1
|
Lerango TL, Markos T, Yehualeshet D, Kefyalew E, Lerango SL. Advanced HIV disease and its predictors among newly diagnosed PLHIV in the Gedeo zone, southern Ethiopia. PLoS One 2024; 19:e0310373. [PMID: 39269935 PMCID: PMC11398689 DOI: 10.1371/journal.pone.0310373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 08/30/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Globally, HIV infection remains a leading cause of morbidity and mortality. Despite reducing new infections, the global response to advanced HIV disease (AHD) remains ineffective, leaving HIV epidemics a significant public health threat worldwide. In Ethiopia, evidence regarding AHD is scarce. Therefore, this study aimed to assess the prevalence and predictors of AHD among newly diagnosed people living with HIV (PLHIV) initiating antiretroviral therapy in the Gedeo zone, southern Ethiopia. METHODS A facility-based cross-sectional study was conducted from May 29, 2023, to February 06, 2024, at health facilities providing HIV care in the Gedeo zone, southern Ethiopia. A total of 427 PLHIV-initiating antiretroviral therapy (ART) were recruited for the study. The data were collected through face-to-face interviews and record reviews using KoboCollect version 2.4 and analyzed using R version 4.3.3. The Akaike information criterion (AIC) model selection was used to evaluate and choose the best-fitting model to describe the relationship between AHD and predictors. Finally, variables with a p-value less than 0.05 were considered independent predictors in the multivariable regression analysis. RESULTS The study participants' mean (±SD) age was 31.3 (±8.7) years. The overall prevalence of AHD among newly diagnosed PLHIV-initiating ART was 34.4% (95% CI: 29.8%, 39.1%). Rural residence (AOR = 3.48, 95% CI: 2.24, 5.47), alcohol consumption (AOR = 2.48, 95% CI: 1.59, 3.90), and being identified through community-based index case testing (ICT) (AOR = 0.26, 95% CI: 0.13, 0.51) were found to be independent predictors of AHD. CONCLUSIONS The prevalence of AHD among newly diagnosed individuals initiating ART was high. PLHIV who consume alcohol should receive detailed counseling on how it can negatively impact their progress with antiretroviral treatment. HIV testing should be enhanced in rural communities by strengthening community health campaigns. Furthermore, community-based index case testing should be strengthened for early identification of PLHIV.
Collapse
Affiliation(s)
- Temesgen Leka Lerango
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Tesfalidet Markos
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Daniel Yehualeshet
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Endashaw Kefyalew
- School of Medicine, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Semalgn Leka Lerango
- School of Medicine, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
2
|
Picchio CA, Nicolàs A, Ayemfouo Fofou IV, Kasone V, Guewo-Fokeng M, Tagny CT, Nanyonjo T, Nansumba H, Kouongni YN, Sezawo Kamdjeu RGE, Seremba E, Kouanfack C, Ssewanyana I, Njouom R, Segura AR, Rodríguez-Frías F, Mbanya JC, Ocama P, Lazarus JV. Acceptability and Feasibility of the Plasma Separation Card for an Integrated Model of Care for HBV and HCV Screening Among People Attending HIV Clinics in Cameroon and Uganda. J Epidemiol Glob Health 2024; 14:827-838. [PMID: 38536619 PMCID: PMC11442892 DOI: 10.1007/s44197-024-00220-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/18/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Sub-Saharan African countries have a high burden of viral hepatitis and poor access to screening and care. The aim of this study was to evaluate the feasibility and acceptability of using the plasma separation card (PSC) for viral hepatitis B and C screening among people living with HIV (PLHIV) in Cameroon and Uganda. METHODS This is a cross-sectional study carried out between 05/2021 and 03/2023 including 192 PLHIV in Cameroon (n = 104) and Uganda (n = 88). Basic sociodemographic variables and whole blood samples were collected. Adequate filling with blood of PSCs was used to determine feasibility together with participant responses to questions on acceptability. A logistic regression model was carried out to assess the relationship between PSC acceptability and factors of interest. RESULTS 70% of participants reported PSC as an acceptable viral hepatitis screening tool, and it was significantly more accepted in Uganda than Cameroon (100% vs. 43.2%, p < 0.001). Similarly, 75% of PSCs had at least one spot sample filled and were viable for analysis, 99% were correctly filled in Uganda and 53.4% in Cameroon. Reported ease of method performance (aOR: 24.77 95% CI 2.97-206.42, p = 0.003) and reduced collection time (aOR: 3.73 95% CI 1.26-11.04, p = 0.017) were associated with greater odds of PSC acceptance. HBsAg + and anti-HCV + prevalence were 11.1% and 1.0%, respectively. CONCLUSIONS In spite of country differences, overall, the PSC was reported as a feasible and acceptable viral hepatitis testing method. Acceptability and feasibility of the method must be explored in heterogeneous target communities and qualitative research to better understand country-specific barriers and facilitators should be carried out.
Collapse
Affiliation(s)
- Camila A Picchio
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
| | - Aina Nicolàs
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ironne Valdèse Ayemfouo Fofou
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
- Laboratory of Molecular Medicine and Metabolism, Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
| | - Viola Kasone
- Central Public Health Laboratories, Ministry of Health of Uganda, Kampala, Uganda
| | - Magellan Guewo-Fokeng
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
- Laboratory of Molecular Medicine and Metabolism, Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
| | - Claude T Tagny
- Hematology and Blood Transfusion Unit, University Teaching Hospital of Yaoundé, Yaoundé, Cameroon
| | - Teddy Nanyonjo
- Central Public Health Laboratories, Ministry of Health of Uganda, Kampala, Uganda
| | - Hellen Nansumba
- Central Public Health Laboratories, Ministry of Health of Uganda, Kampala, Uganda
| | - Yves Nacel Kouongni
- Hematology and Blood Transfusion Unit, University Teaching Hospital of Yaoundé, Yaoundé, Cameroon
| | | | | | - Charles Kouanfack
- Day Hospital, HIV Care and Treatment Unit, Yaoundé Central Hospital, Yaoundé, Cameroon
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Isaac Ssewanyana
- Central Public Health Laboratories, Ministry of Health of Uganda, Kampala, Uganda
| | | | - Ariadna Rando Segura
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- CIBEREHD Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Rodríguez-Frías
- Liver Pathology Unit, Department of Biochemistry, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jean Claude Mbanya
- Laboratory of Molecular Medicine and Metabolism, Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé Central Hospital, National Obesity Centre, University of Yaoundé I, Yaoundé, Cameroon
| | - Ponsiano Ocama
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
- City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| |
Collapse
|
3
|
Buchanan AL, Hernández-Ramírez RU, Lok JJ, Vermund SH, Friedman SR, Forastiere L, Spiegelman D. Assessing Direct and Spillover Effects of Intervention Packages in Network-randomized Studies. Epidemiology 2024; 35:481-488. [PMID: 38709023 DOI: 10.1097/ede.0000000000001742] [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] [Indexed: 05/07/2024]
Abstract
BACKGROUND Intervention packages may result in a greater public health impact than single interventions. Understanding the separate impact of each component on the overall package effectiveness can improve intervention delivery. METHODS We adapted an approach to evaluate the effects of a time-varying intervention package in a network-randomized study. In some network-randomized studies, only a subset of participants in exposed networks receive the intervention themselves. The spillover effect contrasts average potential outcomes if a person was not exposed to themselves under intervention in the network versus no intervention in a control network. We estimated the effects of components of the intervention package in HIV Prevention Trials Network 037, a Phase III network-randomized HIV prevention trial among people who inject drugs and their risk networks using marginal structural models to adjust for time-varying confounding. The index participant in an intervention network received a peer education intervention initially at baseline, then boosters at 6 and 12 months. All participants were followed to ascertain HIV risk behaviors. RESULTS There were 560 participants with at least one follow-up visit, 48% of whom were randomized to the intervention, and 1,598 participant visits were observed. The spillover effect of the boosters in the presence of initial peer education training was a 39% rate reduction (rate ratio = 0.61; 95% confidence interval = 0.43, 0.87). CONCLUSIONS These methods will be useful for evaluating intervention packages in studies with network features.
