AIDS. This study evaluated the effects of one of the largest community-based PHC programs in the world, the Brazilian Family Health Strategy (FHS), on AIDS incidence and mortality. Methods A retrospective cohort study carried out in Brazil, from January 1 2007 to December 31 2015. We conducted a quasi-experimental effect evaluation using a cohort of 3,435,068 ≥13 years low-income individuals who were members of the 100 Million Brazilians Cohort, linked to AIDS diagnoses and deaths registries. We evaluated the effect of FHS on AIDS incidence and mortality and comparing outcomes between residents of municipalities with no FHS coverage with those in municipalities with full FHS coverage. We used multivariable Poisson regressions adjusted for all relevant municipal and individual-level demographic, socioeconomic, and contextual variables, and weighted with inverse probability of treatment weighting (IPTW). We also estimated FHS effect by sex and age, and performed a wide range of sensitivity and triangulation analyses. Findings FHS coverage was associated with lower AIDS incidence (rate ratio [RR]:0.76, 95%CI:0.68-0.84) and mortality (RR:0.68,95%CI:0.56-0.82). FHS effect was similar between men and women, but was larger in people aged ≥35 years old both for incidence (RR 0.62, 95%CI:0.53-0.72) and mortality (RR 0.56, 95%CI:0.43-0.72). Conclusions AIDS should be an avoidable outcome for most people living with HIV today, and our study shows that FHS coverage could significantly reduce AIDS incidence and mortality among low-income populations in Brazil. Universal access to comprehensive healthcare through community-based PHC programs should be promoted to achieve the Sustainable Development Goals of ending AIDS by 2030.
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Affiliation(s)
- Priscila FPS Pinto
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - James Macinko
- Departments of Health Policy and Management and Community Health Sciences, Fielding School of Public Health, University of California (UCLA), Los Angeles, California, The United States of America (USA)
| | - Andréa F Silva
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Iracema Lua
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Gabriela Jesus
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Laio Magno
- Department of Life Sciences, State University of Bahia (UNEB), Salvador, Brazil
| | - Carlos AS Teles Santos
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Maria Yury Ichihara
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Mauricio L Barreto
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Corrina Moucheraud
- Departments of Health Policy and Management and Community Health Sciences, Fielding School of Public Health, University of California (UCLA), Los Angeles, California, The United States of America (USA)
| | - Luis E Souza
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- Instituto de Salud Global Barcelona (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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Yuen CM, Millones AK, Acosta D, Torres I, Farroñay S, Jimenez J, Lecca L. Person-centered strategies for delivering TB diagnostic services in Lima, Peru. Public Health Action 2023; 13:112-116. [PMID: 37736576 PMCID: PMC10446665 DOI: 10.5588/pha.23.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/05/2023] [Indexed: 09/23/2023] Open
Abstract
SETTING Lima, Peru. OBJECTIVE To close the gap in TB diagnosis, TB diagnostic services must match care-seeking preferences. We sought to identify preferred strategies for delivering TB diagnostic services and to determine whether preferences differ among demographic groups. DESIGN During May 2022-January 2023, we recruited adults who recently initiated treatment for pulmonary TB. We used an object-case best-worst scaling instrument to assess the desirability of nine hypothetical strategies for delivering TB diagnostic services. A t-test was used to assess differences in preference scores between groups. RESULTS Among 150 participants, the strategies with the highest preference scores were an integrated mobile unit offering screening for multiple conditions, expedited attention at the health center, and home-based screening. These were strongly preferred by 42%, 25%, and 27% of participants, respectively, and 80% of participants strongly preferred at least one of the three. Expedited attention at the health center scored more highly among people who experienced >2 months delay in TB diagnosis compared to those who experienced a more rapid diagnosis (0.37 ± 0.06 vs. 0.17 ± 0.06; P = 0.031). CONCLUSION Providing person-centered TB diagnostic services at diverse access points could help reach different populations, which could promote early diagnosis and help close the diagnosis gap.
