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Spielman E, Mello MB, Schaefer R, Ong J, Schmidt HMA, Henderson M, Vinti P, Prochazka M, Luhmann N, Baggaley R. Missed opportunities for guidance on sexually transmitted infection services: a global review of national HIV PrEP guidance. Sex Transm Infect 2024:sextrans-2023-056081. [PMID: 38897729 DOI: 10.1136/sextrans-2023-056081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVES People who use or would benefit from pre-exposure prophylaxis (PrEP) for HIV infection are disproportionately affected by sexually transmitted infections (STIs). Integrating STI services when offering PrEP fosters synergies and efficiencies in response to HIV/STI and promotes people-centred care. Including guidance on STI interventions for people on PrEP may facilitate implementation and uptake. We conducted a global review of national PrEP guidance documents and analysed the inclusion of recommendations for the provision of STI services by country level of income. METHODS We searched national PrEP guidance documents published by WHO Member States through the WHO, the Joint United Nations Programme on HIV/AIDS (UNAIDS) databases, the PrEPWatch repository and Google. Information on a range of STI-related interventions was extracted from documents available by October 2023. RESULTS Of the 113 national PrEP guidance documents retrieved, STIs were mentioned in 77% (90/117). Viral hepatitis B testing and vaccination were recommended by most high-income countries (HICs) and low-income and middle-income countries (LMICs). Recommendation for syphilis testing was prominent in HICs (91%) and moderately noted in LMICs (68%). Gonorrhoea and chlamydia testing was recommended frequently in HICs (88%) and 42% in LMICs. However, the review noted that, to a much lesser extent, specific type of testing for these pathogens was mentioned. Recommendation for quarterly STI testing for syphilis, gonorrhoea and chlamydia was ubiquitous, while the need to offer STI partner services was rarely mentioned. CONCLUSIONS PrEP services offer an opportunity for improved and expanded STI services, increasing person-centred care and addressing STI epidemics alongside HIV. Our review highlights the strengths and gaps in incorporating critical STI interventions into national PrEP normative guidance. Addressing these gaps through a stepwise approach and increasing targeted testing and partner services can help improve quality of care and support an effective response to HIV and other STIs.
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Affiliation(s)
- Erica Spielman
- Global HIV, Hepatitis, and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Maeve B Mello
- Global HIV, Hepatitis, and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Robin Schaefer
- Forum for Collaborative Research, Berkeley, California, USA
| | - Jason Ong
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | | | | | - Pietro Vinti
- Joint Infectious Diseases Unit, World Health Organization Regional Office for Europe, Copenhagen, Capital Region, Denmark
| | - Mateo Prochazka
- Global HIV, Hepatitis, and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Niklas Luhmann
- Global HIV, Hepatitis, and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis, and STIs Programmes, World Health Organization, Geneva, Switzerland
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Alemnji G, Mosha F, Maggiore P, Alexander H, Ndlovu N, Kebede Y, Tiam A, Albert H, Edgil D, de Lussigny S, Peter T. Building Integrated Testing Programs for Infectious Diseases. J Infect Dis 2023; 228:1314-1317. [PMID: 37042534 DOI: 10.1093/infdis/jiad103] [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: 06/24/2022] [Revised: 02/02/2023] [Accepted: 04/11/2023] [Indexed: 04/13/2023] Open
Abstract
In the past 2 decades, testing services for diseases such as human immunodeficiency virus (HIV), tuberculosis, and malaria have expanded dramatically. Investments in testing capacity and supportive health systems have often been disease specific, resulting in siloed testing programs with suboptimal capacity, reduced efficiency, and limited ability to introduce additional tests or respond to new outbreaks. Emergency demand for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing overcame these silos and demonstrated the feasibility of integrated testing. Moving forward, an integrated public laboratory infrastructure that services multiple diseases, including SARS-CoV-2, influenza, HIV, tuberculosis, hepatitis, malaria, sexually transmitted diseases, and other infections, will help improve universal healthcare delivery and pandemic preparedness. However, integrated testing faces many barriers including poorly aligned health systems, funding, and policies. Strategies to overcome these include greater implementation of policies that support multidisease testing and treatment systems, diagnostic network optimization, bundled test procurement, and more rapid spread of innovation and best practices across disease programs.