Collapse
Affiliation(s)
- Ashley L Buchanan
- From the Department of Pharmacy Practice and Clinical Research, College of Pharmacy, University of Rhode Island, Kingston, RI
| | - Raúl U Hernández-Ramírez
- Department of Biostatistics, Center for Methods in Implementation and Prevention Science, and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
| | - Judith J Lok
- Department of Mathematics and Statistics, Boston University, Boston, MA
| | - Sten H Vermund
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | - Samuel R Friedman
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Laura Forastiere
- Department of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Donna Spiegelman
- Department of Biostatistics, Center for Methods in Implementation and Prevention Science, and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
| |
Collapse
|
4
|
Buchanan AL, Hernández-Ramírez RU, Lok JJ, Vermund SH, Friedman SR, Forastiere L, Spiegelman D. Assessing Direct and Spillover Effects of Intervention Packages in Network-Randomized Studies. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2022.03.24.22272909. [PMID: 38352598 PMCID: PMC10863001 DOI: 10.1101/2022.03.24.22272909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Intervention packages may result in a greater public health impact than single interventions. Understanding the separate impact of each component in the overall package effectiveness can improve intervention delivery. We adapted an approach to evaluate the effects of a time-varying intervention package in a network-randomized study. In some network-randomized studies, only a subset of participants in exposed networks receive the intervention themselves. The spillover effect contrasts average potential outcomes if a person was not exposed themselves under intervention in the network versus no intervention in a control network. We estimated effects of components of the intervention package in HIV Prevention Trials Network 037, a Phase III network-randomized HIV prevention trial among people who inject drugs and their risk networks using Marginal Structural Models to adjust for time-varying confounding. The index participant in an intervention network received a peer education intervention initially at baseline, then boosters at 6 and 12 months. All participants were followed to ascertain HIV risk behaviors. There were 560 participants with at least one follow-up visit, 48% of whom were randomized to the intervention, and 1,598 participant-visits were observed. The spillover effect of the boosters in the presence of initial peer education training was a 39% rate reduction (Rate Ratio = 0.61; 95% confidence interval= 0.43, 0.87). These methods will be useful to evaluate intervention packages in studies with network features.
Collapse
Affiliation(s)
- Ashley L Buchanan
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI 02881
| | - Raúl Ulises Hernández-Ramírez
- Department of Biostatistics, Center for Methods in Implementation and Prevention Science, and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT 06520
| | - Judith J Lok
- Department of Mathematics and Statistics, Boston University, Boston MA 02215
| | - Sten H Vermund
- Departments of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520
| | - Samuel R Friedman
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016
| | - Laura Forastiere
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06520
| | - Donna Spiegelman
- Department of Biostatistics, Center for Methods in Implementation and Prevention Science, and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT 06520
| |
Collapse
|
5
|
Mezei A, Trawin J, Payne B, Rawat A, Naguti P, Orem J, Murray MC, Nakisige C, Ogilvie G. Acceptability of Integrated Community-Based HIV and Cervical Cancer Screening in Mayuge District, Uganda. JCO Glob Oncol 2024; 10:e2200324. [PMID: 38237095 PMCID: PMC10805429 DOI: 10.1200/go.22.00324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 05/24/2023] [Accepted: 10/31/2023] [Indexed: 01/23/2024] Open
Abstract
PURPOSE To assess the acceptability of integrated screening for cervical cancer and HIV in the community setting. METHODS We developed surveys for patients and community health workers (CHWs) who participated in the Advances in Screening and Prevention in Reproductive Cancers (ASPIRE) Mayuge trial that compared self-collected human papillomavirus testing at home versus community health meetings in Mayuge district, Uganda. Quantitative data were summarized using descriptive statistics. Open-ended questions were analyzed using an inductive approach with thematic content analysis. RESULTS We conducted 102 patient surveys and 31 CHW surveys between June and August 2021. Ninety-nine percent of patients and 100% of CHWs indicated that they would find the addition of an HIV test to their self-collected cervical cancer test acceptable. The most frequently stated reasons in favor of adding an HIV test to the ASPIRE Mayuge cervical cancer screening pathways were time-saving, privacy, and support from other women and CHWs. The most frequently stated reasons against integrated screening were related to concerns about confidentiality, most often in reference to women's family members and other women in their village. CONCLUSION Integrated community-based cervical cancer and HIV testing would be highly acceptable to both women and CHWs.
Collapse
Affiliation(s)
- Alex Mezei
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jessica Trawin
- Women's Health Research Institute, British Columbia Women's Hospital + Health Centre, Vancouver, BC, Canada
| | - Beth Payne
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Angeli Rawat
- Women's Health Research Institute, British Columbia Women's Hospital + Health Centre, Vancouver, BC, Canada
| | - Priscilla Naguti
- Department of Reproductive Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Jackson Orem
- Department of Reproductive Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Melanie C.M. Murray
- Women's Health Research Institute, British Columbia Women's Hospital + Health Centre, Vancouver, BC, Canada
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
| | - Carolyn Nakisige
- Department of Reproductive Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Gina Ogilvie
- Women's Health Research Institute, British Columbia Women's Hospital + Health Centre, Vancouver, BC, Canada
| |
Collapse
|
6
|
Wang MH, Staples P, Prague M, Goyal R, DeGruttola V, Onnela JP. Leveraging Contact Network Information in Clustered Randomized Studies of Contagion Processes. OBSERVATIONAL STUDIES 2023; 9:157-175. [PMID: 37325081 PMCID: PMC10270696 DOI: 10.1353/obs.2023.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
In a randomized study, leveraging covariates related to the outcome (e.g. disease status) may produce less variable estimates of the effect of exposure. For contagion processes operating on a contact network, transmission can only occur through ties that connect affected and unaffected individuals; the outcome of such a process is known to depend intimately on the structure of the network. In this paper, we investigate the use of contact network features as efficiency covariates in exposure effect estimation. Using augmented generalized estimating equations (GEE), we estimate how gains in efficiency depend on the network structure and spread of the contagious agent or behavior. We apply this approach to simulated randomized trials using a stochastic compartmental contagion model on a collection of model-based contact networks and compare the bias, power, and variance of the estimated exposure effects using an assortment of network covariate adjustment strategies. We also demonstrate the use of network-augmented GEEs on a clustered randomized trial evaluating the effects of wastewater monitoring on COVID-19 cases in residential buildings at the the University of California San Diego.
Collapse
|
7
|
Muwanguzi PA, Nelson LE, Ngabirano TD, Kiwanuka N, Osingada CP, Sewankambo NK. Linkage to care and treatment among men with reactive HIV self-tests after workplace-based testing in Uganda: A qualitative study. Front Public Health 2022; 10:650719. [PMID: 36311595 PMCID: PMC9597242 DOI: 10.3389/fpubh.2022.650719] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 09/21/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction HIV self-testing at workplaces has the potential to reach men at risk of HIV infection with lower access to HIV testing services. While several studies have reported high uptake of HIV self-testing, linkage to HIV care following a positive result remains a challenge. This study, therefore, explored the motivators for and barriers to linkage to HIV care and treatment among men who returned positive results following workplace-based HIV self-testing. Methods A qualitative descriptive study, among men in private security services in Kampala district, Uganda. The men were eligible to participate if they were aged 18 to 60 years and had worked at the company for more than 6 months. Following HIV self-testing, participants with reactive (positive) self-test results were purposively sampled and engaged in key informant interviews. Inductive content analysis was employed to identify the motivators and barriers to the men's linkage to HIV treatment and care. Results Overall, 12 men participated in the study, of whom 9 (75%) were security guards, and the rest held management positions. The motivators for linkage to care coalesced under five categories. (i) Communication (open communication, phone reminders, consistent communication) (ii) Navigating health facility systems and processes (enabling health facility environment, easy access to health care, employing ART clinic counselors as part of the study team, health workers) (iii) Linkage support (linkage companions, referral forms, linkage facilitation, individualized linkage plan, pre-arranged clinic appointments) (iv) Psychosocial support (counseling sessions, family support, online and social media support, peer support) (v) workplace environment (employer's support, work schedules and policies). The barriers to linkage to HIV care included (i) Inflexible work schedules, (ii) Far distances to travel to access ART (iii) mandatory work transfers, (iv) disruptive effects of the COVID-19 pandemic, (v) Denial of HIV-positive results and (vi) fear of stigma and discrimination at health facilities. Conclusion The findings suggest the need for innovative interventions to facilitate regular follow-up and open communication with workplace-based HIV self-testers, to improve linkage to HIV care and treatment. Furthermore, initiating linkage plans during pre-test counseling and working in collaboration with health facilities and clinics may improve linkage to care.