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Affiliation(s)
- C M Yuen
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - D Acosta
- Socios En Salud Sucursal Peru, Lima, Peru
| | - I Torres
- Socios En Salud Sucursal Peru, Lima, Peru
| | - S Farroñay
- Socios En Salud Sucursal Peru, Lima, Peru
| | - J Jimenez
- Socios En Salud Sucursal Peru, Lima, Peru
| | - L Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Socios En Salud Sucursal Peru, Lima, Peru
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Abana CZY, Kushitor DK, Asigbee TW, Parbie PK, Ishikawa K, Kiyono H, Mizutani T, Siaw S, Ofori SB, Addo-Tetebo G, Ansong MRD, Williams M, Morton S, Danquah G, Matano T, Ampofo WK, Bonney EY. Community based multi-disease health screening as an opportunity for early detection of HIV cases and linking them to care. BMC Public Health 2023; 23:1051. [PMID: 37264375 PMCID: PMC10236736 DOI: 10.1186/s12889-023-15948-6] [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: 08/22/2022] [Accepted: 05/21/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The 95-95-95 UNAIDS global strategy was adapted to end the AIDS epidemic by 2030. The target is based on the premise that early detection of HIV-infected persons and linking them to treatment regardless of their CD4 counts will lead to sustained viral suppression. HIV testing strategies to increase uptake of testing in Western and Central Africa remain inadequate. Hence, a high proportion of people living with HIV in this region do not know their status. This report describes the implementation of a community based multi-disease health screening (also known as "Know Your Status" -KYS), as part of basic science research, in a way that contributed to achieving public health goals. METHODS A community based multi-disease health screening was conducted in 7 communities within the Eastern region of Ghana between November 2017 and April 2018, to recruit and match HIV seronegative persons to HIV seropositive persons in a case-control HIV gut microbiota study. Health assessments included blood pressure, body mass index, blood sugar, Hepatitis B virus, syphilis, and HIV testing for those who consented. HIV seronegative participants who consented were consecutively enrolled in an ongoing HIV gut microbiota case-control study. Descriptive statistics (percentages) were used to analyze data. RESULTS Out of 738 people screened during the exercise, 700 consented to HIV testing and 23 (3%) were HIV positive. Hepatitis B virus infection was detected in 4% (33/738) and Syphilis in 2% (17/738). Co-infection of HIV and HBV was detected in 4 persons. The HIV prevalence of 3% found in these communities is higher than both the national prevalence of 1.7% and the Eastern Regional prevalence of 2.7 in 2018. CONCLUSION Community based multi-disease health screening, such as the one undertaken in our study could be critical for identifying HIV infected persons from the community and linking them to care. In the case of HIV, it will greatly contribute to achieving the first two 95s and working towards ending AIDS by 2030.
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Affiliation(s)
- Christopher Z-Y Abana
- Virology Department, Noguchi Memorial Institute for Medical Research (NMIMR), University of Ghana, Accra, Ghana
- West African Center for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Dennis K Kushitor
- Virology Department, Noguchi Memorial Institute for Medical Research (NMIMR), University of Ghana, Accra, Ghana
| | - Theodore W Asigbee
- Virology Department, Noguchi Memorial Institute for Medical Research (NMIMR), University of Ghana, Accra, Ghana
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Prince K Parbie
- AIDS Research Center, National Institute of Infectious Diseases (NIID), Tokyo, Japan
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Koichi Ishikawa
- AIDS Research Center, National Institute of Infectious Diseases (NIID), Tokyo, Japan
| | - Hiroshi Kiyono
- Institute of Medical Sciences, The University of Tokyo, Tokyo, Japan
- Future Medicine Education and Research Organization, Institute for Global Prominent Research, Graduate School of Medicine, Chiba University, Chiba, Japan
- Allergy and Vaccines (cMAV), Department of Medicine, Chiba University-University of California San Diego Center for Mucosal Immunology, University of California San Diego, Chiba, USA
| | | | | | | | | | - Maclean R D Ansong
- Virology Department, Noguchi Memorial Institute for Medical Research (NMIMR), University of Ghana, Accra, Ghana
| | | | | | | | - Tetsuro Matano
- AIDS Research Center, National Institute of Infectious Diseases (NIID), Tokyo, Japan
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
- Institute of Medical Sciences, The University of Tokyo, Tokyo, Japan
| | - William K Ampofo
- Virology Department, Noguchi Memorial Institute for Medical Research (NMIMR), University of Ghana, Accra, Ghana
| | - Evelyn Y Bonney
- Virology Department, Noguchi Memorial Institute for Medical Research (NMIMR), University of Ghana, Accra, Ghana.