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Affiliation(s)
- George Alemnji
- Office of the Global AIDS Coordinator and Health Diplomacy, US Department of State, Washington, District of Columbia, USA
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fausta Mosha
- Regional Office for Africa, World Health Organization, Harare, Zimbabwe
| | - Paolo Maggiore
- Laboratory Services, Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Heather Alexander
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nqobile Ndlovu
- Science Unit, African Society for Laboratory medicine, Johannesburg, South Africa
| | - Yenew Kebede
- Division of Laboratory Systems, Africa Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Appolinaire Tiam
- Technical Strategy and Innovation Department, Elizabeth Glaser Pediatrics AIDS Foundation, Washington, District of Columbia, USA
| | - Heidi Albert
- Access Department, Foundation for Innovative New Diagnostics, Cape Town, South Africa
| | - Dianna Edgil
- Supply Chain for Health Division, United States Agency for International Development, Washington, District of Columbia, USA
| | | | - Trevor Peter
- Laboratory Services, Clinton Health Access Initiative, Boston, Massachusetts, USA
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Girdwood S, Pandey M, Machila T, Warrier R, Gautam J, Mukumbwa-Mwenechanya M, Benade M, Nichols K, Shibemba L, Mwewa J, Mzyece J, Lungu P, Albert H, Nichols B, Choonga P. The integration of tuberculosis and HIV testing on GeneXpert can substantially improve access and same-day diagnosis and benefit tuberculosis programmes: A diagnostic network optimization analysis in Zambia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001179. [PMID: 36963019 PMCID: PMC10022337 DOI: 10.1371/journal.pgph.0001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/28/2022] [Indexed: 01/26/2023]
Abstract
Diagnostic network optimization (DNO), a geospatial optimization technique, can improve access to diagnostics and reduce costs through informing policy-makers' decisions on diagnostic network changes. In Zambia, viral load (VL) testing and early infant diagnosis (EID) for HIV has been performed at centralized laboratories, whilst the TB-programme utilizes a decentralized network of GeneXpert platforms. Recently, the World Health Organization (WHO) has recommended point-of-care (POC) EID/VL to increase timely diagnosis. This analysis modelled the impact of integrating EID/VL testing for children and pregnant/breastfeeding-women (priority-HIV) with TB on GeneXpert in Zambia. Using OptiDx, we established the baseline diagnostic network using inputs for testing demand (October 2019-September 2020), referrals, testing sites, testing platforms, and costs for HIV/TB testing (transport, test, device) respectively in Zambia. Next, we integrated priority-HIV testing on GeneXpert platforms, historically only utilized by the TB-programme. 228,265 TB tests were conducted on GeneXpert devices and 167,458 (99%) of priority-HIV tests on centralized devices at baseline, of which 10% were tested onsite at the site of sample collection. With integration, the average distance travelled by priority-HIV tests decreased 10-fold (98km to 10km) and the proportion tested onsite increased (10% to 48%). 52% of EID tests are likely to be processed within the same-day from a baseline of zero. There were also benefits to the TB-programme: the average distance travelled/specimen decreased (11km to 7km), alongside potential savings in GeneXpert device-operating costs (30%) through cost-sharing with the HIV-programme. The total cost of the combined testing programmes reduced marginally by 1% through integration/optimization. DNO can be used to strategically leverage existing capacity to achieve the WHO's recommendation regarding POC VL/EID testing. Through DNO of the Zambian network, we have shown that TB/HIV testing integration can improve the performance of the diagnostic network and increase the proportion of specimens tested closer to the patient whilst not increasing costs.