Collapse
Affiliation(s)
- Patience A. Muwanguzi
- School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda,*Correspondence: Patience A. Muwanguzi
| | - LaRon E. Nelson
- Yale School of Nursing, Yale University, New Haven, CT, United States
| | - Tom D. Ngabirano
- School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Noah Kiwanuka
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Peter Osingada
- School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nelson K. Sewankambo
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
8
|
Eshun‐Wilson I, Akama E, Adhiambo F, Kwena Z, Oketch B, Obatsa S, Iguna S, Kulzer JL, Nyanga J, Nyandieka E, Scheve A, Geng EH, Bukusi EA, Abougi L. Adolescent and young adult preferences for financial incentives to support adherence to antiretroviral therapy in Kenya: a mixed methods study. J Int AIDS Soc 2022; 25:e25979. [PMID: 36109803 PMCID: PMC9478044 DOI: 10.1002/jia2.25979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/20/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION To develop a patient-centred financial incentive delivery strategy to improve antiretroviral treatment adherence in adolescents and young adults (AYA) living with HIV in Kisumu, Kenya, we conducted a mixed methods study exploring preferences. METHODS A discrete choice experiment (DCE) and focus group discussion (FGD) were conducted simultaneously to identify preferences for five incentive delivery strategy features: value, eligibility, recipient, format and disbursement frequency. We used consecutive sampling to recruit AYA (14-24 years) living with HIV attending three health facilities in Kisumu, Kenya. We calculated mean preferences, willingness to trade, latent class membership and predictors of latent class membership. The FGD explored preferred incentive features, and, after deductive and inductive coding, qualitative findings were triangulated with DCE results. RESULTS Two hundred and seven AYA living with HIV (46% 14-17 years, 54% 18-24 years; 33% male sex, 89% viral load <50 copies/ml) were recruited to the study (28 October-16 November 2020). Two distinct preference phenotypes emerged from the DCE analysis (N = 199), 44.8% of the population fell into an "immediate reward" group, who wanted higher value cash or mobile money distributed at each clinic visit, and 55.2% fell into a "moderate spender" group, who were willing to accept lower value incentives in the form of cash or shopping vouchers, and accrued payments. The immediate reward group were willing to trade up to 200 Kenyan Shillings (KSH)-approximately 2 US dollars (USD)-of their 500 KSH (∼5 USD) incentive to get monthly as opposed to accrued yearly payments. The strongest predictor of latent class membership was age (RR 1.45; 95% CI: 1.08-1.95; p = 0.006). Qualitative data highlighted the unique needs of those attending boarding school and confirmed an overwhelming preference for cash incentives which appeared to provide the greatest versatility for use. CONCLUSIONS Providing small financial incentives as cash was well-aligned with AYA preferences in this setting. AYA should additionally be offered a choice of other incentive delivery features (such as mobile money, recipient and disbursement frequency) to optimally align with the specific needs of their age group and life stage.
Collapse
Affiliation(s)
- Ingrid Eshun‐Wilson
- Division of Infectious Diseases, Department of MedicineWashington University in St. LouisSt. LouisMissouriUSA
| | - Eliud Akama
- Research Care Training Program, Centre for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Fridah Adhiambo
- Research Care Training Program, Centre for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Zachary Kwena
- Research Care Training Program, Centre for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Bertha Oketch
- Research Care Training Program, Centre for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Sarah Obatsa
- Research Care Training Program, Centre for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Sarah Iguna
- Research Care Training Program, Centre for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Jayne L. Kulzer
- Department of Obstetrics, Gynecology, and Reproductive ServicesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - James Nyanga
- Research Care Training Program, Centre for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Everlyne Nyandieka
- Research Care Training Program, Centre for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Ally Scheve
- Division of Infectious Diseases, Department of MedicineWashington University in St. LouisSt. LouisMissouriUSA
| | - Elvin H. Geng
- Division of Infectious Diseases, Department of MedicineWashington University in St. LouisSt. LouisMissouriUSA
| | - Elizabeth A. Bukusi
- Research Care Training Program, Centre for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Lisa Abougi
- Division of PediatricsUniversity of ColoradoBoulderColoradoUSA
| |
Collapse
|
9
|
Phiri M, Lemba M, Chomba C, Kanyamuna V. Examining differentials in HIV transmission risk behaviour and its associated factors among men in Southern African countries. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2022; 9:295. [PMID: 36060615 PMCID: PMC9419142 DOI: 10.1057/s41599-022-01312-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Sub-Saharan Africa (SSA), particularly Southern and East Africa, has the highest AIDS deaths and HIV-infected people in the world. Even though considerable effort has been made over the years to study HIV transmission risk behaviours of different population groups in SSA, there is little evidence of studies that have looked at pooled effects of associated HIV risk factors among men, particularly in Southern Africa. Thus, this study sought to fill this gap in knowledge by investigating the variations in HIV risk behaviours among men in the region. The study analysed cross-sectional data based on the most recent country Demographic and Health Survey (DHS) for six countries, namely Lesotho, Mozambique, Namibia, South Africa, Zambia and Zimbabwe. The study employed multivariate logistic regression models on a pooled dataset and individual country data to examine the relative risk of education and other factors on HIV risk behaviour indicators. It considered: (i) condom use during high risk-sex, (ii) multiple sexual partnerships, and (iii) HIV testing among men aged 15-59 years. Findings show that the proportion of men who engaged in HIV transmission risk behaviour was high in Southern Africa. Two-thirds of men reported non-use of a condom during last sex with most recent partners while 22% engaged in multiple sexual partnerships. The percentage of men who used condoms during sex with most recent partners ranged from 18% in Mozambique to 58% in Namibia. Age, residence, marital status and household wealth status were associated with HIV risk factors in the region. The study has established country variations in terms of how individual factors influence HIV transmission risk behaviour among men. Results show that the level of education was associated with increased use of condoms, only in Zambia and Mozambique. Delay in starting a sexual debut was associated with reduced odds of having multiple sexual partnerships in the region. Suggesting the need to strengthen comprehensive sexuality education among young men in school, to promote social behaviour change during adolescence age. The study presents important results to inform direct health policy, programme and government action to address HIV prevalence in the Southern region of Africa.
Collapse
Affiliation(s)
- Million Phiri
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
- Department of Demography and Population Studies, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Musonda Lemba
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Chrispin Chomba
- Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Vincent Kanyamuna
- Department of Development Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| |
Collapse
|
10
|
Wiginton JM, Mathur S, Gottert A, Pilgrim N, Pulerwitz J. Hearing From Men Living With HIV: Experiences With HIV Testing, Treatment, and Viral Load Suppression in Four High-Prevalence Countries in Sub-Saharan Africa. Front Public Health 2022; 10:861431. [PMID: 35651865 PMCID: PMC9149263 DOI: 10.3389/fpubh.2022.861431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/21/2022] [Indexed: 12/02/2022] Open
Abstract
Engaging men in HIV services remains a challenge across sub-Saharan Africa. There is a critical need to better understand facilitators of men's successful engagement with HIV services and assess if there are similarities across contexts. We conducted in-depth interviews and focus group discussions with 92 men living with HIV (MLHIV) across Malawi, Uganda, South Africa, and Eswatini, most of whom had been diagnosed with HIV within the last 5 years. We coded interviews for themes using a constant-comparative approach. We contextualized our findings within a socioecological framework. HIV testing was primarily motivated by illness (individual level), though illness was sometimes accompanied by prompting and support from healthcare providers and/or intimate partners. Once diagnosed, nearly all participants reported immediate linkage to care, initiation of antiretroviral therapy (ART), and subsequent ART adherence. ART initiation and adherence were facilitated by men's sense of agency and ownership over their health (individual level), social support from intimate partners, friends, and family (interpersonal/network level), supportive-directive counseling from healthcare providers (institutional/health systems level), and male-friendly services, i.e., rapid, respectful, private (institutional/health systems level). Health literacy regarding viral suppression (individual level), strengthened by patient-provider communication (institutional/health systems level), was highest in Uganda, where most men could discuss viral load testing experiences, report their viral load status (most reported suppressed), and demonstrate an understanding of treatment as prevention. Elsewhere, few participants understood what viral load suppression was and even fewer knew their viral load status. Our findings reveal socioecological-level facilitators of men's progress across the HIV-care continuum. Programs may want to leverage facilitators of ART initiation and adherence that span socioecological levels—e.g., healthcare ownership and agency, social support, supportive-directive counseling—and apply them to each end of the continuum to encourage early HIV testing/diagnosis and improve health literacy to help men understand and achieve viral load suppression.
Collapse
Affiliation(s)
- John Mark Wiginton
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD, United States
| | | | - Ann Gottert
- Population Council, Washington, DC, United States
| | | | | |
Collapse
|
11
|
Choi Y, Ibrahim S, Park LP, Cohen CR, Bukusi EA, Huchko MJ. Uptake and correlates of cervical cancer screening among women attending a community-based multi-disease health campaign in Kenya. BMC Womens Health 2022; 22:122. [PMID: 35436908 PMCID: PMC9014598 DOI: 10.1186/s12905-022-01702-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/16/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Despite the increased risk of cervical cancer among HIV-positive women, many HIV-care programs do not offer integrated cervical cancer screening. Incorporating self-collected Human Papillomavirus (HPV) testing into HIV programs is a potential strategy to identify women at higher risk for cervical cancer while leveraging the staffing, infrastructure and referral systems for existing services. Community-based HIV and HPV testing has been effective and efficient when offered in single-disease settings. METHODS This cross-sectional study was conducted within a community outreach and multi-disease screening campaigns organized by the Family AIDS Care and Education Services in Kisumu County, Kenya. In addition to HIV testing, the campaigns provided screening for TB, malaria, hypertension, diabetes, and referrals for voluntary medical male circumcision. After these services, women aged 25-65 were offered self-collected HPV testing. Rates and predictors of cervical cancer screening uptake and of HPV positivity were analyzed using tabular analysis and Fisher's Exact Test. Logistic regression was performed to explore multivariate associations with screening uptake. RESULTS Among the 2016 women of screening age who attended the outreach campaigns, 749 women (35.6%) were screened, and 134 women (18.7%) were HPV-positive. In bivariate analysis, women who had no children (p < 0.01), who were not pregnant (p < 0.01), who were using contraceptives (p < 0.01), who had sex without using condoms (p < 0.05), and who were encouraged by a family member other than their spouse (p < 0.01), were more likely to undergo screening. On multivariable analysis, characteristics associated with higher screening uptake included: women aged 45-54 (OR 1.62, 95% CI 1.05-2.52) compared to women aged 25-34; no children (OR 1.65, 95% CI 1.06-2.56); and family support other than their spouse (OR 1.53, 95% CI 1.09-2.16). Women who were pregnant were 0.44 times (95% CI 0.25-0.76) less likely to get screened. Bivariate analyses with participant characteristics and HPV positivity found that women who screened HPV-positive were more likely to be HIV-positive (p < 0.001) and single (p < 0.001). CONCLUSIONS The low screening uptake may be attributed to implementation challenges including long waiting times for service at the campaign and delays in procuring HPV test kits. However, given the potential benefits of integrating HPV testing into HIV outreach campaigns, these challenges should be examined to develop more effective multi-disease outreach interventions.
