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Wamuti B, Jamil MS, Siegfried N, Ford N, Baggaley R, Johnson CC, Cherutich P. Understanding effective post-test linkage strategies for HIV prevention and care: a scoping review. J Int AIDS Soc 2024; 27:e26229. [PMID: 38604993 PMCID: PMC11009370 DOI: 10.1002/jia2.26229] [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: 04/26/2023] [Accepted: 02/20/2024] [Indexed: 04/13/2024] Open
Abstract
INTRODUCTION Following HIV testing services (HTS), the World Health Organization recommends prompt linkage to prevention and treatment. Scale-up of effective linkage strategies is essential to achieving the global 95-95-95 goals for maintaining low HIV incidence by 2030 and reducing HIV-related morbidity and mortality. Whereas linkage to care including same-day antiretroviral therapy (ART) initiation for all people with HIV is now routinely implemented in testing programmes, linkage to HIV prevention interventions including behavioural or biomedical strategies, for HIV-negative individuals remains sub-optimal. This review aims to evaluate effective post-HTS linkage strategies for HIV overall, and highlight gaps specifically in linkage to prevention. METHODS Using the five-step Arksey and O'Malley framework, we conducted a scoping review searching existing published and grey literature. We searched PubMed, Cochrane Library, CINAHL, Web of Science and EMBASE databases for English-language studies published between 1 January 2010 and 30 November 2023. Linkage interventions included as streamlined interventions-involving same-day HIV testing, ART initiation and point-of-care CD4 cell count/viral load, case management-involving linkage coordinators developing personalized HIV care and risk reduction plans, incentives-financial and non-financial, partner services-including contact tracing, virtual-like social media, quality improvement-like use of score cards, and peer-based interventions. Outcomes of interest were linkage to any form of HIV prevention and/or care including ART initiation. RESULTS Of 2358 articles screened, 66 research studies met the inclusion criteria. Only nine linkage to prevention studies were identified (n = 9/66, 14%)-involving pre-exposure prophylaxis, voluntary medical male circumcision, sexually transmitted infection and cervical cancer screening. Linkage to care studies (n = 57/66, 86%) focused on streamlined interventions in the general population and on case management among key populations. DISCUSSION Despite a wide range of HIV prevention interventions available, there was a dearth of literature on HIV prevention programmes and on the use of messaging on treatment as prevention strategy. Linkage to care studies were comparatively numerous except those evaluating virtual interventions, incentives and quality improvement. CONCLUSIONS The findings give insights into linkage strategies but more understanding of how to provide these effectively for maximum prevention impact is needed.
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Affiliation(s)
- Beatrice Wamuti
- Department of Global Health and PopulationHarvard UniversityCambridgeMassachusettsUSA
| | - Muhammad S. Jamil
- Global HIV, Hepatitis and STIs Programs, World Health OrganizationGenevaSwitzerland
- Regional Office to the Eastern Mediterranean, World Health OrganizationCairoEgypt
| | | | - Nathan Ford
- Global HIV, Hepatitis and STIs Programs, World Health OrganizationGenevaSwitzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programs, World Health OrganizationGenevaSwitzerland
| | - Cheryl Case Johnson
- Global HIV, Hepatitis and STIs Programs, World Health OrganizationGenevaSwitzerland
| | - Peter Cherutich
- Global HIV, Hepatitis and STIs Programs, World Health OrganizationGenevaSwitzerland
- Department of Preventive and Promotive HealthMinistry of HealthNairobiKenya
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Ahrenstorf G, Dopfer-Jablonka A, Joean O, Knuth C, Silchmueller M, Thiele T, Ringshausen FC, Slevogt H, Witte T, Behrens GMN. Status of HIV and comorbidities in refugees with HIV from Ukraine. HIV Med 2024; 25:479-483. [PMID: 38043508 DOI: 10.1111/hiv.13597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE To describe the clinical characteristics of refugees with HIV from Ukraine that seek continuation of medical care in Germany. METHODS Fourty-six refugees with HIV that had left Ukraine between 24 February and 30 December 2022 were examined. Information on patients' history was obtained using a standardized questionnaire for clinical care. Interviews were conducted in Russian during their first clinical presentation. RESULTS Fourty-six persons (41 females and 5 males) were included and their mean age was 39.6 (±8.4) years. The mean time since HIV diagnosis was 8.0 (median, IQR 7.15) years and 70.3% of participants currently received tenfofovir-DF, lamividine and dolutegravir. Most refugees had an undetectable HIV viral load and their current mean CD4 T cell count was 702 (SD ± 289) per μL. Serology revealed previous hepatitis B infection in 50.4% without evidence for replication, with undetectable anti-hepatitis B surface antigen in the remaining refugees. Antibodies against hepatitis C were present in 23 refugees (50%), but only 10 patients had been diagnosed with hepatitis C previously. Five refugees had undergone successful antiviral treatment for hepatitis C. Detectable HCV-RNA was evident in nine patients (19.6%). Sixteen (38.6%) refugees had a positive tuberculosis (TB) interferon gamma release assay, and four were on TB treatment for previously diagnosed infection. One had been diagnosed with multidrug-resistant (MDR) TB, two with pre-extensively drug-resistant (pre-XDR) TB and two with XDR TB and were treated with combinations of second-line and novel agents according to WHO guidelines. CONCLUSIONS Based on this preliminary analysis of a not fully representative cohort, refugees with HIV from Ukraine were young, mostly healthy females highly adherent to antiretroviral therapy. The rate of transmittable co-infections urges early diagnostic evaluation and treatment.