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Affiliation(s)
- Sarah Girdwood
- Department of Internal Medicine, Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medical Microbiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Trevor Machila
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Ranjit Warrier
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | | | - Mariet Benade
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | | | | | | | | | - Patrick Lungu
- National TB and Leprosy Programme, Ministry of Health, Lusaka, Zambia
| | | | - Brooke Nichols
- Department of Internal Medicine, Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medical Microbiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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Fonjungo PN, Lecher S, Zeh C, Rottinghaus E, Chun H, Adje-Toure C, Lloyd S, Mwangi JW, Mwasekaga M, Eshete YM, Pati R, Mots’oane T, Mitruka K, Beukes A, Mwangi C, Bowen N, Hamunime N, Beard RS, Kabuje A, Nabadda S, Auld AF, Balachandra S, Zungu I, Kandulu J, Alemnji G, Ehui E, Alexander H, Ellenberger D. Progress in scale up of HIV viral load testing in select sub-Saharan African countries 2016-2018. PLoS One 2023; 18:e0282652. [PMID: 36920918 PMCID: PMC10016655 DOI: 10.1371/journal.pone.0282652] [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: 05/30/2022] [Accepted: 02/19/2023] [Indexed: 03/16/2023] Open
Abstract
INTRODUCTION We assessed progress in HIV viral load (VL) scale up across seven sub-Saharan African (SSA) countries and discussed challenges and strategies for improving VL coverage among patients on anti-retroviral therapy (ART). METHODS A retrospective review of VL testing was conducted in Côte d'Ivoire, Kenya, Lesotho, Malawi, Namibia, Tanzania, and Uganda from January 2016 through June 2018. Data were collected and included the cumulative number of ART patients, number of patients with ≥ 1 VL test result (within the preceding 12 months), the percent of VL test results indicating viral suppression, and the mean turnaround time for VL testing. RESULTS Between 2016 and 2018, the proportion of PLHIV on ART in all 7 countries increased (range 5.7%-50.2%). During the same time period, the cumulative number of patients with one or more VL test increased from 22,996 to 917,980. Overall, viral suppression rates exceeded 85% for all countries except for Côte d'Ivoire at 78% by June 2018. Reported turnaround times for VL testing results improved in 5 out of 7 countries by between 5.4 days and 27.5 days. CONCLUSIONS These data demonstrate that remarkable progress has been made in the scale-up of HIV VL testing in the seven SSA countries.
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Affiliation(s)
- Peter N. Fonjungo
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, United States of America
- * E-mail:
| | - Shirley Lecher
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, United States of America
| | - Clement Zeh
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, United States of America
| | - Erin Rottinghaus
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, United States of America
| | - Helen Chun
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, United States of America
| | - Christiane Adje-Toure
- Division of Global HIV and TB, Center for Global Health, CDC, Abidjan, Côte d’Ivoire
| | - Spencer Lloyd
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, United States of America
| | - Jane W. Mwangi
- Division of Global HIV and TB, Center for Global Health, CDC, Nairobi, Kenya
| | - Michael Mwasekaga
- Division of Global HIV and TB, Center for Global Health, CDC, Dar es Salaam, Tanzania
| | | | - Rituparna Pati
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, United States of America
| | | | - Kiren Mitruka
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, United States of America
| | - Anita Beukes
- Namibia Institute of Pathology, Windhoek, Namibia
| | - Christina Mwangi
- Division of Global HIV and TB, Center for Global Health, CDC, Kampala, Uganda
| | | | | | - Rachel S. Beard
- Division of Global HIV and TB, Center for Global Health, CDC, Windhoek, Namibia
| | | | | | - Andrew F. Auld
- Division of Global HIV and TB, Center for Global Health, CDC, Lilongwe, Malawi
| | - Shirish Balachandra
- Division of Global HIV and TB, Center for Global Health, CDC, Abidjan, Côte d’Ivoire
| | - Innocent Zungu
- Division of Global HIV and TB, Center for Global Health, CDC, Lilongwe, Malawi
| | | | - George Alemnji
- Office of the Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
| | - Eboi Ehui
- Ministry of Health, Abidjan, Côte D’Ivoire
| | - Heather Alexander
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, United States of America
| | - Dennis Ellenberger
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, United States of America