Collapse
Affiliation(s)
- Yujung Choi
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | | | - Lawrence P Park
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, San Francisco, CA, USA
| | | | - Megan J Huchko
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| |
Collapse
|
12
|
Shenoi SV, Kyriakides TC, Dokubo EK, Guddera V, Vranken P, Desai M, Friedland G, Moll AP. Community-based referral for tuberculosis preventive therapy is effective for treatment completion. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001269. [PMID: 36962910 PMCID: PMC10021376 DOI: 10.1371/journal.pgph.0001269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/19/2022] [Indexed: 12/15/2022]
Abstract
Expansion of tuberculous preventive therapy (TPT) is essential to curb TB incidence and mortality among people with HIV (PWH), yet implementation has been slow. Innovative strategies to operationalize TPT are urgently needed. Here we present an evaluation of community-based identification and referral of PWH on completion of a six-month course of isoniazid in a highly prevalent region in rural South Africa. Using a community-based TB/HIV intensive case finding strategy, a team of nurses and lay workers identified community members with HIV who were without fever, night sweats, weight loss, or cough and referred them to the government primary care clinics for daily oral isoniazid, the only available TPT regimen. We measured monthly adherence and six-month treatment completion in the community-based identification and referral (CBR) group compared to those already engaged in HIV care. Adherence was measured by self-report and urine isoniazid metabolite testing. A multivariable analysis was performed to identify independent predictors of TPT completion. Among 240 participants, 81.7% were female, median age 35 years (IQR 30-44), and 24.6% had previously been treated for TB. The median CD4 count in the CBR group was 457 (IQR 301-648), significantly higher than the clinic-based comparison group median CD4 of 344 (IQR 186-495, p<0.001). Independent predictors of treatment completion included being a woman (aOR 2.41, 95% 1.02-5.72) and community-based identification and referral for TPT (aOR 2.495, 95% 1.13-5.53). Among the CBR group, treatment completion was 90.0%, an absolute 10.8% higher than the clinic-based comparison group (79.2%, p = 0.02). Adherence was significantly greater in the CBR group than the clinic-based comparison group, as measured by self-report (p = 0.02) and urine isoniazid testing (p = 0.01). Among those not on ART at baseline, 10% of eligible PWH subsequently initiated ART. Community members living with HIV in TB endemic regions identified and referred for TPT demonstrated higher treatment completion and adherence compared to PWH engaged for TPT while receiving clinic-based care. Community-based identification and referral is an innovative adjunctive strategy to facilitate implementation of TB preventive therapy in people living with HIV.
Collapse
Affiliation(s)
- Sheela V Shenoi
- Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale Institute of Global Health, New Haven, Connecticut, United States of America
| | - Tassos C Kyriakides
- Yale School of Public Health, Biostatistics, Yale Center for Analytical Sciences, New Haven, Connecticut, United States of America
| | - Emily Kainne Dokubo
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Vijayanand Guddera
- Philanjalo NGO, Tugela Ferry, South Africa
- South African Medical Research Council, Durban, South Africa
| | - Peter Vranken
- U.S. Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Mitesh Desai
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gerald Friedland
- Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale Institute of Global Health, New Haven, Connecticut, United States of America
| | | |
Collapse
|
13
|
Siddharthan T, Kalyesubula R, Morgan B, Ermer T, Rabin TL, Kayongo A, Munana R, Anton N, Kast K, Schaeffner E, Kirenga B, Knauf F. The rural Uganda non-communicable disease (RUNCD) study: prevalence and risk factors of self-reported NCDs from a cross sectional survey. BMC Public Health 2021; 21:2036. [PMID: 34743687 PMCID: PMC8572568 DOI: 10.1186/s12889-021-12123-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 10/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are an increasing global concern, with morbidity and mortality largely occurring in low- and middle-income settings. We established the prospective Rural Uganda Non-Communicable Disease (RUNCD) cohort to longitudinally characterize the NCD prevalence, progression, and complications in rural Africa. Methods We conducted a population-based census for NCD research. We systematically enrolled adults in each household among three sub-counties of the larger Nakaseke Health district and collected baseline demographic, health status, and self-reported chronic disease information. We present our data on self-reported chronic disease, as stratified by age, sex, educational attainment, and sub-county. Results A total of 16,694 adults were surveyed with 10,563 (63%) respondents enrolled in the self-reported study. Average age was 37.8 years (SD = 16.5) and 45% (7481) were male. Among self-reported diseases, hypertension (HTN) was most prevalent (6.3%). 1.1% of participants reported a diagnosis of diabetes, 1.1% asthma, 0.7% COPD, and 0.4% kidney disease. 2.4% of the population described more than one NCD. Self-reported HTN was significantly higher in the peri-urban subcounty than in the other two rural sub-counties (p < 0.001); diagnoses for all other diseases did not differ significantly between sub-counties. Odds for self-reported HTN increased significantly with age (OR = 1.87 per 10 years of age, 95% CI 1.78–1.96). Male sex was associated with lower odds of reporting asthma (OR = 0.53, 95% CI 0.34–0.82) or HTN (OR = 0.31, 95% CI 0.26–0.40). Conclusions The RUNCD will establish one of the largest NCD patient cohorts in rural Africa. First analysis highlights the feasibility of systematically enrolling large numbers of adults living in a rural Ugandan district. In addition, our study demonstrates low levels of self-reported NCDs compared to the nation-wide established levels, emphasizing the need to better educate, characterize, and care for the majority of rural communities. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12123-7.
Collapse
Affiliation(s)
- Trishul Siddharthan
- Division of Pulmonary and Critical Care, School of Medicine, University of Miami, 1951 NW 7th Ave, Suite 2308, Miami, FL, 33136, USA. .,Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Robert Kalyesubula
- Makerere College of Health Sciences, Makerere University, Kampala, Uganda.,African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Brooks Morgan
- Division of Pulmonary and Critical Care, School of Medicine, University of Miami, 1951 NW 7th Ave, Suite 2308, Miami, FL, 33136, USA.,Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Theresa Ermer
- Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Tracy L Rabin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Alex Kayongo
- Makerere College of Health Sciences, Makerere University, Kampala, Uganda.,African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Richard Munana
- Makerere College of Health Sciences, Makerere University, Kampala, Uganda.,African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Nora Anton
- World Health Summit c/o Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Kast
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Elke Schaeffner
- Institute of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bruce Kirenga
- Makerere College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Knauf
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | |
Collapse
|
14
|
MacKellar D, Thompson R, Nelson R, Casavant I, Pals S, Bonzela J, Jaramillo A, Cardoso J, Ujamaa D, Tamele S, Chivurre V, Malimane I, Pathmanathan I, Heitzinger K, Wei S, Couto A, Vergara A. Annual home-based HIV testing in the Chókwè Health Demographic Surveillance System, Mozambique, 2014 to 2019: serial population-based survey evaluation. J Int AIDS Soc 2021; 24:e25762. [PMID: 34259391 PMCID: PMC8278856 DOI: 10.1002/jia2.25762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION WHO recommends implementing a mix of community and facility testing strategies to diagnose 95% of persons living with HIV (PLHIV). In Mozambique, a country with an estimated 506,000 undiagnosed PLHIV, use of home-based HIV testing services (HBHTS) to help achieve the 95% target has not been evaluated. METHODS HBHTS was provided at 20,000 households in the Chókwè Health Demographic Surveillance System (CHDSS), Mozambique, in annual rounds (R) during 2014 to 2019. Trends in prevalence of HIV infection, prior HIV diagnosis among PLHIV (diagnostic coverage), and undiagnosed HIV infection were assessed with three population-based surveys conducted in R1 (04/2014 to 04/2015), R3 (03/2016 to 12/2016), and R5 (04/2018 to 03/2019) of residents aged 15 to 59 years. Counts of patients aged ≥15 years tested for HIV in CHDSS healthcare facilities were obtained from routine reports. RESULTS During 2014 to 2019, counsellors conducted 92,512 home-based HIV tests and newly diagnosed 3711 residents aged 15 to 59 years. Prevalence of HIV infection was stable (R1, 25.1%; R3 23.6%; R5 22.9%; p-value, 0.19). After the first two rounds (44,825 home-based tests; 31,717 facility-based tests), diagnostic coverage increased from 73.8% (95% CI 70.3 to 77.2) in R1 to 93.0% (95% CI 91.3 to 94.7) in R3, and prevalence of undiagnosed HIV infection decreased from 6.6% (95% CI 5.6 to 7.5) in R1 to 1.7% (95% CI 1.2 to 2.1) in R3. After two more rounds (32,226 home-based tests; 46,003 facility-based tests), diagnostic coverage was 95.4% (95% CI 93.7 to 97.1) and prevalence of undiagnosed HIV infection was 1.1% (95% CI 0.7 to 1.5) in R5. Prevalence of having last tested at home was 12.7% (95% CI 11.3 to 14.0) in R1, 45.2% (95% CI 43.4 to 47.0) in R3, and 41.4% (95% CI 39.5 to 43.2) in R5, and prevalence of having last tested at a healthcare facility was 45.3% (95% CI 43.3 to 47.3) in R1, 40.1% (95% CI 38.4 to 41.8) in R3, and 45.2% (95% CI 43.3 to 47.0) in R5. CONCLUSIONS HBHTS successfully augmented facility-based testing to achieve HIV diagnostic coverage in a high-burden community of Mozambique. HBHTS should be considered in sub-Saharan Africa communities striving to diagnose 95% of persons living with HIV.