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Affiliation(s)
- Gerrit Ahrenstorf
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Alexandra Dopfer-Jablonka
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Hannover, Germany
| | - Oana Joean
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
| | - Christine Knuth
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Marc Silchmueller
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Thea Thiele
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Felix C Ringshausen
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
- Biomedical Research in End-stage and Obstructive Lung Disease (BREATH), Deutsches Zentrum für Lungenforschung (DZL), Hannover, Germany
| | - Hortense Slevogt
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
- Center for Individualised Infection Medicine, Hannover, Germany
| | - Torsten Witte
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany
| | - Georg M N Behrens
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Hannover, Germany
- Center for Individualised Infection Medicine, Hannover, Germany
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Secor AM, Ihnatiuk A, Shapoval A, McDowell M, Hetman L, Wagner AD, Pintye J, Beima-Sofie K, Golden MR, Puttkammer N. Does HIV index testing bring patients into treatment at earlier stages of HIV disease? Results from a retrospective study in Ukraine. BMC Infect Dis 2024; 24:328. [PMID: 38500055 PMCID: PMC10949801 DOI: 10.1186/s12879-024-09190-7] [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: 12/10/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Over one-third of people living with HIV (PLH) in Ukraine are not on treatment. Index testing services, which link potentially exposed partners (named partners) of known PLH (index patients) with testing and treatment services, are being scaled in Ukraine and could potentially close this gap. METHODS This retrospective study included patient data from 14,554 adult PLH who initiated antiretroviral treatment (ART) between October 2018 and May 2021 at one of 35 facilities participating in an intervention to strengthen index testing services. Mixed effects modified Poisson models were used to assess differences between named partners and other ART initiators, and an interrupted time series (ITS) analysis was used to assess changes in ART initiation over time. RESULTS Compared to other ART initiators, named partners were significantly less likely to have a confirmed TB diagnosis (aRR = 0.56, 95% CI = 0.40, 0.77, p < 0.001), a CD4 count less than 200 cells/mm3 (aRR = 0.84, 95% CI = 0.73, 0.97, p = 0.017), or be categorized as WHO HIV stage 4 (aRR = 0.68, 9% CI = 0.55, 0.83, p < 0.001) at the time of ART initiation, and were significantly more likely to initiate ART within seven days of testing for HIV (aRR = 1.36, 95% CI = 1.22, 1.50, p < 0.001). Our ITS analysis showed a modest 2.34% (95% CI = 0.26%, 4.38%; p = 0.028) month-on-month reduction in mean ART initiations comparing the post-intervention period to the pre-intervention period, although these results were likely confounded by the COVID epidemic. CONCLUSION Our findings suggest that index testing services may be beneficial in bringing PLH into treatment at an earlier stage of HIV disease and decreasing delays between HIV testing and ART initiation, potentially improving patient outcomes and retention in the HIV care cascade.
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Affiliation(s)
- Andrew M Secor
- Department of Global Health, University of Washington, Hans Rosling Center, 3980 15th Ave NE, 98105, Seattle, WA, USA.
| | - Alyona Ihnatiuk
- International Training and Education Center for Health (I-TECH), Kyiv, Ukraine
| | - Anna Shapoval
- International Training and Education Center for Health (I-TECH), Kyiv, Ukraine
| | - Misti McDowell
- International Training and Education Center for Health (I-TECH), Seattle, WA, USA
| | - Larisa Hetman
- Public Health Center (PHC) of the Ministry of Health (MoH) of Ukraine, Kyiv, Ukraine
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Hans Rosling Center, 3980 15th Ave NE, 98105, Seattle, WA, USA
| | - Jillian Pintye
- Department of Global Health, University of Washington, Hans Rosling Center, 3980 15th Ave NE, 98105, Seattle, WA, USA
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Hans Rosling Center, 3980 15th Ave NE, 98105, Seattle, WA, USA
| | - Matthew R Golden
- Department of Medicine, University of Washington, Seattle, WA, USA
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA
| | - Nancy Puttkammer
- Department of Global Health, University of Washington, Hans Rosling Center, 3980 15th Ave NE, 98105, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), Seattle, WA, USA
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Khan A, Tarr A, Berahmana AB, Johnson E, Schultz M, Johnson S. Rapid point-of-care testing for hepatitis C - assessment of feasibility, knowledge of participants and outcomes. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2024; 17:260-269. [PMID: 39308536 PMCID: PMC11413387 DOI: 10.22037/ghfbb.v17i3.2989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/06/2024] [Indexed: 09/25/2024]
Abstract
Aim We assessed the feasibility of point-of-care testing to gain insights into participants' knowledge, experience and its effect on hepatitis C management. Background In New Zealand, only 50% of people infected with hepatitis C (HCV) are currently diagnosed. HCV infection is the most common diagnosis leading to liver transplantation in New Zealand. A point-of-care test can streamline HCV management. Methods The OraQuick HCV test (mouth swab or finger-prick) was offered to participants aged 45 to 65 and anyone with a risk factor for hepatitis C. Data collected included demographics, risk factors, and participant experience with testing. Results A total of 218 participants were recruited. The median age was 29 years (IQR 22 to 46). All the tests via the finger-prick method were negative. Fourteen positive mouth-swab tests were negative on ELISA testing. One person was detected to have HCV infection and treated. Knowledge regarding HCV was low. There were no statistically significant differences in knowledge between participants with different education levels, F (4213=0.857, P=0.491 and different ethnicities, F (4,213)0.857, P=0.491. The majority of study participants preferred the point-of-care test. Conclusion Point-of-care testing for HCV is feasible and preferred. Knowledge regarding HCV was low. This study has also provided valuable insights into the viability and experience of offering point-of-care testing.
