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Molemans M, Reis R, Shabalala F, Dlamini N, Masilela N, Simelane N, Pell C, Chao A, Spiegelman D, Vernooij E, van Leth F. Reasons for using traditional and complementary care by people living with HIV on antiretroviral therapy and association with interrupted care: a mixed methods study in Eswatini. BMC Complement Med Ther 2023; 23:350. [PMID: 37794359 PMCID: PMC10548651 DOI: 10.1186/s12906-023-04184-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Abstract
The use of traditional, complementary, and alternative medicine (TCAM) can lead to delays and interruptions in the HIV continuum of care. This study explores reasons for TCAM use in people living with HIV on antiretroviral therapy (ART) in Eswatini and compares interrupted care between different types of TCAM users. Data were collected using surveys in the MaxART study (a test-and-treat trial) between 2014 and 2017 to assess the exposure, namely visiting a TCAM provider. Additionally, visit dates were retrieved from clinic records to assess the outcome, interrupted care. Open-ended questions were analysed with qualitative content analysis (n = 602) and closed questions with bivariable and multivariable analysis (n = 202). Out of 202 participants, 145 (72%) never used TCAM, 40 (20%) ever used, and 17 (8%) is currently using TCAM (diviners, herbalists, and religious healers). No differences in interrupted care were found comparing never (reference category), past (Odds Ratio: 1.31, 95% confidence interval: 0.63-2.72), and current users (1.34, 0.47-3.77), while adjusting for gender, time since HIV diagnosis, and time on ART. Contextual factors affecting the choice for TCAM were the influence of family, advice from the health facility, and religious beliefs. Individual factors include trust in biomedical care, type of illness, no need for additional care, and practical reasons such as financial means. In conclusion, individual and contextual factors influence the choice for TCAM. Interrupted care does not differ between never, past, and current users.
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Affiliation(s)
- Marjan Molemans
- Amsterdam Institute for Social Science Research, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Ria Reis
- Amsterdam Institute for Social Science Research, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
- The Children's Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Fortunate Shabalala
- Department of Community Health Nursing, Faculty of Health Sciences, University of Eswatini, Mbabane, Eswatini, Swaziland
| | - Njabuliso Dlamini
- National Emergency Response Council on HIV and AIDS (NERCHA), Mbabane, Eswatini, Swaziland
| | - Nelisiwe Masilela
- Department of Community Health Nursing, Faculty of Health Sciences, University of Eswatini, Mbabane, Eswatini, Swaziland
| | - Njabulo Simelane
- Ministry of Foreign Affairs and Trade, Mbabane, Eswatini, Swaziland
| | - Christopher Pell
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Global Health, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Ariel Chao
- Yale School of Public Health, New Haven, USA
| | | | - Eva Vernooij
- Amsterdam Institute for Social Science Research, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Frank van Leth
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Health Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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Olislagers Q, van Leth F, Shabalala F, Dlamini N, Simelane N, Masilela N, Gomez GB, Pell C, Vernooij E, Reis R, Molemans M. Reasons for, and factors associated with, positive HIV retesting: a cross-sectional study in Eswatini. AIDS Care 2022:1-8. [PMID: 36449635 DOI: 10.1080/09540121.2022.2142930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Eswatini has a high HIV prevalence but has made progress towards improving HIV-status awareness, ART uptake and viral suppression. However, there is still a delay in ART initiation, which could partly be attributed to positive HIV-retesting. This study examines reasons for, and factors associated with, positive HIV-retesting among MaxART participants in Eswatini. Data from 601 participants is included in this cross-sectional study. Descriptive statistics and logistic regressions were used. Of the participants, 32.8% has ever retested after a previous positive result. Most participants who retested did this because they could not accept their results (61.9% of all retesters). Other main reasons are related to external influences, gender or the progression of their HIV infection (respectively 18.3%, 10.2%, and 6.1% of all retesters). Participants without a current partner and participants with less time since their first positive test have lower odds of retesting. To decrease retesting and reduce the delay in ART initiation resulting from it, efforts could be made on increasing the acceptance of positive HIV results. Providing more information on the process of testing and importance of early ART initiation, could be part of the solution.