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Maluleke K, Musekiwa A, Mashamba-Thompson TP. Study protocol for developing a novel approach for improving supply chain management for SARS-CoV-2 point of care diagnostic services in resource-limited settings: a case study of Mopani District in Limpopo province, South Africa. BMJ Open 2022; 12:e062509. [PMID: 36424106 PMCID: PMC9693879 DOI: 10.1136/bmjopen-2022-062509] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Recent evidence shows that point-of-care (POC) testing is a more feasible alternative for diagnosis of COVID-19 in settings that have poor access to laboratory diagnostic services. Equitable access to POC testing can be optimised through well-established supply chain management (SCM) systems. The proposed study aims to develop a novel approach for improving SCM for COVID-19 POC diagnostic services in resource-limited settings with poor access to laboratory diagnostic services, using Mopani District in Limpopo Province, South Africa as a study setting. METHODS AND ANALYSIS This study was guided by results of the scoping review. Following the scoping review, we propose a mixed-methods study, which will be implemented in three phases. First, we will perform a geospatial analysis to investigate the spatial distribution of COVID-19 testing services. Second, we will perform an audit of POC diagnostic services including its supply chain to evaluate the effect of SCM on accessibility of COVID-19 POC diagnostic services and reveal SCM barriers and enablers of accessibility of COVID-19 POC diagnostic services. Third, we will perform a nominal group technique to collaborate with key stakeholders in co-creation of a novel approach for improving SCM systems for COVID-19 POC diagnostic services. For the geospatial analysis, we will employ the ArcGIS Software. For the analysis of quantitative and qualitative data that will be generated from the audit and nominal group discussion, we will employ Stata software and NVivo software, respectively. ETHICS AND DISSEMINATION This study has been ethically reviewed and approved by two institutional review boards: University of Pretoria Faculty of Health Sciences Research Ethics Committee (approval number 655/2021) and Limpopo Department of Health Research Ethics Committee (approval number LP-2021-12-007). The results of this study will be disseminated through national and international presentations and peer-reviewed publications.
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Affiliation(s)
- Kuhlula Maluleke
- School of Health Systems and Public Health, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Alfred Musekiwa
- School of Health Systems and Public Health, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
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Getaneh T, Negesse A, Dessie G, Desta M, Assemie MA, Tigabu A, Gelaye K, Alemu AA, Lebu S. Treatment failure and its associated factors among children receiving highly active antiretroviral therapy in Ethiopia: A systematic review and meta-analysis. SAGE Open Med 2022; 10:20503121221081335. [PMID: 35251655 PMCID: PMC8891854 DOI: 10.1177/20503121221081335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/28/2022] [Indexed: 01/22/2023] Open
Abstract
Objectives: Over the last decades, large number of children living with human immunodeficiency virus (HIV) have been successfully enrolled in care and initiated treatment. However, treatment failure is still a major challenge in the track, missing far too many children. National-level evidence on antiretroviral therapy failure and its associated factors among children receiving highly active antiretroviral therapy is required to alleviate this challenge. Methods: PubMed/Medline, EMBASE, CINAHL, Cochrane library, Google, and Google Scholar databases were used to access eligible studies. This meta-analysis was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In addition, Newcastle–Ottawa Scale quality assessment was applied for critical appraisal. Cochran’s Q statistic, funnel asymmetry plot, and Egger’s test were used to assess heterogeneity and publication bias. Random effect model was computed to explore the pooled burden of treatment failure and its associated factors among children living with HIV. Odds ratio with 95% confidence interval was considered to identify associated factors. Result: The overall pooled prevalence of treatment failure among children living with HIV was 16.6%. Whereas virological, immunological, and clinical failure were 4.49%, 5.41%, and 5.71% respectively, where either of parent is deceased (odds ratio = 2.13, 95% confidence interval: 1.4–3.3), opportunistic infection (odds ratio = 1.67, 95% confidence interval: 1.1–2.5), absence of disclosure of status (odds ratio = 1.6, 95% confidence interval: 1.0–2.5), advanced World Health Organization stage (odds ratio = 4.2, 95% confidence interval: 1.6–10.5), and drug substitution (odds ratio = 2.0, 95% CI: 1.5–2.7) were significantly associated factors. Conclusion: The pooled prevalence of treatment failure among children living with HIV in Ethiopia was lower when compared to most African countries. Accordingly, either prevention or early treatment of opportunistic infection and advanced World Health Organization clinical stages, special care for children whose either parents are deceased, advocating disclosure of status, and avoiding drug substitution as much as possible were still needed to prevent treatment failure.