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Affiliation(s)
- Afrasyab Khan
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Anna Tarr
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Eric Johnson
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Michael Schultz
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Steven Johnson
- Department of Medicine, University of Otago, Dunedin, New Zealand
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Schweitzer AM, Dišković A, Krongauz V, Newman J, Tomažič J, Yancheva N. Addressing HIV stigma in healthcare, community, and legislative settings in Central and Eastern Europe. AIDS Res Ther 2023; 20:87. [PMID: 38082352 PMCID: PMC10714556 DOI: 10.1186/s12981-023-00585-1] [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: 08/08/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Surging HIV prevalence across countries of Central and Eastern Europe (CEE) is largely a result of poor HIV care engagement and a lack of comprehensive support for key populations. This is fostered by widespread stigma across healthcare, community, and legislative settings. DISCUSSION Throughout CEE, HIV stigma and intersectional stigma are serious obstacles to providing adequate medical care to people living with HIV. Anticipated and enacted (experienced) stigma from healthcare professionals, and fears of breaches in confidentiality, deter individuals from having an HIV test and engaging in HIV care. Furthermore, negative connotations surrounding HIV infection can lead to discrimination from family, friends, colleagues, and the public, leading to internalized stigma and depression. Key populations that have higher HIV prevalence, such as men who have sex with men, people who inject drugs, transgender individuals, and sex workers, experience additional stigma and discrimination based on their behaviour and identities. This contributes to the concentrated HIV epidemics seen in these populations in many CEE countries. The stigma is exacerbated by punitive legislation that criminalizes HIV transmission and penalizes sexual orientation, drug use, gender identities, and sex work. Despite high levels of HIV stigma and intersectional stigma, there are many evidence-based interventions that have reduced stigma in other parts of the world. Here, we discuss the interventions that are currently being enacted in various countries of CEE, and we suggest additional effective, evidence-based interventions that will tackle stigma and lead to increased HIV care engagement and higher rates of viral suppression. We cover the promotion of the undetectable = untransmittable (U = U) message, stigma-reduction education and training for healthcare professionals, patient-centric approaches for testing and treatment, and advocacy for non-discriminatory legislation, policies, and practices. We also consider targeted stigma-reduction interventions that acknowledge the wider challenges faced by marginalized populations. CONCLUSIONS HIV stigma and intersectional stigma in CEE drive poor engagement with HIV testing services and care. Widespread adoption of evidence-based interventions to tackle stigma highlighted in this review will improve the quality of life of people living with HIV, improve HIV care engagement, and ultimately slow the surging HIV prevalence and concentrated epidemics occurring throughout CEE.
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Affiliation(s)
| | - Arian Dišković
- Croatian Association for HIV and Viral Hepatitis (HUHIV), Zagreb, Croatia
| | - Veronica Krongauz
- European Distributor Markets, Medical Department, Gilead Sciences, Uxbridge, UK
| | - Julie Newman
- HIV Strategic Implementation & Franchise, Global Medical Affairs, Gilead Sciences, Melbourne, Australia
| | - Janez Tomažič
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases, Sofia, Bulgaria
- Department for Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria
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The Relationship Between Intersectional Drug Use and HIV Stigma and HIV Care Engagement Among Women Living with HIV in Ukraine. AIDS Behav 2022; 27:1914-1925. [PMID: 36441406 PMCID: PMC9703403 DOI: 10.1007/s10461-022-03925-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/29/2022]
Abstract
This study used an intersectional approach to explore the association between enacted and internalized drug use and HIV stigma on HIV care outcomes among HIV-positive women who inject drugs in Ukraine. Surveys were conducted in Kyiv in 2019-2020. Among the 306 respondents, 55% were engaged in HIV care. More than half (52%) of participants not engaged in care reported internalized stigma related to both drug use and HIV status (i.e., intersectional stigma), compared to only 35% of those who were engaged in HIV care. Among those engaged in care, 36% reported intersectional enacted stigma compared to 44% of those not engaged in care; however, this difference was not statistically significant in the univariable analysis (p = 0.06). In the univariable analysis, participants who reported intersectional internalized stigma had 62% lower odds of being engaged in HIV care (OR 0.38, 95% CI 0.22, 0.65, p < 0.001). In the adjusted model, reported intersectional internalized stigma (aOR 0.52, 95% CI 0.30, 0.92, p = 0.026), reported intersectional enacted stigma (aOR 0.47, 95% CI 0.23, 0.95, p = 0.036), and knowing their HIV status for more than 5-years (aOR 2.29, 95% CI 1.35, 3.87, p = 0.002) were significant predictors of HIV care engagement. These findings indicate that interventions to improve HIV care engagement must address women's experiences of both HIV and drug use stigma and the different mechanisms through which stigma operates.