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Affiliation(s)
- Quint Olislagers
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Frank van Leth
- Department of health sciences, VU University, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Fortunate Shabalala
- Department of Community Health Nursing Sciences, Faculty of Health Sciences, University of Eswatini, Mbabane, Eswatini
| | - Njabuliso Dlamini
- National Emergency Response Council on HIV and AIDS (NERCHA), Mbabane, Eswatini
| | | | - Nelisiwe Masilela
- Department of Community Health Nursing Sciences, Faculty of Health Sciences, University of Eswatini, Mbabane, Eswatini
| | - Gabriela B. Gomez
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Pell
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Global Health Amsterdam, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
| | - Eva Vernooij
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands
| | - Ria Reis
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- The Children’s Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Marjan Molemans
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands
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Orievulu KS, Ayeb-Karlsson S, Ngema S, Baisley K, Tanser F, Ngwenya N, Seeley J, Hanekom W, Herbst K, Kniveton D, Iwuji CC. Exploring linkages between drought and HIV treatment adherence in Africa: a systematic review. Lancet Planet Health 2022; 6:e359-e370. [PMID: 35397224 PMCID: PMC7612934 DOI: 10.1016/s2542-5196(22)00016-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/11/2022] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
Climate change is directly and indirectly linked to human health, including through access to treatment and care. Our systematic review presents a systems understanding of the nexus between drought and antiretroviral therapy (ART) adherence in HIV-positive individuals in the African setting. Narrative synthesis of 111 studies retrieved from Web of Science, PubMed/MEDLINE, and PsycINFO suggests that livelihoods and economic conditions, comorbidities and ART regimens, human mobility, and psychobehavioural dispositions and support systems interact in complex ways in the drought-ART adherence nexus in Africa. Economic and livelihood-related challenges appear to impose the strongest impact on human interactions, actions, and systems that culminate in non-adherence. Indeed, the complex pathways identified by our systems approach emphasise the need for more integrated research approaches to understanding this phenomenon and developing interventions.
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Affiliation(s)
- Kingsley Stephen Orievulu
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Centre for Africa-China Studies, University of Johannesburg, Johannesburg, South Africa; Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Sonja Ayeb-Karlsson
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK; United Nations University Institute for Environment and Human Security, Bonn, Germany; Institute for Risk and Disaster Reduction, University College London, London, UK; School of Global Studies, University of Sussex, Brighton, UK
| | - Sthembile Ngema
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Kathy Baisley
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Frank Tanser
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Lincoln Institute for Health, University of Lincoln, Lincoln, UK
| | - Nothando Ngwenya
- Africa Health Research Institute, KwaZulu-Natal, South Africa; School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Global Health and Development Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Willem Hanekom
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Division of Infection and Immunity, University College London, London, UK
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa; DSI-MRC South African Population Research Infrastructure Network, Durban, South Africa
| | | | - Collins C Iwuji
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
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Khan S, Spiegelman D, Walsh F, Mazibuko S, Pasipamire M, Chai B, Reis R, Mlambo K, Delva W, Khumalo G, Zwane M, Fleming Y, Mafara E, Hettema A, Lejeune C, Chao A, Bärnighausen T, Okello V. Early access to antiretroviral therapy versus standard of care among HIV-positive participants in Eswatini in the public health sector: the MaxART stepped-wedge randomized controlled trial. J Int AIDS Soc 2021; 23:e25610. [PMID: 32949103 PMCID: PMC7507004 DOI: 10.1002/jia2.25610] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 06/10/2020] [Accepted: 07/15/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction The WHO recommends antiretroviral treatment (ART) for all HIV‐positive patients regardless of CD4 count or disease stage, referred to as “Early Access to ART for All” (EAAA). The health systems effects of EAAA implementation are unknown. This trial was implemented in a government‐managed public health system with the aim to examine the “real world” impact of EAAA on care retention and viral suppression. Methods In this stepped‐wedge randomized controlled trial, 14 public sector health facilities in Eswatini were paired and randomly assigned to