Collapse
Affiliation(s)
- Duncan MacKellar
- Division of Global HIV and TBNational Center for Global HealthUS Centers for Disease Control and PreventionAtlantaGAUSA
| | - Ricardo Thompson
- Chókwè Health Research and Training CenterNational Institute of HealthChókwèMozambique
| | - Robert Nelson
- Division of Global HIV and TBNational Center for Global HealthUS Centers for Disease Control and PreventionAtlantaGAUSA
| | | | - Sherri Pals
- Division of Global HIV and TBNational Center for Global HealthUS Centers for Disease Control and PreventionAtlantaGAUSA
| | - Juvencio Bonzela
- Chókwè Health Research and Training CenterNational Institute of HealthChókwèMozambique
| | | | | | | | - Stelio Tamele
- District Directorate of Public HealthChókwèMozambique
| | | | - Inacio Malimane
- US Centers for Disease Control and PreventionMaputoMozambique
| | - Ishani Pathmanathan
- Division of Global HIV and TBNational Center for Global HealthUS Centers for Disease Control and PreventionAtlantaGAUSA
| | | | - Stanley Wei
- US Centers for Disease Control and PreventionMaputoMozambique
| | - Aleny Couto
- Mozambique Ministry of HealthMaputoMozambique
| | - Alfredo Vergara
- US Centers for Disease Control and PreventionMaputoMozambique
| |
Collapse
|
15
|
Abstract
BACKGROUND Social isolation among HIV-positive persons might be an important barrier to care. Using data from the SEARCH Study in rural Kenya and Uganda, we constructed 32 community-wide, sociocentric networks and evaluated whether less socially connected HIV-positive persons were less likely to know their status, have initiated treatment, and be virally suppressed. METHODS Between 2013 and 2014, 168,720 adult residents in the SEARCH Study were census-enumerated, offered HIV testing, and asked to name social contacts. Social networks were constructed by matching named contacts to other residents. We characterized the resulting networks and estimated risk ratios (aRR) associated with poor HIV care outcomes, adjusting for sociodemographic factors and clustering by community with generalized estimating equations. RESULTS The sociocentric networks contained 170,028 residents (nodes) and 362,965 social connections (edges). Among 11,239 HIV-positive persons who named ≥1 contact, 30.9% were previously undiagnosed, 43.7% had not initiated treatment, and 49.4% had viral nonsuppression. Lower social connectedness, measured by the number of persons naming an HIV-positive individual as a contact (in-degree), was associated with poorer outcomes in Uganda, but not Kenya. Specifically, HIV-positive persons in the lowest connectedness tercile were less likely to be previously diagnosed (Uganda-West aRR: 0.89 [95% confidence interval (CI): 0.83, 0.96]; Uganda-East aRR: 0.85 [95% CI: 0.76, 0.96]); on treatment (Uganda-West aRR: 0.88 [95% CI: 0.80, 0.98]; Uganda-East aRR: 0.81 [0.72, 0.92]), and suppressed (Uganda-West aRR: 0.84 [95% CI: 0.73, 0.96]; Uganda-East aRR: 0.74 [95% CI: 0.58, 0.94]) than those in the highest connectedness tercile. CONCLUSIONS HIV-positive persons named as a contact by fewer people may be at higher risk for poor HIV care outcomes, suggesting opportunities for targeted interventions.
Collapse
|
16
|
Kasaie P, Weir B, Schnure M, Dun C, Pennington J, Teng Y, Wamai R, Mutai K, Dowdy D, Beyrer C. Integrated screening and treatment services for HIV, hypertension and diabetes in Kenya: assessing the epidemiological impact and cost-effectiveness from a national and regional perspective. J Int AIDS Soc 2021; 23 Suppl 1:e25499. [PMID: 32562353 PMCID: PMC7305418 DOI: 10.1002/jia2.25499] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/28/2020] [Accepted: 04/03/2020] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION As people with HIV age, prevention and management of other communicable and non-communicable diseases (NCDs) will become increasingly important. Integration of screening and treatment for HIV and NCDs is a promising approach for addressing the dual burden of these diseases. The aim of this study was to assess the epidemiological impact and cost-effectiveness of a community-wide integrated programme for screening and treatment of HIV, hypertension and diabetes in Kenya. METHODS Coupling a microsimulation of cardiovascular diseases (CVDs) with a population-based model of HIV dynamics (the Spectrum), we created a hybrid HIV/CVD model. Interventions were modelled from year 2019 (baseline) to 2023, and population was followed to 2033. Analyses were carried at a national level and for three selected regions (Nairobi, Coast and Central). RESULTS At a national level, the model projected 7.62 million individuals living with untreated hypertension, 692,000 with untreated diabetes and 592,000 individuals in need of ART in year 2018. Improving ART coverage from 68% at baseline to 88% in 2033 reduced HIV incidence by an estimated 64%. Providing NCD treatment to 50% of diagnosed cases from 2019 to 2023 and maintaining them on treatment afterwards could avert 116,000 CVD events and 43,600 CVD deaths in Kenya over the next 15 years. At a regional level, the estimated impact of expanded HIV services was highest in Nairobi region (averting 42,100 HIV infections compared to baseline) while Central region experienced the highest impact of expanded NCD treatment (with a reduction of 22,200 CVD events). The integrated HIV/NCD intervention could avert 7.76 million disability-adjusted-life-years (DALYs) over 15 years at an estimated cost of $6.68 billion ($445.27 million per year), or $860.30 per DALY averted. At a cost-effectiveness threshold of $2,010 per DALY averted, the probability of cost-effectiveness was 0.92, ranging from 0.71 in Central to 0.92 in Nairobi region. CONCLUSIONS Integrated screening and treatment of HIV and NCDs can be a cost-effective and impactful approach to save lives of people with HIV in Kenya, although important variation exists at the regional level. Containing the substantial costs required for scale-up will be critical for management of HIV and NCDs on a national scale.
Collapse
Affiliation(s)
- Parastu Kasaie
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brian Weir
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa Schnure
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chen Dun
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeff Pennington
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yu Teng
- Avenir Health, Glastonbury, CT, USA
| | - Richard Wamai
- Department of Cultures, Societies and Global Studies, Integrated Initiative for Global Health, Northeastern University, Boston, MA, USA
| | | | - David Dowdy
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chris Beyrer
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
17
|
Schaffer EM, Gonzalez JM, Wheeler SB, Kwarisiima D, Chamie G, Thirumurthy H. Promoting HIV Testing by Men: A Discrete Choice Experiment to Elicit Preferences and Predict Uptake of Community-based Testing in Uganda. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:413-432. [PMID: 31981135 PMCID: PMC7255957 DOI: 10.1007/s40258-019-00549-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND AND OBJECTIVES HIV testing is essential to access HIV treatment and care and plays a critical role in preventing transmission. Despite this, testing coverage is low among men in sub-Saharan Africa. Community-based testing has demonstrated potential to expand male testing coverage, yet scant evidence reveals how community-based services can be designed to optimize testing uptake. We conducted a discrete choice experiment (DCE) to elicit preferences and predict uptake of community-based testing by men in Uganda. METHODS Hypothetical choices between alternative community-based testing services and the option to opt-out of testing were presented to a random, population-based sample of 203 adult male residents. The testing alternatives varied by service delivery model (community health campaign, counselor-administered home-based testing, distribution of HIV self-test kits at local pharmacies), availability of multi-disease testing, access to antiretroviral therapy (ART), and provision of a US$0.85 incentive. We estimated preferences using a random parameters logit model and explored whether preferences varied by participant characteristics through subgroup analyses. We simulated uptake when a single and when two community-based testing services are made available, using reference values of observed uptake to calibrate predictions. RESULTS The share of the adult male population predicted to test for HIV ranged from 0.15 to 0.91 when a single community-based testing service is made available and from 0.50 to 0.96 when two community-based services are provided concurrently. ART access was the strongest driver of choices (relative importance [RI] = 3.01, 95% confidence interval [CI]: 1.74-4.29), followed by the service delivery model (RI = 1.27, 95% CI 0.72-1.82) and availability of multi-disease testing (RI = 1.27, 95% CI 0.09-2.45). A US$0.85 incentive had the least yet still significant influence on choices (RI = 0.77, 95% CI 0.06-1.49). Men who perceived their risk of having HIV to be relatively elevated had higher predicted uptake of HIV self-test kits at local pharmacies, as did young adult men compared to men aged ≥ 30 years. Men who earned ≤ the daily median income had higher predicted uptake of all community-based testing services versus men who earned above the daily median income. CONCLUSION Substantial opportunity exists to optimize the delivery of HIV testing to expand uptake by men; using an innovative DCE, we deliver timely, actionable guidance for promoting community-based testing by men in Uganda. We advance the stated preference literature methodologically by describing how we constructed and evaluated a pragmatic experimental design, used interaction terms to conduct subgroup analyses, and harnessed participant-specific preference estimates to predict and calibrate testing uptake.