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Schlehr SR, Singh L, Nyatela A, Nqakala S, Lalla-Edward ST. Experiences in receiving financial incentives to access HIV care in Johannesburg, South Africa. South Afr J HIV Med 2022; 23:1426. [PMID: 36479419 PMCID: PMC9724036 DOI: 10.4102/sajhivmed.v23i1.1426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/07/2022] [Indexed: 09/10/2024] Open
Abstract
Background Financial incentivisation has been used to improve all steps of the HIV cascade with varying results. Most studies conducted on the matter are of a quantitative nature, not giving enough space for in-depth understanding as to why financial incentives work or do not work. Objectives To describe experiences with, and opinions on, the use of financial incentives to promote linkage to and retention in care from the perspective of people living with HIV. Method We performed a qualitative cross-sectional study. In-depth interviews were conducted with adult men and women with HIV accessing health services or research study visits. After codebook development, NVivo 12 software was used to code and analyse the data. Results Through the provision of financial incentives, participants were able to cover basic needs. However, some deemed financial incentives as a form of income rather than a nudge to spark interest in changing their health behaviour. Participants communicated that a need for some type of incentive exists and recommended food vouchers as the best possible solution. Conclusion Financial incentivisation can facilitate engagement in the HIV care continuum through providing support to people living with HIV. What this study adds This study complements the body of research that explores the feasibility of using incentives and which of them may be most beneficial in encouraging patients with HIV to enter into and sustain HIV care.
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Affiliation(s)
- Sara Rachel Schlehr
- Department of Interdisciplinary Social Sciences, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, the Netherlands
- Department of Research Development, Ezintsha Research Centre, Johannesburg, South Africa
| | - Leanne Singh
- Department of Research Development, Ezintsha Research Centre, Johannesburg, South Africa
| | - Athini Nyatela
- Department of Research Development, Ezintsha Research Centre, Johannesburg, South Africa
| | - Sizwe Nqakala
- Department of Research Development, Ezintsha Research Centre, Johannesburg, South Africa
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Dumchev K, Kiriazova T, Riabokon S, Shost A, Parrish C, Shapoval A, Germanovych M, Penner J, Beste J, Puttkammer N. Comparative Clinical Outcomes With Scale-up of Dolutegravir as First-Line Antiretroviral Therapy in Ukraine. J Acquir Immune Defic Syndr 2022; 91:197-209. [PMID: 36094487 PMCID: PMC9472572 DOI: 10.1097/qai.0000000000003038] [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: 02/01/2022] [Accepted: 05/31/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Achievement of the UNAIDS 95-95-95 targets requires ARV regimens that are easy to use, well-tolerated, and cost-effective. Dolutegravir (DTG)-based regimens are efficacious and less costly than other common first-line regimens. This study assessed real-world effectiveness of DTG regimens in treatment-naive people living with HIV in Ukraine. METHODS We extracted data from the national Medical Information System on all adult patients who initiated antiretroviral therapy (ART) with DTG, lopinavir/ritonavir, or efavirenz (EFV) between October 2017 and June 2018, at 23 large clinics in 12 regions of Ukraine. Viral suppression at 12 ± 3 months and retention at 12 months after treatment initiation were the outcomes of interest. RESULTS Of total 1057 patients, 721 had a viral load test within the window of interest, and 652 (90%) had viral load of ≤ 200 copies/mL. The proportion with suppression was lower in the EFV group [aOR = 0.4 (95% confidence interval: 0.2 to 0.8)] and not different in the LPV group [aOR = 1.6 (0.5 to 4.9)] compared with the DTG group. A 24-month or longer gap between diagnosis and treatment was associated with lower odds of suppression [aOR = 0.4 (0.2 to 0.8)]. Treatment retention was 90% (957/1057), with no significant difference by regimen group. History of injecting drug use was associated with decreased retention [aOR = 0.5 (0.3 to 0.8)]. CONCLUSIONS DTG-based regimens were comparable with LPV and more effective than EFV in achieving viral suppression among ART-naive patients in a multisite cohort in Ukraine. Treatment retention was equally high in all 3 groups. This evidence from Ukraine supports the ART Optimization Initiative as a strategy to improve efficiency of the ART program without negatively affecting patient clinical outcomes.
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Affiliation(s)
| | | | - Serhiy Riabokon
- Public Health Center of the Ministry of Health of Ukraine, Ukraine
| | - Alyona Shost
- International Training & Education Center for Health, Kyiv, Ukraine
| | - Canada Parrish
- Emergency Medicine Department, University of Washington, Seattle, WA
| | - Anna Shapoval
- International Training & Education Center for Health, Kyiv, Ukraine
| | | | - Jeremy Penner
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada; and
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van Oorschot E, Koc ÖM, Oude Lashof AML, van Loo IHM, Ackens R, Posthouwer D, Koek GH. Cascade of care among hepatitis B patients in Maastricht, the Netherlands, 1996 to 2018. J Virus Erad 2022; 8:100075. [PMID: 35784678 PMCID: PMC9241047 DOI: 10.1016/j.jve.2022.100075] [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: 01/26/2022] [Accepted: 06/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background & aims Methods Results Conclusions
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Affiliation(s)
- Eva van Oorschot
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Corresponding author. Maastricht UMC+P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands.
| | - Özgür M. Koc
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Astrid ML. Oude Lashof
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Maastricht University Medical Centre, the Netherlands
| | - Inge HM. van Loo
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, the Netherlands
| | - Robin Ackens
- Department of Integrated Care, Maastricht University Medical Centre, the Netherlands
| | - Dirk Posthouwer
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Maastricht University Medical Centre, the Netherlands
| | - Ger H. Koek
- School of Nutrition and Translational Research in Metabolism (Nutrim), Maastricht University, the Netherlands
- Department of Visceral and Transplantation Surgery, Klinikum, RWTH, Aachen, Germany
- Department of Internal Medicine Division of Gastroenterology and Hepatology, Maastricht University, the Netherlands
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Lunze K, Kiriazova T, Blokhina E, Bushara N, Bridden C, Gnatienko N, Bendiks S, Quinn E, Krupitsky E, Raj A, Samet JH. Linking HIV-positive people in addiction care to HIV services in St. Petersburg, Russia - Mixed-methods implementation study of strengths-based case management. Glob Public Health 2021; 16:1711-1723. [PMID: 33091311 PMCID: PMC8634803 DOI: 10.1080/17441692.2020.1834599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/20/2020] [Indexed: 10/23/2022]
Abstract
Access to HIV services for HIV-positive patients in addiction care is challenging in Russia, because both care systems are organised independently from each other. Strengths-based case management is an effective strategy to connect people with HIV (PHIV) to HIV care. This mixed-methods study's objective was to investigate implementation of a case management intervention in St. Petersburg, Russia, designed to connect PHIV who inject drugs to HIV care. We analysed survey data from 118 HIV-positive patients in addiction care and conducted six focus groups (n=38). Quantitative analyses of fidelity and satisfaction outcomes and qualitative text analysis assessed intervention implementation. Participants who linked to HIV services embraced empowerment and motivation resulting from case management as supporting self-efficacy and linkage to services. Among participants who did not link to care, drug use impeded their care engagement. Main levers to implementation were empowerment to cope with challenges of a fragmented health system and persistent stigma. Those who connected to HIV services credited case managers for facilitating linkage; those who did not link attributed it to personal issues. Implementation of case management for HIV care in Russia should focus on effective substance use treatment and empowerment, motivation and support in addressing personal and system factors.
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Affiliation(s)
- Karsten Lunze
- Boston University School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | | | - Elena Blokhina
- First Pavlov State Medical University, St. Petersburg, Russia
| | - Natalia Bushara
- First Pavlov State Medical University, St. Petersburg, Russia
| | - Carly Bridden
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Natalia Gnatienko
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Sally Bendiks
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Emily Quinn
- Boston University School of Public Health, Boston, MA, USA
| | - Evgeny Krupitsky
- First Pavlov State Medical University, St. Petersburg, Russia
- Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia
| | - Anita Raj
- Department of Medicine, Center on Gender Equity and Health, University of California - San Diego School of Medicine, La Jolla, California, USA
| | - Jeffrey H Samet
- Boston University School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
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Allen A, Zaviryukha I, Kiriazova T, Shenoi S, Rozanova J. The Lived Experience of a Newly Diagnosed Older Person With HIV in Ukraine. QUALITATIVE HEALTH RESEARCH 2021; 31:2290-2303. [PMID: 34414837 PMCID: PMC8930274 DOI: 10.1177/10497323211026914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Low- and middle-income countries are home to 80% of older people with HIV (OPWH). Ukrainian OPWH experience higher mortality and decreased antiretroviral therapy (ART) initiation than younger patients, but there is little data examining OPWH's perspectives around new diagnosis and impact on care. In this study, we examined accounts of 30 newly diagnosed OPWH in Ukraine, exploring challenges faced in the peri-diagnosis period. Themes emerged representing the longitudinal coping process: OPWH (1) viewed themselves as low risk before diagnosis; (2) experienced HIV diagnosis as a traumatic event challenging their self-image; (3) used disclosure to seek support among a small circle of family, friends, or health care providers; (4) avoided disclosure to outsiders including primary care providers for fears of stigma and breaches in confidentiality; (5) viewed age as an asset; and (6) used HIV diagnosis as starting point for growth. These findings highlight the need for age-specific programming to increase HIV knowledge and coping, increase screening, and improve long-term planning.