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Okorie CN, Gutin SA, Getahun M, Lebu SA, Okiring J, Neilands TB, Ssali S, Cohen CR, Maeri I, Eyul P, Bukusi EA, Charlebois ED, Camlin CS. Sex specific differences in HIV status disclosure and care engagement among people living with HIV in rural communities in Kenya and Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000556. [PMID: 37027350 PMCID: PMC10081749 DOI: 10.1371/journal.pgph.0000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 02/28/2023] [Indexed: 04/08/2023]
Abstract
Non-disclosure of human immunodeficiency virus (HIV) status can hinder optimal health outcomes for people living with HIV (PLHIV). We sought to explore experiences with and correlates of disclosure among PLHIV participating in a study of population mobility. Survey data were collected from 1081 PLHIV from 2015-16 in 12 communities in Kenya and Uganda participating in a test-and-treat trial (SEARCH, NCT#01864603). Pooled and sex-stratified multiple logistic regression models examined associations of disclosure with risk behaviors controlling for covariates and community clustering. At baseline, 91.0% (n = 984) of PLHIV had disclosed their serostatus. Amongst those who had never disclosed, 31% feared abandonment (47.4% men vs. 15.0% women; p = 0.005). Non-disclosure was associated with no condom use in the past 6 months (aOR = 2.44; 95%CI, 1.40-4.25) and with lower odds of receiving care (aOR = 0.8; 95%CI, 0.04-0.17). Unmarried versus married men had higher odds of non- disclosure (aOR = 4.65, 95%CI, 1.32-16.35) and no condom use in the past 6 months (aOR = 4.80, 95%CI, 1.74-13.20), as well as lower odds of receiving HIV care (aOR = 0.15; 95%CI, 0.04-50 0.49). Unmarried versus married women had higher odds of non-disclosure (aOR = 3.14, 95%CI, 1.47-6.73) and lower odds of receiving HIV care if they had never disclosed (aOR = 0.05, 95%CI, 0.02-0.14). Findings highlight gender differences in barriers to HIV disclosure, use of condoms, and engagement in HIV care. Interventions focused on differing disclosure support needs for women and men are needed and may help facilitate better care engagement for men and women and improve condom use in men.
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Affiliation(s)
- Chinomnso N. Okorie
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Sarah A. Gutin
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, California, United States of America
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Sarah A. Lebu
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Torsten B. Neilands
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, California, United States of America
| | - Sarah Ssali
- School of Women and Gender Studies, Makerere University, Kampala, Uganda
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Irene Maeri
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - Patrick Eyul
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Elizabeth A. Bukusi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - Edwin D. Charlebois
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, California, United States of America
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, California, United States of America
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Nicol E, Mehlomakulu V, Jama NA, Hlongwa M, Basera W, Pass D, Bradshaw D. Healthcare provider perceptions on the implementation of the universal test-and-treat policy in South Africa: a qualitative inquiry. BMC Health Serv Res 2023; 23:293. [PMID: 36978086 PMCID: PMC10045036 DOI: 10.1186/s12913-023-09281-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND South Africa had an estimated 7.5 million people living with HIV (PLHIV), accounting for approximately 20% of the 38.4 million PLHIV globally in 2021. In 2015, the World Health Organization recommended the universal test and treat (UTT) intervention which was implemented in South Africa in September 2016. Evidence shows that UTT implementation faces challenges in terms of human resources capacity or infrastructure. We aim to explore healthcare providers (HCPs)' perspectives on the implementation of the UTT strategy in uThukela District Municipality in KwaZulu-Natal province. METHODS A qualitative study was conducted with one hundred and sixty-one (161) healthcare providers (HCPs) within 18 healthcare facilities in three subdistricts, comprising of Managers, Nurses, and Lay workers. HCPs were interviewed using an open ended-survey questions to explore their perceptions providing HIV care under the UTT strategy. All interviews were thematically analysed using both inductive and deductive approaches. RESULTS Of the 161 participants (142 female and 19 male), 158 (98%) worked at the facility level, of which 82 (51%) were nurses, and 20 (12.5%) were managers (facility managers and PHC manager/supervisors). Despite a general acceptance of the UTT policy implementation, HCPs expressed challenges such as increased patient defaulter rates, increased work overload, caused by the increased number of service users, and physiological and psychological impacts. The surge in the workload under conditions of inadequate systems' capacity and human resources, gave rise to a greater burden on HCPs in this study. However, increased life expectancy, good quality of life, and immediate treatment initiation were identified as perceived positive outcomes of UTT on service users. Perceived influence of UTT on the health system included, increased number of patients initiated, decreased burden on the system, meeting the 90-90-90 targets, and financial aspects. CONCLUSION Health system strengthening such as providing more systems' capacity for expected increase in workload, proper training and retraining of HCPs with new policies in the management of patient readiness for lifelong ART journey, and ensuring availability of medicines, may reduce strain on HCPs, thus improving the delivery of the comprehensive UTT services to PLHIV.
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Affiliation(s)
- Edward Nicol
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg, 7505, South Africa.
- Division of Health Systems and Public Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
| | - Vuyelwa Mehlomakulu
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg, 7505, South Africa
| | - Ngcwalisa Amanda Jama
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg, 7505, South Africa
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Mbuzeleni Hlongwa
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg, 7505, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Wisdom Basera
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg, 7505, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Desiree Pass
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg, 7505, South Africa
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg, 7505, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Nepomuceno M, Abad CL, Salvaña EM. A descriptive retrospective study on HIV care cascade in a tertiary hospital in the Philippines. PLoS One 2023; 18:e0281104. [PMID: 36719909 PMCID: PMC9888700 DOI: 10.1371/journal.pone.0281104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 01/16/2023] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The HIV care cascade is a model used to examine the engagement of people living with HIV (PLHIV) in medical care from the time of diagnosis to sustained viral suppression. This study describes the stages of the cascade from linkage to care, antiretroviral therapy (ART) initiation, retention in care, and virologic suppression- at the University of the Philippines-Philippine General Hospital (UP-PGH) STD/AIDS Guidance and Intervention Prevention (SAGIP) treatment hub in the context of existing cascades with similar demographics. METHODS We retrospectively reviewed the medical records of patients enrolled at the UP-PGH SAGIP treatment hub from June 2015 to December 2017. Baseline demographic and clinical data were collected, relevant to each stage of the cascade. Descriptive statistics using Microsoft Excel version 16.0 was used to characterize data and cumulative and conditional proportions were reported. RESULTS Of the 584 patients included in the cohort, majority were male (91.1%), with a median age of 29 years (range, 0.17 to 68 years). Male-to-male sex was the most common mode of transmission (325/584, 55.6%). Among all patients enrolled at the UP PGH SAGIP treatment hub, 99.5% were linked to care, 95.0% initiated ART, 78.8% were retained in care and maintained on ART, 47.9% were tested for HIV viral load, and 45.5% achieved viral suppression. CONCLUSION A high proportion of patients enrolled at the UP-PGH SAGIP treatment hub are linked to care and initiate ART, exceeding the set goal of 90%, which is higher than reported nationwide. However, there is a substantial decrease in the number of patients who are subsequently retained in care, tested for HIV viral load, and achieve viral suppression. Gaps in the cascade related to healthcare delivery need to be investigated further and addressed by future studies. We recommend implementation of a community-based, patient-centered approach in order to reach the goals of the HIV cascade, with particular focus on young, MSM-PLHIV.
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Affiliation(s)
- Marisse Nepomuceno
- Division of Infectious Diseases, Department of Medicine, University of the Philippines–Philippine General Hospital, Manila, Philippines
- * E-mail:
| | - Cybele Lara Abad
- Division of Infectious Diseases, Department of Medicine, University of the Philippines–Philippine General Hospital, Manila, Philippines
| | - Edsel Maurice Salvaña
- Division of Infectious Diseases, Department of Medicine, University of the Philippines–Philippine General Hospital, Manila, Philippines
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10
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Bachanas P, Moore J. Effect of UTT on viral suppression and ART adherence. THE LANCET HIV 2022; 9:e738-e739. [DOI: 10.1016/s2352-3018(22)00300-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
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11
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Ssensamba JT, Nakafeero M, Musana H, Amollo M, Ssennyonjo A, Kiwanuka SN. Primary care provider notions on instituting community-based geriatric support in Uganda. BMC Geriatr 2022; 22:258. [PMID: 35351013 PMCID: PMC8962536 DOI: 10.1186/s12877-022-02897-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Understanding of the most economical and sustainable models of providing geriatric care to Africa’s rising ageing population is critical. In Uganda, the number of old adults (60 years and above) continues to rise against absence of policies and guidelines, and models for providing care to this critical population. Our study explored public primary health care provider views on how best community-based geriatric support (CBGS) could be instituted as an adaptable model for delivering geriatric care in Uganda’s resource-limited primary public health care settings. Methods We interviewed 20 key informants from four districts of Bukomansimbi, Kalungu, Rakai, and Lwengo in Southern Central Uganda. Respondents were leads (in-charges) of public primary health units that had spent at least 6 months at the fore said facilities. All interviews were audio-recorded, transcribed verbatim, and analysed based on Hsieh and Shannon’s approach to conventional manifest content analysis. Results During analysis, four themes emerged: 1) Structures to leverage for CBGS, 2) How to promote CBGS, 3) Who should be involved in CBGS, and 4) What activities need to be leveraged to advance CBGS? The majority of the respondents viewed using the existing village health team and local leadership structures as key to the successful institutionalization of CBGS; leveraging community education and sensitization using radio, television, and engaging health workers, family relatives, and neighbors. Health outreach activities were mentioned as one of the avenues that could be leveraged to provide CBGS. Conclusion Provider notions pointed to CBGS as a viable model for instituting geriatric care in Uganda’s public primary healthcare system. However, this requires policymakers to leverage existing village health team and local governance structures, conduct community education and sensitization about CBGS, and bring onboard health workers, family relatives, and neighbors. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02897-9.
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Affiliation(s)
- Jude Thaddeus Ssensamba
- Division of Infectious Diseases and Geriatric Health, Center for Innovations in Health Africa, Kampala, Uganda. .,Health Care Programmes, VIVES University of Applied Sciences, Kortrijk, Belgium. .,School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Mary Nakafeero
- Division of Infectious Diseases and Geriatric Health, Center for Innovations in Health Africa, Kampala, Uganda.,School of Public Health, Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Hellen Musana
- Division of Infectious Diseases and Geriatric Health, Center for Innovations in Health Africa, Kampala, Uganda.,School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mathew Amollo
- School of Public Health, Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Aloysius Ssennyonjo
- School of Public Health, Department of Health Policy and Planning, Makerere University College of Health Sciences, Kampala, Uganda
| | - Suzanne N Kiwanuka
- School of Public Health, Department of Health Policy and Planning, Makerere University College of Health Sciences, Kampala, Uganda
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Sibanda EL, Mangenah C, Neuman M, Tumushime M, Watadzaushe C, Mutseta MN, Maringwa G, Dirawo J, Fielding KL, Johnson C, Ncube G, Taegtmeyer M, Hatzold K, Corbett EL, Terris-Prestholt F, Cowan FM. Comparison of community-led distribution of HIV self-tests kits with distribution by paid distributors: a cluster randomised trial in rural Zimbabwean communities. BMJ Glob Health 2021; 6:e005000. [PMID: 34275872 PMCID: PMC8287604 DOI: 10.1136/bmjgh-2021-005000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We compared community-led versus an established community-based HIV self-testing (HIVST) model in rural Zimbabwe using a cluster-randomised trial. METHODS Forty village groups were randomised 1:1 using restricted randomisation to community-led HIVST, where communities planned and implemented HIVST distribution for 4 weeks, or paid distribution (PD), where distributors were paid US$50 to distribute kits door-to-door over 4 weeks. Individual level primary outcomes compared household survey responses by arm 4 months post-intervention for: (1) newly diagnosed HIV during/within 4 months following HIVST distribution, (2) linkage to confirmatory testing, pre-exposure prophylaxis or voluntary medical male circumcision during/within 4 months following HIVST distribution. Participants were not masked to allocation; analysis used masked data. Trial analysis used random-effects logistic regression.Distribution costs compared: (1) community-led HIVST, (2) PD HIVST and (3) PD costs when first implemented in 2016/2017. RESULTS From October 2018 to August 2019, 27 812 and 36 699 HIVST kits were distributed in community-led and PD communities, respectively. We surveyed 11 150 participants and 5683 were in community-led arm. New HIV diagnosis was reported by 211 (3.7%) community-led versus 197 (3.6%) PD arm participants, adjusted OR (aOR) 1.1 (95% CI 0.72 to 1.56); 318 (25.9%) community-led arm participants linked to post-test services versus 361 (23.9%) in PD arm, aOR 1.1 (95% CI 0.75 to 1.49.Cost per HIVST kit distributed was US$6.29 and US$10.25 for PD and community-led HIVST, both lower than 2016/2017 costs for newly implemented PD (US$14.52). No social harms were reported. CONCLUSIONS Community-led HIVST can perform as well as paid distribution, with lower costs in the first year. These costs may reduce with programme maturity/learning. TRIAL REGISTRATION NUMBER PACTR201811849455568.
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Affiliation(s)
- Euphemia Lindelwe Sibanda
- CeSHHAR Zimbabwe, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Melissa Neuman
- Department of Infectious Disease Epidemiology and MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Miriam N Mutseta
- Department of Sexual Reproductive Health Rights and Innovations, Population Services International Zimbabwe, Harare, Zimbabwe
| | | | | | - Katherine L Fielding
- Department of Infectious Disease Epidemiology and MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Johnson
- HIV, Hepatitis and STI Department, World Health Organisation, Geneva, Switzerland
| | - Getrude Ncube
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Karin Hatzold
- Population Services International, Washington, District of Columbia, USA
| | - Elizabeth Lucy Corbett
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- TB-HIV Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Fern Terris-Prestholt
- Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | - Frances M Cowan
- CeSHHAR Zimbabwe, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Jopling R, Nyamayaro P, Andersen LS, Kagee A, Haberer JE, Abas MA. A Cascade of Interventions to Promote Adherence to Antiretroviral Therapy in African Countries. Curr HIV/AIDS Rep 2021; 17:529-546. [PMID: 32776179 PMCID: PMC7497365 DOI: 10.1007/s11904-020-00511-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose of Review We reviewed interventions to improve uptake and adherence to antiretroviral therapy (ART) in African countries in the Treat All era. Recent Findings ART initiation can be improved by facilitated rapid receipt of first prescription, including community-based linkage and point-of-care strategies, integration of HIV care into antenatal care and peer support for adolescents. For people living with HIV (PLHIV) on ART, scheduled SMS reminders, ongoing intensive counselling for those with viral non-suppression and economic incentives for the most deprived show promise. Adherence clubs should be promoted, being no less effective than facility-based care for stable patients. Tracing those lost to follow-up should be targeted to those who can be seen face-to-face by a peer worker. Summary Investment is needed to promote linkage to initiating ART and for differentiated approaches to counselling for youth and for those with identified suboptimal adherence. More evidence from within Africa is needed on cost-effective strategies to identify and support PLHIV at an increased risk of non-adherence across the treatment cascade. Electronic supplementary material The online version of this article (10.1007/s11904-020-00511-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca Jopling
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Primrose Nyamayaro
- Department of Psychiatry, University of Zimbabwe College of Health Sciences, Mazowe Street, Avondale, Harare, Zimbabwe
| | - Lena S Andersen
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital Anzio Road, Observatory, Cape Town, South Africa
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Stellenbosch, 7602, South Africa
| | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Melanie Amna Abas
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
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Ponticiello M, Mwanga-Amumpaire J, Tushemereirwe P, Nuwagaba G, King R, Sundararajan R. "Everything is a Mess": How COVID-19 is Impacting Engagement with HIV Testing Services in Rural Southwestern Uganda. AIDS Behav 2020; 24:3006-3009. [PMID: 32451939 PMCID: PMC7246959 DOI: 10.1007/s10461-020-02935-w] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Gabriel Nuwagaba
- Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rachel King
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Radhika Sundararajan
- Weill Cornell Center for Global Health, 402 East 67th Street, 2nd floor, New York, NY, 10065, USA.
- Weill Cornell Department of Emergency Medicine, New York, NY, USA.
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Secondary distribution of HIV self-tests improves coverage. Lancet HIV 2020; 7:e732-e733. [PMID: 33045192 DOI: 10.1016/s2352-3018(20)30237-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 11/20/2022]
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Tanser F, Kim HY, Vandormael A, Iwuji C, Bärnighausen T. Opportunities and Challenges in HIV Treatment as Prevention Research: Results from the ANRS 12249 Cluster-Randomized Trial and Associated Population Cohort. Curr HIV/AIDS Rep 2020; 17:97-108. [PMID: 32072468 PMCID: PMC7072051 DOI: 10.1007/s11904-020-00487-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The ANRS 12249 treatment as prevention (TasP) trial investigated the impact of a universal test and treat (UTT) approach on reducing HIV incidence in one of the regions of the world most severely affected by the HIV epidemic-KwaZulu-Natal, South Africa. We summarize key findings from this trial as well as recent findings from controlled studies conducted in the linked population cohort quantifying the long-term effects of expanding ART on directly measured HIV incidence (2004-2017). RECENT FINDINGS The ANRS TasP trial did not-and could not-demonstrate a reduction in HIV incidence, because the offer of UTT in the intervention communities did not increase ART coverage and population viral suppression compared to the standard of care in the control communities. Ten controlled studies from the linked population cohort-including several quasi-experimental study designs-exploit heterogeneity in ART exposure to show a consistent and substantial impact of expanding provision of ART and population viral suppression on reduction in HIV incidence at the couple, household, community, and population levels. In this setting, all of the evidence from large, population-based studies (inclusive of the ANRS TasP trial) is remarkably coherent and consistent-i.e., higher ART coverage and population viral suppression were repeatedly associated with clear, measurable decreases in HIV incidence. Thus, the expanded provision of ART has plausibly contributed in a major way toward the dramatic 43% decline in population-level HIV incidence in this typical rural African population. The outcome of the ANRS TasP trial constitutes a powerful null finding with important insights for overcoming implementation challenges in the population delivery of ART. This finding does not imply lack of ART effectiveness in blocking onward transmission of HIV nor its inability to reduce HIV incidence. Rather, it demonstrates that large increases in ART coverage over current levels will require health systems innovations to attract people living with HIV in early stages of the disease to participate in HIV treatment. Such innovations and new approaches are required for the true potential of UTT to be realized.
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Affiliation(s)
- Frank Tanser
- Lincoln Institute for Health, University of Lincoln, Lincoln, LN6 7TS, UK.
- Africa Health Research Institute, KwaZulu-Natal, South Africa.
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
| | - Hae-Young Kim
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Population Health, New York University School of Medicine, New York, USA
- KwaZulu-Natal Innovation and Sequencing Platform, Durban, KwaZulu-Natal, South Africa
| | - Alain Vandormael
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- KwaZulu-Natal Innovation and Sequencing Platform, Durban, KwaZulu-Natal, South Africa
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Collins Iwuji
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Till Bärnighausen
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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