Collapse
Affiliation(s)
- Elisabeth M Schaffer
- Data Science to Patient Value, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Stephanie B Wheeler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Gabriel Chamie
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Harsha Thirumurthy
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
18
|
Latha K, Meena KS, Pravitha MR, Dasgupta M, Chaturvedi SK. Effective use of social media platforms for promotion of mental health awareness. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2020; 9:124. [PMID: 32642480 PMCID: PMC7325786 DOI: 10.4103/jehp.jehp_90_20] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/02/2020] [Indexed: 05/23/2023]
Abstract
BACKGROUND Social media platforms are progressively developing as a rich source of mass communication. Increasing mental health awareness with the help of social media can be a good initiative to reach out to a large number of people in a short time frame. This study was conducted to understand the usefulness of social media platforms for health promotion. MATERIALS AND METHODS It was a qualitative study to evaluate the effectiveness of social media platforms in hosting health promotion campaigns in the field of mental health, which was observed over 5 months from May to September 2019 to reach more people for effective information dissemination. The campaigns were as follows (1) The Buddies for Suicide Prevention: an online campaign to create awareness about suicide prevention. The campaign included script writing, slogan writing, poster making, and short films making, organized for the general public who were interested to take part; (2) The #Iquitobacco was a 21-day campaign with an idea of tobacco cessation in the community, conducted among social media viewers who were willing to participate; and (3) #Migrainethepainfultruth was yet another campaign conducted among the social media viewers who were interested to participate. All the campaigns were conducted using two famous social media platforms commonly used by young adults. Descriptive statistics such as frequency and proportions were computed for the number of likes and shares. RESULTS The Facebook and Instagram posts concerning all the campaigns brought about a considerable amount of reach to the targeted population. After the campaigns, the page reached to around 10.3 k people (both fans and nonfans). CONCLUSIONS Use of social media to conduct mental health campaigns is an effective initiative as one can reach out to several people over a short time period. There is an increasing trend in the awareness of mental health with the effective use of digital media as a platform for disseminating information.
Collapse
Affiliation(s)
- K. Latha
- Department of Mental Health Education, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - K. S. Meena
- Department of Mental Health Education, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - M. R. Pravitha
- Department of Mental Health Education, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Madhuporna Dasgupta
- Department of Mental Health Education, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - S. K. Chaturvedi
- Department of Mental Health Education, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| |
Collapse
|
19
|
Hlongwa M, Mashamba-Thompson T, Makhunga S, Hlongwana K. Barriers to HIV testing uptake among men in sub-Saharan Africa: a scoping review. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 19:13-23. [PMID: 32174231 DOI: 10.2989/16085906.2020.1725071] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction: HIV testing among men remains low globally and in sub-Saharan Africa (SSA) in particular, when compared with their female counterparts. The aim of this study was to synthesise evidence on barriers to HIV testing among men in SSA using a scoping review method.Methods: A scoping review was conducted, guided by Arksey and O'Malley's framework. A search was made in PubMed, American Doctoral Dissertations via EBSCOhost, Union Catalogue of Theses and Dissertations and SA ePublications via SABINET Online and World Cat Dissertations, Theses via OCLC and Google Scholar. The PRISMA (preferred reporting items for systematic reviews and meta-analyses) chart was used to document the review process. The PRISMA extension for scoping reviews - PRISMA-ScR: checklist and explanation - was also used. The mixed method appraisal tool version 2018 was used to determine the methodological quality of the included studies. Thematic analyses were conducted using NVivo version 11.Results: Key barriers to HIV testing among men in SSA were knowledge of HIV, fear of testing positive for HIV, stigma associated with HIV, healthcare providers' services, confidentiality, and clinic setting.Conclusion: Structural and individual factors present barriers to HIV testing uptake among men in SSA. Community and home-based initiatives have the potential to improve the uptake of HIV testing among men in SSA, considering the confidentiality concerns posed by clinic settings.
Collapse
Affiliation(s)
- Mbuzeleni Hlongwa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Sizwe Makhunga
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Khumbulani Hlongwana
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
20
|
Comulada WS, Wynn A, van Rooyen H, Barnabas RV, Eashwari R, van Heerden A. Using mHealth to Deliver a Home-Based Testing and Counseling Program to Improve Linkage to Care and ART Adherence in Rural South Africa. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:126-136. [PMID: 30259235 DOI: 10.1007/s11121-018-0950-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Community-based HIV testing and counseling (HTC) programs have become an important part of the healthcare system in South Africa and other low- and middle-income countries with a high HIV prevalence and strained primary healthcare system. Current HTC programs excel at identifying people living with HIV (PLH) but leave gaps in linkage to care and antiretroviral therapy (ART) as most HTC programs do not have the capacity to ensure that linkage has occurred. This article presents the protocol for an mHealth study, that is, pilot testing a mobile platform in KwaZulu-Natal (KZN), South Africa, to improve linkage to care and ART adherence after home-based HTC. Testing data are shared with designated clinics. PLH are identified using fingerprint scans, mobile numbers, or South African IDs. If PLH do not present at a designated clinic after testing HIV positive, study field staff are sent SMS alerts to prompt follow-up visits. Similarly, if PLH do not refill ART prescriptions after their initial 1-month dose runs out, SMS alerts that are sent to field staff. This paper presents the mHealth study protocol and baseline sample characteristics (N = 101 PLH). Analyses will summarize rates of linkage to care and ART prescription refills. Cost-effectiveness analyses will examine the costs and benefits of linkage and ART adherence using our mHealth system. Linkage to care rates will be compared between our study and a historical control, that is, provided by a prior HTC program that was conducted in KZN without our mHealth system (n = 615).
Collapse
Affiliation(s)
- W Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 10920 Wilshire Blvd. Suite 350, Los Angeles, CA, 90024, USA.
| | - Adriane Wynn
- Department of Health Policy Management, University of California, Los Angeles, CA, USA
| | - Heidi van Rooyen
- Human and Social Development Research Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Ruanne V Barnabas
- Global Health and Medicine, University of Washington, Seattle, WA, USA
| | - Rajeev Eashwari
- eHealth Directorate, KwaZulu-Natal Provincial Department of Health, Durban, South Africa
| | - Alastair van Heerden
- Human and Social Development Research Programme, Human Sciences Research Council, Pretoria, South Africa.,Developmental Pathways to Health Research Unit, School of Community Medicine, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
21
|
Alwano MG, Bachanas P, Block L, Roland M, Sento B, Behel S, Lebelonyane R, Wirth K, Ussery F, Bapati W, Motswere-Chirwa C, Abrams W, Ussery G, Miller JA, Bile E, Fonjungo P, Kgwadu A, Holme MP, Del Castillo L, Gaolathe T, Leme K, Majingo N, Lockman S, Makhema J, Bock N, Moore J. Increasing knowledge of HIV status in a country with high HIV testing coverage: Results from the Botswana Combination Prevention Project. PLoS One 2019; 14:e0225076. [PMID: 31765394 PMCID: PMC6876886 DOI: 10.1371/journal.pone.0225076] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/27/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Achieving widespread knowledge of HIV-positive status is a crucial step to reaching universal ART coverage, population level viral suppression, and ultimately epidemic control. We implemented a multi-modality HIV testing approach to identify 90% or greater of HIV-positive persons in the Botswana Combination Prevention Project (BCPP) intervention communities. METHODS BCPP is a cluster-randomized trial designed to evaluate the impact of combination prevention interventions on HIV incidence in 30 communities in Botswana. Community case finding and HIV testing that included home and targeted mobile testing were implemented in the 15 intervention communities. We described processes for identifying HIV-positive persons, uptake of HIV testing by age, gender and venue, characteristics of persons newly diagnosed through BCPP, and coverage of knowledge of status reached at the end of study. RESULTS Of the 61,655 eligible adults assessed in home or mobile settings, 13,328 HIV-positive individuals, or 93% of the estimated 14,270 positive people in the communities were identified through BCPP. Knowledge of status increased by 25% over the course of the study with the greatest increases seen among men (37%) as compared to women (19%) and among youth aged 16-24 (77%) as compared to older age groups (21%). Although more men were tested through mobile than through home-based testing, higher rates of newly diagnosed HIV-positive men were found through home than mobile testing. CONCLUSIONS Even when HIV testing coverage is high, additional gains can be made using a multi-modality HIV testing strategy to reach different sub-populations who are being missed by non-targeted program activities. Men and youth can be reached and will engage in community testing when services are brought to places they access routinely.