stepwise transition from standard of care (SoC) to EAAA. ART‐naïve participants ≥18 years who were not pregnant or breastfeeding were eligible for enrolment. We used Cox proportional hazard models with censoring at clinic transition to estimate the effects of EAAA on retention in care and retention and viral suppression combined. Results Between September 2014 and August 2017, 3405 participants were enrolled. In SoC and EAAA respectively, 12‐month HIV care retention rates were 80% (95% CI: 77 to 83) and 86% (95% CI: 83 to 88). The 12‐month combined retention and viral suppression endpoint rates were 44% (95% CI: 40 to 48) under SoC compared to 80% (95% CI: 77 to 83) under EAAA. EAAA increased both retention (HR: 1·60, 95% CI: 1·15 to 2·21, p = 0.005) and retention and viral suppression combined (HR: 4.88, 95% CI: 2.96 to 8.05, p < 0.001). We also identified significant gaps in current health systems ability to provide viral load (VL) monitoring with 80% participants in SoC and 66% in EAAA having a missing VL at last contact. Conclusions The observed improvement in retention in care and on the combined retention and viral suppression provides an important co‐benefit of EAAA to HIV‐positive adults themselves, at least in the short term. Our results from this “real world” health systems trial strongly support EAAA for Eswatini and countries with similar HIV epidemics and health systems. VL monitoring needs to be scaled up for appropriate care management.
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Affiliation(s)
- Shaukat Khan
- Clinton Health Access Initiative (CHAI), Mbabane, Swaziland
| | - Donna Spiegelman
- Center on Methods for Implementation and Prevention Science and Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.,Departments of Epidemiology, Biostatistics, Nutrition and Global Health, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Fiona Walsh
- Clinton Health Access Initiative (CHAI), Boston, MA, USA
| | - Sikhatele Mazibuko
- Eswatini National ART program (SNAP), Ministry of Health, Mbabane, Swaziland
| | | | - Boyang Chai
- Department of Nutrition, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Ria Reis
- Leiden University Medical Center, Leiden University, Leiden, the Netherlands.,Amsterdam Institute for Social Science, University of Amsterdam, Amsterdam, the Netherlands.,Children's Institute, University of Cape Town, Cape Town, South Africa
| | - Khudzie Mlambo
- Clinton Health Access Initiative (CHAI), Mbabane, Swaziland
| | - Wim Delva
- The South African Department of Science and Technology - National Research Foundation (DST-NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.,Center for Statistics, Hasselt University, Diepenbeek, Belgium.,International Centre for Reproductive Health, Ghent University, Gent, Belgium.,KU Leuven, Rega Institute for Medical Research, Leuven, Belgium.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Gavin Khumalo
- Eswatini National Network of People Living with HIV (SWANNEPHA), Mbabane, Swaziland
| | | | | | - Emma Mafara
- Clinton Health Access Initiative (CHAI), Mbabane, Swaziland
| | - Anita Hettema
- Clinton Health Access Initiative (CHAI), Mbabane, Swaziland
| | | | - Ariel Chao
- Center on Methods for Implementation and Prevention Science and Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Till Bärnighausen
- Heidelberg Institute of Public Health, University of Heidelberg, Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Velephi Okello
- Directorate Office, Ministry of Health, Mbabane, Swaziland
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Lifson AR, Workneh S, Hailemichael A, MacLehose RF, Horvath KJ, Hilk R, Sites A, Shenie T. Disclosure of HIV status among patients new to HIV care in Southern Ethiopia: role of perceived social support and other factors. AIDS Care 2020; 33:1133-1138. [PMID: 32613851 DOI: 10.1080/09540121.2020.1785999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Reports from Sub-Saharan Africa, with a large HIV-infected population, vary widely in how often HIV status is disclosed to others, including spouses and other partners. We surveyed 1799 Ethiopian HIV patients newly enrolled in care within the previous 3 months at one of 32 local hospitals and health centers about disclosure of HIV status and two perceived social support domains: emotional/informational (EI) and tangible assistance (TA) support. Disclosure to another person was reported by 1389 (77%) persons. Disclosure rates to specific persons were: spouses or other partners = 74%; mothers = 24%; fathers = 16%; children = 26%; other family members = 37%; friends = 19%, and neighbors/other community members = 13%. Disclosure to another person was associated with higher social support scores on both EI and TA domains, marriage, and a longer time knowing HIV status. In multivariate adjusted models, disclosure to any person, as well as disclosure specifically to a spouse or partner, were associated with higher EI and higher TA social support scores. Provision of knowledgeable and emotionally supportive assistance can be an important factor in facilitating HIV disclosure. Helping persons with HIV decide who to disclose to and how to do so in the most positive manner is an essential component of HIV care and support.
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Affiliation(s)
- Alan R Lifson
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Sale Workneh
- National Alliance of State and Territorial AIDS Directors, Ethiopian Office, Addis Ababa, Ethiopia
| | - Abera Hailemichael
- National Alliance of State and Territorial AIDS Directors, Ethiopian Office, Addis Ababa, Ethiopia
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Rose Hilk
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Anne Sites
- National Alliance of State and Territorial AIDS Directors, Global Program, Washington DC, USA
| | - Tibebe Shenie
- National Alliance of State and Territorial AIDS Directors, Ethiopian Office, Addis Ababa, Ethiopia
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Moosa A, Gengiah TN, Lewis L, Naidoo K. Long-term adherence to antiretroviral therapy in a South African adult patient cohort: a retrospective study. BMC Infect Dis 2019; 19:775. [PMID: 31488063 PMCID: PMC6727323 DOI: 10.1186/s12879-019-4410-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/26/2019] [Indexed: 12/31/2022] Open
Abstract
Background South Africa has the highest HIV prevalence and supports the largest antiretroviral therapy (ART) programme globally. With the introduction of a test and treat policy, ensuring long term optimal adherence to ART (≥95%) is essential for successful patient and public health outcomes. The aim of this study was to assess long-term ART adherence to inform best practices for chronic HIV care. Method Long-term ART adherence was retrospectively analysed over a median duration of 5 years (interquartile range [IQR]: 5.3–6.5) in patients initially enrolled in a randomised controlled trial assessing tuberculosis and HIV treatment integration and subsequently followed post-trial in an observational cohort study in Durban, South Africa. The association between baseline patient characteristics and adherence over time was estimated using generalized estimating equations (GEE). Adherence was assessed using pharmacy pill counts conducted at each study visit and compared to 6 monthly viral load measurements. A Kaplan Meier survival analysis was used to estimate time to treatment failure. The McNemar test (with exact p-values) was used to determine the effect of pill burden and concurrent ART and tuberculosis treatment on adherence. Results Of the 270 patients included in the analysis; 54.8% were female, median age was 34 years (IQR:29–40) and median time on ART was 70 months (IQR = 64–78). Mean adherence was ≥95% for each year on ART. Stable patients provided with an extended 3-month ART supply maintained adherence > 99%. At study end, 96 and 94% of patients were optimally adherent and virologically suppressed, respectively. Time since ART initiation, female gender and primary breadwinner status were significantly associated with ≥95% adherence to ART. The cumulative probability of treatment failure was 10.7% at 5 years after ART initiation. Concurrent ART and tuberculosis treatment, or switching to a second line ART regimen with higher pill burden, did not impair ART adherence. Conclusion Optimal long-term adherence with successful treatment outcomes are possible within a structured ART programme with close adherence monitoring. This adherence support approach is relevant to a resource limited setting adopting a test and treat strategy.
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Affiliation(s)
- Atika Moosa
- CAPRISA-Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa.
| | - Tanuja N Gengiah
- CAPRISA-Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Lara Lewis
- CAPRISA-Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Kogieleum Naidoo
- CAPRISA-Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa.,MRC-CAPRISA HIV-TB Pathogenesis and Treatment, Research Unit, Nelson R Mandela School of Medicine, Doris Duke Medical Research Institute (2nd floor), University of KwaZulu-Natal, 719 Umbilo Road, Private Bag X7, Congella, Durban, 4013, South Africa
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