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Affiliation(s)
- Temesgen Getaneh
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Ayenew Negesse
- Department of Human Nutrition and Food Science, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- Center of Excellence in Human Nutrition, School of Human Nutrition, Food Science and Technology, Hawassa University, Awasa, Ethiopia
| | - Getenet Dessie
- Department of Nursing, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Melaku Desta
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Moges Agazhe Assemie
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Agimasie Tigabu
- Department of Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Kihinetu Gelaye
- Department of Midwifery, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Addisu Alehegn Alemu
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Sarah Lebu
- School of Public Health, University of California, Berkley, Berkeley, CA, USA
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Maluleke K, Musekiwa A, Kgarosi K, Gregor EM, Dlangalala T, Nkambule S, Mashamba-Thompson T. A Scoping Review of Supply Chain Management Systems for Point of Care Diagnostic Services: Optimising COVID-19 Testing Capacity in Resource-Limited Settings. Diagnostics (Basel) 2021; 11:diagnostics11122299. [PMID: 34943536 PMCID: PMC8700402 DOI: 10.3390/diagnostics11122299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Point of care (POC) testing has enabled rapid coronavirus disease 2019 (COVID-19) diagnosis in resource-limited settings with limited laboratory infrastructure and high disease burden. However, the accessibility of the tests is not optimal in these settings. This scoping review mapped evidence on supply chain management (SCM) systems for POC diagnostic services to reveal evidence that can help guide future research and inform the improved implementation of SARS-CoV-2 POC diagnostics in resource-limited settings. Methodology: This scoping review was guided by an adapted version of the Arksey and O’Malley methodological framework. We searched the following electronic databases: Medline Ovid, Medline EBSCO, Scopus, PubMed, PsychInfo, Web of Science and EBSCOHost. We also searched grey literature in the form of dissertations/theses, conference proceedings, websites of international organisations such as the World Health Organisation and government reports. A search summary table was used to test the efficacy of the search strategy. The quality of the included studies was appraised using the mixed method appraisal tool (MMAT) version 2018. Results: We retrieved 1206 articles (databases n = 1192, grey literature n = 14). Of these, 31 articles were included following abstract and full-text screening. Fifteen were primary studies conducted in LMICs, and 16 were reviews. The following themes emerged from the included articles: availability and accessibility of POC diagnostic services; reasons for stockouts of POC diagnostic tests (procurement, storage, distribution, inventory management and quality assurance) and human resources capacity in POC diagnostic services. Of the 31 eligible articles, 15 underwent methodological quality appraisal with scores between 90% and 100%. Conclusions: Our findings revealed limited published research on SCM systems for POC diagnostic services globally. We recommend primary studies aimed at investigating the barriers and enablers of SCM systems for POC diagnostic services for highly infectious pathogens such SARS-CoV-2 in high disease-burdened settings with limited laboratory infrastructures.
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Affiliation(s)
- Kuhlula Maluleke
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0084, South Africa; (A.M.); (T.D.)