Collapse
Affiliation(s)
- Mary Grace Alwano
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Gaborone, Botswana
| | - Pamela Bachanas
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, Georgia, United States of America
| | - Lisa Block
- Northrop Grumman, Atlanta, Georgia, United States of America
| | - Michelle Roland
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Gaborone, Botswana
| | - Baraedi Sento
- Tebelopele HIV Counseling and Testing Center, Gaborone, Botswana
| | - Stephanie Behel
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, Georgia, United States of America
| | | | - Kathleen Wirth
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Faith Ussery
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, Georgia, United States of America
| | - William Bapati
- Tebelopele HIV Counseling and Testing Center, Gaborone, Botswana
| | | | - William Abrams
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Gaborone, Botswana
| | - Gene Ussery
- Northrop Grumman, Atlanta, Georgia, United States of America
| | - James A. Miller
- Northrop Grumman, Atlanta, Georgia, United States of America
| | - Ebi Bile
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Gaborone, Botswana
| | - Peter Fonjungo
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, Georgia, United States of America
| | - Agisanag Kgwadu
- Tebelopele HIV Counseling and Testing Center, Gaborone, Botswana
| | - Molly Pretorius Holme
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Lisetta Del Castillo
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Gaborone, Botswana
| | | | - Kelebemang Leme
- Tebelopele HIV Counseling and Testing Center, Gaborone, Botswana
| | | | - Shahin Lockman
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Naomi Bock
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, Georgia, United States of America
| | - Janet Moore
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, Georgia, United States of America
| |
Collapse
|
22
|
Labhardt ND, Ringera I, Lejone TI, Amstutz A, Klimkait T, Muhairwe J, Glass TR. Effect and cost of two successive home visits to increase HIV testing coverage: a prospective study in Lesotho, Southern Africa. BMC Public Health 2019; 19:1441. [PMID: 31676001 PMCID: PMC6825349 DOI: 10.1186/s12889-019-7784-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home-based HIV testing and counselling (HB-HTC) is frequently used to increase awareness of HIV status in sub-Saharan Africa. Whereas acceptance of HB-HTC is usually high, testing coverage may remain low due to household members being absent during the home visits. This study assessed whether two consecutive visits, one during the week, one on the weekend, increase coverage. METHODS The study was a predefined nested-study of the CASCADE-trial protocol and conducted in 62 randomly selected villages and 17 urban areas in Butha-Buthe district, Lesotho. HB-HTC teams visited each village/urban area twice: first during a weekday, followed by a weekend visit to catch-up for household members absent during the week. Primary outcome was HTC coverage after first and second visit. Coverage was defined as all individuals who knew their HIV status out of all household members (present and absent). RESULTS HB-HTC teams visited 6665 households with 18,286 household members. At first visit, 69.2 and 75.4% of household members were encountered in rural and urban households respectively (p < 0.001) and acceptance for testing was 88.5% in rural and 79.5% in urban areas (p < 0.001), resulting in a coverage of 61.8 and 61.5%, respectively. After catch-up visit, the HTC coverage increased to 71.9% in rural and 69.4% in urban areas. The number of first time testers was higher at the second visit (47% versus 35%, p < 0.001). Direct cost per person tested and per person tested HIV positive were lower during weekdays (10.50 and 335 USD) than during weekends (20 and 1056 USD). CONCLUSIONS A catch-up visit on weekends increased the proportion of persons knowing their HIV status from 62 to 71% and reached more first-time testers. However, cost per person tested during catch-up visits was nearly twice the cost during first visit. TRIAL REGISTRATION NCT02692027 (prospectively registered on February 21, 2016).
Collapse
Affiliation(s)
- Niklaus Daniel Labhardt
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Isaac Ringera
- SolidarMed, Swiss Organization for Health in Africa, Maseru, Lesotho
| | | | - Alain Amstutz
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Thomas Klimkait
- University of Basel, Basel, Switzerland
- Molecular Virology, Department of Biomedicine, Basel, Switzerland
| | | | - Tracy Renee Glass
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
23
|
Siwingwa M, Nzala SH, Sikateyo B, Mutale W. Perceptions on the feasibility of decentralizing phlebotomy services in community anti-retroviral therapy group model in Lusaka, Zambia. BMC Health Serv Res 2019; 19:570. [PMID: 31412849 PMCID: PMC6694622 DOI: 10.1186/s12913-019-4386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The focus of the community anti-retroviral therapy Group model is on drug refill, adherence and support groups. However, laboratory services are completely neglected in this model, and stable patient still have to go to the clinic for blood draws after drugs refills from the community. Due to the introduction of new ART drugs, the guidelines now recommend the use of viral loads to guide decision in switching all patients from NNRTI to dolutegravir based first line ART regimens. But the national viral load testing coverage stands at 37% and and falls short of meeting the global UNAIDS and phlebotomy delivery system is congested. The purpose of this study was to identify the perceptions in decentralizing phlebotomy services into the community anti-retroviral therapy Group model. METHOD A qualitative case study design was used. Data were collected through ten Focused group discussions among community anti-retroviral therapy Group members, community and health care workers at anti-retroviral therapy clinics and in-depth interviews with five key informants. Data were managed with the help of Nvivo version 10 and analyzed using thematic method. RESULTS Positive perceptions were identified as those which contributed to decongesting phlebotomy rooms, reduced missing phlebotomy appointments, work Load, and lost results. Improved quality of phlebotomy service delivery and testing coverage, innovative access to laboratory services and encouraged patient's accountability. The negative perceptions were compromised sample integrity, inability to perform prevention control and patients less contact with clinicians. CONCLUSION The study has demonstrated that decentralizing phlebotomy services within the CAG model has greater potential to improve the quality of services delivery for patients. In addition, it has perceived threats on the quality of specimen collected, patient's safety, and health care.
Collapse
Affiliation(s)
- Mpanji Siwingwa
- Department of health policy and management, University of Zambia, School of public health, P.O BOX 50110 Lusaka, Zambia
| | - Selestine H. Nzala
- Department of medical education development, University of Zambia, School of Medicine, P.O BOX 50110 Lusaka, Zambia
| | - Bornwell Sikateyo
- Department of bioethics, University of Zambia, School of medicine, P.O BOX 50110 Lusaka, Zambia
| | - Wilbroad Mutale
- Department of health policy and management, University of Zambia, School of public health, P.O BOX 50110 Lusaka, Zambia
| |
Collapse
|
24
|
Chang AY, Gómez-Olivé FX, Payne C, Rohr JK, Manne-Goehler J, Wade AN, Wagner RG, Montana L, Tollman S, Salomon JA. Chronic multimorbidity among older adults in rural South Africa. BMJ Glob Health 2019; 4:e001386. [PMID: 31423345 PMCID: PMC6688670 DOI: 10.1136/bmjgh-2018-001386] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/17/2019] [Accepted: 06/01/2019] [Indexed: 12/16/2022] Open
Abstract
Introduction The rapid ageing of populations around the world is accompanied by increasing prevalence of multimorbidity. This study is one of the first to present the prevalence of multimorbidity that includes HIV in the complex epidemiological setting of South Africa, thus filling a gap in the multimorbidity literature that is dominated by studies in high-income or low-HIV prevalence settings. Methods Out of the full sample of 5059 people aged 40+, we analysed cross-sectional data on 10 conditions from 3889 people enrolled in the Health and Ageing in Africa: A longitudinal study of an INDEPTH Community in South Africa (HAALSI) Programme. Two definitions of multimorbidity were applied: the presence of more than one condition and the presence of conditions from more than one of the following categories: cardiometabolic conditions, mental disorders, HIV and anaemia. We conducted descriptive and regression analyses to assess the relationship between prevalence of multimorbidity and sociodemographic factors. We examined the frequencies of the most prevalent combinations of conditions and assessed relationships between multimorbidity and physical and psychological functioning. Results 69.4 per cent (95% CI 68.0 to 70.9) of the respondents had at least two conditions and 53.9% (52.4–55.5) of the sample had at least two categories of conditions. The most common condition groups and multimorbid profiles were combinations of cardiometabolic conditions, cardiometabolic conditions and depression, HIV and anaemia and combinations of mental disorders. The commonly observed positive relationships between multimorbidity and age and decreasing wealth were not observed in this population, namelydue to different epidemiological profiles in the subgroups, with higher prevalence of HIV and anaemia in the poorer and younger groups, and higher prevalence of cardiometabolic conditions in the richer and older groups. Both physical functioning and well-being negatively associated with multimorbidity. Discussion More coordinated, long-term integrated care management across multiple chronic conditions should be provided in rural South Africa.