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Affiliation(s)
- Amy Allen
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
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12
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Edsall A, Dinh TTT, Mai PP, Hoffman K, Nguyen HT, Khuyen TT, Trang NT, Bart G, Giang LM, Korthuis PT. Provider Perspectives on Integration of Substance Use Disorder and HIV Care in Vietnam: A Qualitative Study. J Behav Health Serv Res 2021; 48:274-286. [PMID: 32940824 PMCID: PMC7965786 DOI: 10.1007/s11414-020-09730-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNAIDS recommends integration of medications for substance use disorders (SUD) with HIV care to improve HIV outcomes. Yet, integration of HIV and SUD services remains limited in many countries. The objective of this study was to assess provider perceptions of care integration in Vietnam. Qualitative interviews were conducted with 43 providers (nurses, physicians, counselors, pharmacists, and clinic managers) in 8 HIV clinics in northern Vietnam, 2013-2015. Providers identified five themes informing HIV and SUD treatment integration: (1) treatment for alcohol use disorder is often neglected compared to other SUD treatment; (2) structural challenges must be addressed to increase integration feasibility; (3) workforce limitations; (4) societal and healthcare stigmatization of SUD; and (5) providers' conflicting views regarding integration challenges. The experience of providers in Vietnam may be useful to other countries attempting to integrate HIV and SUD services.
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Affiliation(s)
- Andrew Edsall
- Oregon Health & Science University School of Medicine, Portland, OR, USA
| | | | | | - Kim Hoffman
- Portland State University-Oregon Health & Science University School of Public Health, Portland, OR, USA.
| | - Hang T Nguyen
- Portland State University-Oregon Health & Science University School of Public Health, Portland, OR, USA
| | | | | | - Gavin Bart
- Hennepin Healthcare and University of Minnesota, Minneapolis, MN, USA
| | | | - P Todd Korthuis
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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13
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Moges NA, Adesina OA, Okunlola MA, Berhane Y. Barriers and Facilitators of Same-Day Antiretroviral Therapy Initiation Among People Newly Diagnosed with HIV in Ethiopia: Qualitative Study Using the Transtheoretical Model of Behavioral Change. J Multidiscip Healthc 2020; 13:1801-1815. [PMID: 33293823 PMCID: PMC7719330 DOI: 10.2147/jmdh.s282116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/25/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose HIV test and treat approach is currently a strategy used as a part of the prevention and control program in Ethiopia. The strategy adopts initiating antiretroviral therapy (ART) on the same-day as HIV diagnosis or in the next visit. However, there is little evidence on barriers and facilitators of same-day (ART) initiation in Ethiopia. Therefore, this study aimed to investigate barriers and facilitators of same-day (ART) initiation in the northwest Ethiopia. Patients and Methods A qualitative study was conducted in East Gojjam Zone in northwest Ethiopia. Purposively selected HIV patients, healthcare workers, and treatment assistants participated in the qualitative study. Data were collected through in-depth interviews and focus group discussions (FGDs). Coding was done via ATLAS.ti software thematically. The interviews and FGDs were conducted in Amharic (local language) and then transcribed verbatim and translated into English. Coding was done via ATLAS.ti software. The thematic analysis approach was employed using the constructs of the transtheoretical behavioral model (TTM) to show stages of change that newly HIV diagnosed experienced in the course of preparation for treatment initiation. Results A total of 19 patients, 12 treatment supporters, and 9 healthcare workers participated in the qualitative study. Shocking due to the test result, having no symptoms, mistrust of the test result, and seeking spiritual healing from holy water were the major barriers to start ART in the same-day of diagnosis or within the next visit. Conclusion During HIV diagnosis, more barriers were observed in the early stages, while treatment facilitators emerged in the later stages of TTM. The TTM model can be applied to characterize where participants were in the stages of change.
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Affiliation(s)
- Nurilign Abebe Moges
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.,Pan African University, Life and Earth Sciences Including Health and Agriculture Institute (PAULESI), University of Ibadan, Ibadan, Nigeria
| | - Olubukola Adeponle Adesina
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
| | - Micheal A Okunlola
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
| | - Yemane Berhane
- Department of Epidemiology, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Moges NA, Adesina OA, Okunlola MA, Berhane Y. Same-day antiretroviral treatment (ART) initiation and associated factors among HIV positive people in Northwest Ethiopia: baseline characteristics of prospective cohort. Arch Public Health 2020; 78:87. [PMID: 32983450 PMCID: PMC7510057 DOI: 10.1186/s13690-020-00473-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/15/2020] [Indexed: 11/30/2022] Open
Abstract
Background Despite a well-established fact that same-day or rapid ART initiation after a positive HIV test result is vital for faster viral suppression and for prevention of further sexual transmissions of HIV, there is a paucity of evidence on the uptake of same-day ART initiation among newly HIV diagnosed people in Northwest, Ethiopia. Methods A cross-sectional study was conducted between December 1st, 2018 and July 30, 2019. About 759 newly HIV diagnosed adults were recruited from 24 health facilities. Data were collected using interviewer-administered questionnaire. Data were entered using EPI-Data and exported to SPSS and STATA software for further analysis. Bivariate logistic regression was used to select candidate variables at p-value less than 0.25 for multivariate logistic regression. Then adjusted odds ratio with 95% Confidence Interval (CI) at p-value of less than 0.05 was used to declare the statistical associations between the dependent and independent variables. Result Magnitude of same-day ART initiation was 318 (41.90%) [(95% CI, 38.2–45.20%)]. Factors associated with same-day ART initiation were: Patients resided in West Gojjam Zone were 2.04 times more likely to initiate same-day ART compared to those in Bahir Dar city administration [AOR = 2.04 (1.04–3.97)], patients in the health centers were 3.06 times more likely to initiate same-day ART initiation compared to those in the hospitals [AOR = 3.06 (1.90–4.92)] and Patients who were diagnosed their HIV status at the same health facility where they linked for ART were 2.16 times more likely to initiate ART at the same-day of diagnosis [AOR = 2.16 (91.24–3.74)]. Moreover, patients with no opportunistic infection [AOR = 2.08 (1.04–4.19)] and pregnant women [AOR = 3.97 (1.78–8.87)] were more likely to initiate ART same-day of diagnosis. Conclusions Same-day ART initiation was low among HIV patients in Ethiopia. Patients attending their treatment at hospitals and those from big city (Bahir Dar) were less likely to initiate same-day ART. Clinical factors such as having opportunistic infections and non-pregnancy status affected the immediate initiation of treatment. HIV positive people who seek care in hospitals and those tested HIV positive from another health facilities in which they did not intend to continue their ART follow-up care need special attention.
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Neduzhko O, Postnov O, Sereda Y, Kulchynska R, Bingham T, Myers JJ, Flanigan T, Kiriazova T. Modified Antiretroviral Treatment Access Study (MARTAS): A Randomized Controlled Trial of the Efficacy of a Linkage-to-Care Intervention Among HIV-Positive Patients in Ukraine. AIDS Behav 2020; 24:3142-3154. [PMID: 32333208 PMCID: PMC7508967 DOI: 10.1007/s10461-020-02873-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Between October 2015 and March 2018, we conducted the Modified Antiretroviral Treatment Access Study (MARTAS), a nurse-delivered case management intervention to improve linkage-to-care for persons recently tested HIV positive. Adult participants from nine urban clinics in three regions of Ukraine were randomized to either MARTAS or standard of care (SOC) using individual, parallel, two-arm design. The main study outcome was linkage-to-care (defined as registration at an HIV clinic) within a 3-month period from enrollment in the study. Intention-to-treat analysis of MARTAS (n = 135) versus SOC (n = 139) showed intervention efficacy in linkage to HIV care (84.4% vs. 33.8%; adjusted RR 2.45; 95% CI 1.72, 3.47; p < 0.001). MARTAS is recommended for implementation in Ukraine and may be helpful in other countries with similar gaps in linkage-to-care. Clinicaltrials.gov registration number: NCT02338024.
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Affiliation(s)
- Oleksandr Neduzhko
- Ukrainian Institute on Public Health Policy, 5 Mala Zhytomyrska str., Office 61A, Kiev, 01001, Ukraine.
| | - Oleksandr Postnov
- Ukrainian Institute on Public Health Policy, 5 Mala Zhytomyrska str., Office 61A, Kiev, 01001, Ukraine
| | - Yuliia Sereda
- Ukrainian Institute on Public Health Policy, 5 Mala Zhytomyrska str., Office 61A, Kiev, 01001, Ukraine
| | - Roksolana Kulchynska
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Kiev, Ukraine
| | - Trista Bingham
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Janet J Myers
- Prevention Research Center, University of California, San Francisco, USA
| | | | - Tetiana Kiriazova
- Ukrainian Institute on Public Health Policy, 5 Mala Zhytomyrska str., Office 61A, Kiev, 01001, Ukraine
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Neduzhko O, Postnov O, Bingham T, Myers JJ, Flanigan T, Kiriazova T. Feasibility and Acceptability of the Modified Antiretroviral Treatment Access Study (MARTAS) Intervention Based on a Pilot Study in Ukraine. J Int Assoc Provid AIDS Care 2020; 18:2325958218823257. [PMID: 30672381 PMCID: PMC6748547 DOI: 10.1177/2325958218823257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
We conducted a pilot of the Modified Antiretroviral Treatment Access Study (MARTAS), a linkage to HIV treatment intervention, prior to implementing a multisite randomized controlled trial (RCT) in Ukraine. The objectives of the pilot were to assess the feasibility and acceptability of the MARTAS intervention among a small sample of adults recently diagnosed with HIV at specialty clinics in the Mykolaiv region of Ukraine in 2015. The adapted intervention consisted of up to 6 individual-level sessions with a linkage coordinator (nurse) over a 90-day period. Overall, 22 persons participated in the pilot. On average, participants received 4.2 sessions and 14 participants linked to HIV care within 3 months of study enrollment. All 18 participants who completed the acceptability survey expressed high satisfaction with their interaction with their linkage coordinator. The results of the pilot demonstrated feasibility and acceptability of the MARTAS intervention in advance of a larger scale RCT in Ukraine.
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Affiliation(s)
| | | | - Trista Bingham
- 2 Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janet J Myers
- 3 Prevention Research Center, University of California, San Francisco, CA, USA
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HIV-related stigma, knowledge about HIV, HIV risk behavior and HIV testing motivation among women in Lampung, Indonesia. ENFERMERIA CLINICA 2019. [PMID: 31311744 DOI: 10.1016/j.enfcli.2019.04.084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aims to identify factors that influence HIV testing motivation among women at the Dr. H. Abdul Moeloek General Hospitalin Lampung, Indonesia. METHOD A cross-sectional method was used in this study that employed a consecutive sampling technique involving 120 women with HIV. The participants were outpatients at the Voluntary Counseling and Testing (VCT) Dr. H. Abdul Moeloek General Hospital. This study utilized three instruments: the Berger HIV Stigma Scale, HIV Knowledge Questionnaire (HIV-KQ-18) and Safe Sex Behavior Questionnaire (SSBQ). RESULTS The study examined factors that influence HIV testing motivation among women: HIV-related stigma, knowledge about HIV and HIV risk behavior. The results of the analysis showed that there is a significant relationship among the HIV-related stigma variable (p=0.019, OR=2.727), knowledge about HIV variable (p=0.011, OR=3.750) and HIV risk behavior variable (p=0.041, OR=2.381). The most dominant factor influencing HIV testing motivation is HIV risk behavior (p=0.016, ά=0.05 at 95% CI and OR=3.217). This indicates that Women Living With HIV (WLWH) who engage in risk HIV behavior demonstrate 3.2 times to HIV testing motivation. CONCLUSION HIV-related stigma, knowledge about HIV and HIV risk behavior influence HIV testing motivation for women. RECOMMENDATION Our findings have implications for nursing and healthcare practice as well as research, especially in supporting HIV testing for women who are at risk for HIV. Nurses should focus their attention on motivating women with a high risk of HIV to undergo early HIV testing.
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Vasylyeva TI, Liulchuk M, du Plessis L, Fearnhill E, Zadorozhna V, Babii N, Scherbinska A, Novitsky V, Pybus OG, Faria NR. The Changing Epidemiological Profile of HIV-1 Subtype B Epidemic in Ukraine. AIDS Res Hum Retroviruses 2019; 35:155-163. [PMID: 30430838 PMCID: PMC6360399 DOI: 10.1089/aid.2018.0167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
While HIV-1 subtype B has caused a large epidemic in the Western world, its transmission in Ukraine remains poorly understood. We assessed the genetic diversity of HIV-1 subtype B viruses circulating in Ukraine, characterized the transmission group structure, and estimated key evolutionary and epidemiological parameters. We analyzed 120 HIV-1 subtype B pol sequences (including 46 newly generated) sampled from patients residing in 11 regions of Ukraine between 2002 and 2017. Phylogenies were estimated using maximum likelihood and Bayesian phylogenetic methods. A Bayesian molecular clock coalescent analysis was used to estimate effective population size dynamics and date the most recent common ancestors of identified clades. A phylodynamic birth-death model was used to estimate the effective reproductive number (Re) of these clades. We identified two phylogenetically distinct predominantly Ukrainian (≥75%) clades of HIV-1 subtype B. We found no significant transmission group structure for either clade, suggesting frequent mixing among transmission groups. The estimated dates of origin of both subtype B clades were around early 1970s, similar to the introduction of HIV-1 subtype A into Ukraine. Re was estimated to be 1.42 [95% highest posterior density (HPD) 1.26-1.56] for Clade 1 and 1.69 (95% HPD 1.49-1.84) for Clade 2. Evidently, the subtype B epidemic in the country is no longer concentrated in specific geographical regions or transmission groups. The study results highlight the necessity for strengthening preventive and monitoring efforts to reduce the further spread of HIV-1 subtype B.
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Affiliation(s)
| | - Mariia Liulchuk
- L.V. Gromashevskij Institute of Epidemiology and Infectious Diseases of National Academy of Sciences of Ukraine, Kyiv, Ukraine
| | - Louis du Plessis
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Esther Fearnhill
- Institute for Global Health, University College London, United Kingdom
| | - Victoriia Zadorozhna
- L.V. Gromashevskij Institute of Epidemiology and Infectious Diseases of National Academy of Sciences of Ukraine, Kyiv, Ukraine
| | - Nataliia Babii
- L.V. Gromashevskij Institute of Epidemiology and Infectious Diseases of National Academy of Sciences of Ukraine, Kyiv, Ukraine
| | - Alla Scherbinska
- L.V. Gromashevskij Institute of Epidemiology and Infectious Diseases of National Academy of Sciences of Ukraine, Kyiv, Ukraine
| | - Vladimir Novitsky
- Department of Immunology and Infectious diseases, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Oliver G. Pybus
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Nuno R. Faria
- Department of Zoology, University of Oxford, Oxford, United Kingdom
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