- Correspondence:
| | - Alfred Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0084, South Africa; (A.M.); (T.D.)
| | - Kabelo Kgarosi
- Department of Library Services, Faculty of Health Sciences, University of Pretoria, Pretoria 0084, South Africa;
| | - Emily Mac Gregor
- School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0084, South Africa;
| | - Thobeka Dlangalala
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0084, South Africa; (A.M.); (T.D.)
| | - Sphamandla Nkambule
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4000, South Africa;
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Okere NE, Sambu V, Ndungile Y, van Praag E, Hermans S, Naniche D, de Wit TFR, Maokola W, Gomez GB. The Shinyanga Patient: A Patient's Journey through HIV Treatment Cascade in Rural Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8418. [PMID: 34444166 PMCID: PMC8393654 DOI: 10.3390/ijerph18168418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/23/2021] [Accepted: 08/04/2021] [Indexed: 12/30/2022]
Abstract
The 2016-2017 Tanzania HIV Impact Survey (THIS) reported the accomplishments towards the 90-90-90 global HIV targets at 61-94-87, affirming the need to focus on the first 90 (i.e., getting 90% of people living with HIV (PLHIV) tested). We conducted a patient-pathway analysis to understand the gap observed, by assessing the alignment between where PLHIV seek healthcare and where HIV services are available in the Shinyanga region, Tanzania. We used existing and publicly available data from the National AIDS Control program, national surveys, registries, and relevant national reports. Region-wide, the majority (n = 458/722, 64%) of THIS respondents accessed their last HIV test at public sector facilities. There were 65.9%, 45.1%, and 74.1% who could also access antiretroviral therapy (ART), CD4 testing, and HIV viral load testing at the location of their last HIV test, respectively. In 2019, the viral suppression rate estimated among PLHIV on ART in the Shinyanga region was 91.5%. PLHIV access HIV testing mostly in public health facilities; our research shows that synergies can be achieved to improve access to services further down the cascade in this sector. Furthermore, effective engagement with the private sector (not-for-profit and for-profit) will help to achieve the last mile toward ending the HIV epidemic.
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Affiliation(s)
- Nwanneka E Okere
- Department of Global Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.H.); (T.F.R.d.W.)
- Amsterdam Institute for Global Health and Development, 1105 BP Amsterdam, The Netherlands;
| | - Veryeh Sambu
- National AIDS Control Programme, Dodoma 41110, Tanzania; (V.S.); (W.M.)
| | - Yudas Ndungile
- Regional Health Management Team, Shinyanga 37103, Tanzania;
| | - Eric van Praag
- Amsterdam Institute for Global Health and Development, 1105 BP Amsterdam, The Netherlands;
| | - Sabine Hermans
- Department of Global Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.H.); (T.F.R.d.W.)
- Amsterdam Institute for Global Health and Development, 1105 BP Amsterdam, The Netherlands;
| | - Denise Naniche
- ISGlobal-Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain;
| | - Tobias F Rinke de Wit
- Department of Global Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.H.); (T.F.R.d.W.)
- Amsterdam Institute for Global Health and Development, 1105 BP Amsterdam, The Netherlands;
| | - Werner Maokola
- National AIDS Control Programme, Dodoma 41110, Tanzania; (V.S.); (W.M.)
| | - Gabriela B Gomez
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
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Bringing Data Analytics to the Design of Optimized Diagnostic Networks in Low- and Middle-Income Countries: Process, Terms and Definitions. Diagnostics (Basel) 2020; 11:diagnostics11010022. [PMID: 33374315 PMCID: PMC7823670 DOI: 10.3390/diagnostics11010022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022] Open
Abstract
Diagnostics services are an essential component of healthcare systems, advancing universal health coverage and ensuring global health security, but are often unavailable or under-resourced in low- and middle-income (LMIC) countries. Typically, diagnostics are delivered at various tiers of the laboratory network based on population needs, and resource and infrastructure constraints. A diagnostic network additionally incorporates screening and includes point-of-care testing that may occur outside of a laboratory in the community and clinic settings; it also emphasizes the importance of supportive network elements, including specimen referral systems, as being critical for the functioning of the diagnostic network. To date, design and planning of diagnostic networks in LMICs has largely been driven by infectious diseases such as TB and HIV, relying on manual methods and expert consensus, with a limited application of data analytics. Recently, there have been efforts to improve diagnostic network planning, including diagnostic network optimization (DNO). The DNO process involves the collection, mapping, and spatial analysis of baseline data; selection and development of scenarios to model and optimize; and lastly, implementing changes and measuring impact. This review outlines the goals of DNO and steps in the process, and provides clarity on commonly used terms.
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