Collapse
Affiliation(s)
- Angela Y Chang
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Collin Payne
- School of Demography, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Julia K Rohr
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alisha N Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Livia Montana
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joshua A Salomon
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| |
Collapse
|
25
|
Cham HJ, MacKellar D, Maruyama H, Rwabiyago OE, Msumi O, Steiner C, Kundi G, Weber R, Byrd J, Suraratdecha C, Mengistu T, Churi E, Pals S, Madevu-Matson C, Alexander G, Porter S, Kazaura K, Mbilinyi D, Morales F, Rutachunzibwa T, Justman J, Rwebembera A. Methods, outcomes, and costs of a 2.5 year comprehensive facility-and community-based HIV testing intervention in Bukoba Municipal Council, Tanzania, 2014-2017. PLoS One 2019; 14:e0215654. [PMID: 31048912 PMCID: PMC6497243 DOI: 10.1371/journal.pone.0215654] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/07/2019] [Indexed: 11/18/2022] Open
Abstract
To diagnose ≥90% HIV-infected residents (diagnostic coverage), the Bukoba Combination Prevention Evaluation (BCPE) implemented provider-initiated (PITC), home- (HBHTC), and venue-based (VBHTC) HIV testing and counseling (HTC) intervention in Bukoba Municipal Council, a mixed urban and rural lake zone community of 150,000 residents in Tanzania. This paper describes the methods, outcomes, and incremental costs of these HTC interventions. PITC was implemented in outpatient department clinics in all eight public and three faith-based health facilities. In clinics, lay counselors routinely screened and referred eligible patients for HIV testing conducted by HTC-dedicated healthcare workers. In all 14 wards, community teams offered HTC to eligible persons encountered at 31,293 home visits and at 79 male- and youth-frequented venues. HTC was recommended for persons who were not in HIV care or had not tested in the prior 90 days. BCPE conducted 133,695 HIV tests during the 2.5 year intervention (PITC: 88,813, 66%; HBHTC: 27,407, 21%; VBHTC: 17,475, 13%). Compared with other strategies, PITC conducted proportionally more tests among females (65%), and VBHTC conducted proportionally more tests among males (69%) and young-adults aged 15-24 years (42%). Of 5,550 (4.2% of all tests) HIV-positive tests, 4,143 (75%) clients were newly HIV diagnosed, including 1,583 males and 881 young adults aged 15-24 years. Of HIV tests conducted 3.7%, 1.8%, and 2.1% of PITC, HBHTC, and VBHTC clients, respectively, were newly HIV diagnosed; PITC accounted for 79% of all new diagnoses. Cost per test (per new diagnosis) was $4.55 ($123.66), $6.45 ($354.44), and $7.98 ($372.67) for PITC, HBHTC, and VBHTC, respectively. In a task-shifting analysis in which lay counselors replaced healthcare workers, estimated costs per test (per new diagnosis) would have been $3.06 ($83.15), $ 4.81 ($264.04), and $5.45 ($254.52), for PITC, HBHTC, and VBHTC, respectively. BCPE models reached different target groups, including men and young adults, two groups with consistently low coverage. Implementation of multiple models is likely necessary to achieve ≥90% diagnostic coverage.
Collapse
Affiliation(s)
- Haddi Jatou Cham
- Division of Global HIV and TB, National Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Duncan MacKellar
- Division of Global HIV and TB, National Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Omari Msumi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | | | - Gerald Kundi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | - Rachel Weber
- U.S. Centers for Disease Control and Prevention, Yaounde, Cameroon
| | - Johnita Byrd
- ICF International, Atlanta, Georgia, United States of America
| | - Chutima Suraratdecha
- Division of Global HIV and TB, National Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tewodaj Mengistu
- Division of Global HIV and TB, National Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eliufoo Churi
- Henry Jackson Foundation Medical Research International, Mbeya, Tanzania
| | - Sherri Pals
- Division of Global HIV and TB, National Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Sarah Porter
- Division of Global HIV and TB, National Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kokuhumbya Kazaura
- U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | | | | | - Thomas Rutachunzibwa
- Ministry of Health, Community Development, Gender, Elderly and Children, Bukoba, Tanzania
| | | | - Anath Rwebembera
- National AIDS Control Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| |
Collapse
|
26
|
Manne‐Goehler J, Siedner MJ, Montana L, Harling G, Geldsetzer P, Rohr J, Gómez‐Olivé F, Goehler A, Wade A, Gaziano T, Kahn K, Davies JI, Tollman S, Bärnighausen TW. Hypertension and diabetes control along the HIV care cascade in rural South Africa. J Int AIDS Soc 2019; 22:e25213. [PMID: 30916897 PMCID: PMC6436499 DOI: 10.1002/jia2.25213] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 11/02/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Participation in antiretroviral therapy (ART) programmes has been associated with greater utilization of care for hypertension and diabetes in rural South Africa. The objective of this study was to assess whether people living with HIV on ART with comorbid hypertension or diabetes also have improved chronic disease management indicators. METHODS The Health and Aging in Africa: a longitudinal study of an INDEPTH Community in South Africa (HAALSI) is a cohort of 5059 adults >40 years old. Enrollment took place between November 2014 and November 2015. The study collected population-based data on demographics, healthcare utilization, height, weight, blood pressure (BP) and blood glucose as well as HIV infection, HIV-1 RNA viral load (VL) and ART exposure. We used regression models to determine whether HIV care cascade stage (HIV-negative, HIV+ /No ART, ART/Detected HIV VL, and ART/Undetectable VL) was associated with diagnosis or treatment of hypertension or diabetes, and systolic blood pressure and glucose among those with diagnosed hypertension or diabetes. ART use was measured from drug level testing on dried blood spots. RESULTS AND DISCUSSION Compared to people without HIV, ART/Undetectable VL was associated with greater awareness of hypertension diagnosis (adjusted risk ratio (aRR) 1.18, 95% CI: 1.09 to 1.28) and treatment of hypertension (aRR 1.24, 95% CI: 1.10 to 1.41) among those who met hypertension diagnostic criteria. HIV care cascade stage was not significantly associated with awareness of diagnosis or treatment of diabetes. Among those with diagnosed hypertension or diabetes, ART/Undetectable VL was associated with lower mean systolic blood pressure (5.98 mm Hg, 95% CI: 9.65 to 2.32) and lower mean glucose (3.77 mmol/L, 95% CI: 6.85 to 0.69), compared to being HIV-negative. CONCLUSIONS Participants on ART with an undetectable VL had lower systolic blood pressure and blood glucose than the HIV-negative participants. HIV treatment programmes may provide a platform for health systems strengthening for cardiometabolic disease.
Collapse
Affiliation(s)
- Jennifer Manne‐Goehler
- Division of Infectious DiseasesMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
- Department of Global Health & PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Mark J Siedner
- Massachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Livia Montana
- Harvard Center for Population & Development StudiesHarvard UniversityCambridgeMAUSA
| | - Guy Harling
- Harvard Center for Population & Development StudiesHarvard UniversityCambridgeMAUSA
- Africa Health Research Institute (AHRI)MtubatubaSouth Africa
- Institute for Global HealthUniversity College LondonLondonUK
| | - Pascal Geldsetzer
- Department of Global Health & PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Julia Rohr
- Harvard Center for Population & Development StudiesHarvard UniversityCambridgeMAUSA
| | - F Xavier Gómez‐Olivé
- Medical Research Council/Wits Rural Public Health & Health Transitions Research UnitSchool of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- INDEPTH NetworkAccraGhana
| | - Alexander Goehler
- Department of Radiology, Brigham & Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Alisha Wade
- Medical Research Council/Wits Rural Public Health & Health Transitions Research UnitSchool of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Thomas Gaziano
- Department of Cardiovascular MedicineBrigham & Women's HospitalHarvard Medical SchoolBostonMAUSA
- Center for Health Decision ScienceHarvard Medical SchoolBostonMAUSA
| | - Kathleen Kahn
- Medical Research Council/Wits Rural Public Health & Health Transitions Research UnitSchool of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- INDEPTH NetworkAccraGhana
| | - Justine I Davies
- Medical Research Council/Wits Rural Public Health & Health Transitions Research UnitSchool of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- Centre for Global HealthKing's College LondonLondonUK
| | - Stephen Tollman
- Medical Research Council/Wits Rural Public Health & Health Transitions Research UnitSchool of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- INDEPTH NetworkAccraGhana
| | - Till W Bärnighausen
- Department of Global Health & PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
- