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Tassembedo S, Traore IT, Ouedraogo AS, Meda N, Van de Perre P, Nagot N, Kirakoya-Samadoulougou F. Context-specific estimates of vertical transmission. Lancet HIV 2024; 11:e353. [PMID: 38701820 DOI: 10.1016/s2352-3018(24)00095-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Souleymane Tassembedo
- Infectious Disease Research Programme, Centre Muraz, National Institute of Public Health, Bobo-Dioulasso, Burkina Faso 01 BP 390.
| | | | | | - Nicolas Meda
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Philippe Van de Perre
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, INSERM, EFS, Montpellier, France
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, INSERM, EFS, Montpellier, France
| | - Fati Kirakoya-Samadoulougou
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA; Research Center in Epidemiology, Biostatistics, and Clinical Research, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
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Stevens O, Boothe M, Tiberi O, Mahy M, Walker P, Glaubius R, McOwen J, Couto A, Cunha M, Imai-Eaton JW. Triangulation of Routine Antenatal HIV Prevalence Data and Adjusted HIV Estimates in Mozambique. J Acquir Immune Defic Syndr 2024; 95:e70-e80. [PMID: 38180740 PMCID: PMC10769169 DOI: 10.1097/qai.0000000000003333] [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: 01/06/2024]
Abstract
BACKGROUND Routine health system data are central to monitoring HIV trends. In Mozambique, the reported number of women receiving antenatal care (ANC) and antiretroviral therapy for prevention of mother-to-child transmission (PMTCT) has exceeded the Spectrum-estimated number of pregnant women since 2017. In some provinces, reported HIV prevalence in pregnant women has declined faster than epidemiologically plausible. We hypothesized that these issues are linked and caused by programmatic overenumeration of HIV-negative pregnant women at ANC. METHODS We triangulated program-reported ANC client numbers with survey-based fertility estimates and facility birth data adjusted for the proportion of facility births. We used survey-reported ANC attendance to produce adjusted time series of HIV prevalence in pregnant women, adjusted for hypothesized program double counting. We calibrated the Spectrum HIV estimation models to adjusted HIV prevalence data to produce adjusted adult and pediatric HIV estimates. RESULTS ANC client numbers were not consistent with facility birth data or modeled population estimates indicating ANC data quality issues in all provinces. Adjusted provincial ANC HIV prevalence in 2021 was median 45% [interquartile range 35%-52% or 2.3 percentage points (interquartile range 2.5-3.5)] higher than reported HIV prevalence. In 2021, calibrating to adjusted antenatal HIV prevalence lowered PMTCT coverage to less than 100% in most provinces and increased the modeled number of new child infections by 35%. The adjusted results better reconciled adult and pediatric antiretroviral treatment coverage and antenatal HIV prevalence with regional fertility estimates. CONCLUSIONS Adjusting HIV prevalence in pregnant women using nationally representative household survey data on ANC attendance produced estimates more consistent with surveillance data. The number of children living with HIV in Mozambique has been substantially underestimated because of biased routine ANC prevalence. Renewed focus on HIV surveillance among pregnant women would improve PMTCT coverage and pediatric HIV estimates.
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Affiliation(s)
- Oliver Stevens
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Makini Boothe
- Data for Impact, The Joint United Nations Program on HIV/AIDS (UNAIDS), Maputo, Mozambique
| | - Orrin Tiberi
- National STI and HIV/AIDS Control Program, Ministry of Health Maputo, Maputo, Mozambique
| | - Mary Mahy
- Data for Impact, The Joint United Nations Program on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Patrick Walker
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Robert Glaubius
- Center for Modeling, Planning and Policy Analysis, Avenir Health, Glastonbury, CT
| | - Jordan McOwen
- US Centers for Disease Control and Prevention, Maputo, Mozambique; and
| | - Aleny Couto
- National STI and HIV/AIDS Control Program, Ministry of Health Maputo, Maputo, Mozambique
| | - Morais Cunha
- National STI and HIV/AIDS Control Program, Ministry of Health Maputo, Maputo, Mozambique
| | - Jeffrey W. Imai-Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
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Singogo E, Chagomerana M, Van Ryn C, M’bwana R, Likaka A, M’baya B, Puerto-Meredith S, Chipeta E, Mwapasa V, Muula A, Reilly C, Hosseinipour MC. Prevalence and incidence of transfusion-transmissible infections among blood donors in Malawi: A population-level study. Transfus Med 2023; 33:483-496. [PMID: 37828838 PMCID: PMC11096640 DOI: 10.1111/tme.13006] [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: 11/30/2022] [Revised: 08/04/2023] [Accepted: 09/09/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Voluntary non-remunerated blood donors (VNRBDs) are essential to sustain national blood supplies. Expanding testing capacity for the major transfusion-transmitted infections (TTI) is crucial to ensure safe blood products. Understanding trends in TTIs can inform prioritisation of resources. METHODS We conducted a retrospective cohort data analysis of routine blood donation data collected from VNRBDs by the Malawi Blood Transfusion Service from January 2015 to October 2021. Variables included age, occupation; and screening results of TTIs (HIV, Hepatitis B and C, and syphilis). We estimated both prevalence and incidence per person-year for each TTI using longitudinal and spatial logistic regression models. RESULTS Of the 213 626 donors, 204 920 (95.8%) donors were included in the final analysis. Most donors (77.4%) were males, baseline median age was 19.9 (IQR 18.0, 24.1), 70.9% were students, and over 80.0% were single at first donation. Overall TTI prevalence among donors was 10.7%, with HBV having the highest prevalence (3.4%), followed by syphilis (3.3%), then HIV (2.4%) and HCV (2.4%). Incidence per 1000 person-years for syphilis was 20.1 (19.0, 21.3), HCV was 18.4 (17.3, 19.5), HBV was 13.7 (12.8, 14.7), and HIV was 11.4 (10.6, 12.3). We noted geographical variations with the northern region having lower rates of both prevalence and incidence compared to central and southern regions. CONCLUSION The individual TTI prevalence and incidence rates from this study are consistent with Southern African regional estimates. By identifying geographical variations of TTI prevalence and incidence, these findings could potentially inform prioritisation of blood collection efforts to optimise blood collection processes.
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Affiliation(s)
| | | | - Collin Van Ryn
- Department of Biostatistics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | | | | | | | | | - Effie Chipeta
- Centre for Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Victor Mwapasa
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Adamson Muula
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Cavan Reilly
- Department of Biostatistics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Mina C. Hosseinipour
- UNC Project, Lilongwe, Malawi
- Division of Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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Mphonda S, Dussault J, Bengtson A, Gaynes BN, Go V, Hosseinipour MC, Kulisewa K, Kutengule A, Meltzer-Brody S, Udedi M, Pence B. Preferences for enhanced treatment options to address HIV care engagement among women living with HIV and perinatal depression in Malawi. BMC Public Health 2023; 23:1922. [PMID: 37794350 PMCID: PMC10552213 DOI: 10.1186/s12889-023-16835-w] [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: 11/03/2022] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Option B + offers lifelong ART to pregnant or breastfeeding mothers, but postpartum loss to HIV care, partially driven by perinatal depression (PND), threatens the impact of this policy. This study aims to understand women's and providers' preferences for developing a feasible intervention to address PND and support engagement in HIV care among women living with PND and HIV. METHODS We conducted a total of 6 focus group discussions (FGDs) involving 4 clinics in Lilongwe District from December 2018 through February 2019. We conducted 2 FGDs each among 3 stakeholder groups: clinical staff, prenatal women, and postnatal women. Perinatal participants were living with HIV and screened positively for PND using the validated Edinburgh Postnatal Depression Scale (EPDS). Clinical staff were nurses who were trained antiretroviral therapy (ART) providers. Interviewers led FGDs in Chichewa using a semi-structured guide. Data were analyzed using deductive and inductive coding in NVivo 12 software. RESULTS Women favored ART linkage services, but providers said they already offered such services, with mixed results. Individual counselling was universally supported. A perceived benefit of group counselling was peer support, but there were concerns among women regarding confidentiality and stigma. Women liked mobile appointment reminders but identified low phone ownership as a barrier. Participants recommended home visits as an additional care engagement strategy. Women consistently discussed the need for social support from family members and friends to address PND and support engagement in HIV care. CONCLUSION This study highlights the importance of peer encouragement to support perinatal HIV care engagement among women with HIV and PND. The results from this study can be used to support intervention development to increase HIV care engagement and improve long-term HIV outcomes in women with PND.
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Affiliation(s)
- Steve Mphonda
- UNC-Project Malawi, Private Bag A-104, Lilongwe, Malawi.
| | - Josée Dussault
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Angela Bengtson
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI, USA
| | - Bradley N Gaynes
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vivian Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mina C Hosseinipour
- UNC-Project Malawi, Private Bag A-104, Lilongwe, Malawi
- Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kazione Kulisewa
- Department of Psychiatry and Mental health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Samantha Meltzer-Brody
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael Udedi
- Department of Psychiatry and Mental health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Ministry of Health, Lilongwe, Malawi
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Msukwa MT, MacLachlan EW, Gugsa ST, Theu J, Namakhoma I, Bangara F, Blair CL, Payne D, Curran KG, Arons M, Namachapa K, Wadonda N, Kabaghe AN, Dobbs T, Shanmugam V, Kim E, Auld A, Babaye Y, O'Malley G, Nyirenda R, Bello G. Characterising persons diagnosed with HIV as either recent or long-term using a cross-sectional analysis of recent infection surveillance data collected in Malawi from September 2019 to March 2020. BMJ Open 2022; 12:e064707. [PMID: 36153024 PMCID: PMC9511604 DOI: 10.1136/bmjopen-2022-064707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In Malawi, a recent infection testing algorithm (RITA) is used to characterise infections of persons newly diagnosed with HIV as recent or long term. This paper shares results from recent HIV infection surveillance and describes distribution and predictors. SETTING Data from 155 health facilities in 11 districts in Malawi were pooled from September 2019 to March 2020. PARTICIPANTS Eligible participants were ≥13 years, and newly diagnosed with HIV. Clients had RITA recent infections if the rapid test for recent infection (RTRI) test result was recent and viral load (VL) ≥1000 copies/mL; if VL was <1000 copies/mL the RTRI result was reclassified as long-term. Results were stratified by age, sex, pregnancy/breastfeeding status and district. RESULTS 13 838 persons consented to RTRI testing and 12 703 had valid RTRI test results and VL results after excluding clients not newly HIV-positive, RTRI negative or missing data (n=1135). A total of 12 365 of the 12 703 were included in the analysis after excluding those whose RTRI results were reclassified as long term (n=338/784 or 43.1%). The remainder, 446/12 703 or 3.5%, met the definition of RITA recent infection. The highest percentage of recent infections was among breastfeeding women (crude OR (COR) 3.2; 95% CI 2.0 to 5.0), young people aged 15-24 years (COR 1.6; 95% CI 1.3 to 1.9) and persons who reported a negative HIV test within the past 12 months (COR 3.3; 95% CI 2.6 to 4.2). Factors associated with recent infection in multivariable analysis included being a non-pregnant female (adjusted OR (AOR) 1.4; 95% CI 1.2 to 1.8), a breastfeeding female (AOR 2.2; 95% CI 1.4 to 3.5), aged 15-24 years (AOR 1.6; 95% CI 1.3 to 1.9) and residents of Machinga (AOR 2.0; 95% CI 1.2 to 3.5) and Mzimba (AOR 2.4; 95% CI 1.3 to 4.5) districts. CONCLUSIONS Malawi's recent HIV infection surveillance system demonstrated high uptake and identified sub-populations of new HIV diagnoses with a higher percentage of recent infections.
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Affiliation(s)
- Malango T Msukwa
- Department of Global Health, I-TECH, University of Washington, Lilongwe, Malawi
| | - Ellen W MacLachlan
- Department of Global Health, I-TECH, University of Washington, Seattle, Washington, USA
| | - Salem T Gugsa
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Joe Theu
- Department of Global Health, I-TECH, University of Washington, Lilongwe, Malawi
| | - Ireen Namakhoma
- Department of Global Health, I-TECH, University of Washington, Lilongwe, Malawi
| | - Fred Bangara
- Department of Global Health, I-TECH, University of Washington, Lilongwe, Malawi
| | - Christopher L Blair
- Department of Global Health, I-TECH, University of Washington, Lilongwe, Malawi
| | - Danielle Payne
- Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Kathryn G Curran
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa Arons
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Khumbo Namachapa
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Central Region, Malawi
| | - Nellie Wadonda
- Centers for Disease Control and Prevention, Lilongwe, Malawi
| | | | - Trudy Dobbs
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Evelyn Kim
- Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Andrew Auld
- Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Yusuf Babaye
- Department of Global Health, I-TECH, University of Washington, Lilongwe, Malawi
| | - Gabrielle O'Malley
- Department of Global Health, I-TECH, University of Washington, Seattle, Washington, USA
| | - Rose Nyirenda
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Central Region, Malawi
| | - George Bello
- Department of Global Health, I-TECH, University of Washington, Lilongwe, Malawi
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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
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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
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Summarizing the results and methods of the 2019 Joint United Nations Programme on HIV/AIDS HIV estimates. AIDS 2019; 33 Suppl 3:S197-S201. [PMID: 31725433 PMCID: PMC6919222 DOI: 10.1097/qad.0000000000002440] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
UNAIDS and other partners provide support to countries to develop estimates of HIV and related indicators on an annual basis. These estimates are used to monitor epidemic trends, guide program planning and resource allocation, and inform policy decision-making. The collection of articles in this AIDS supplement provide the headline results for the 2019 UNAIDS estimates and describe the new developments in the methods used to produce these estimates.
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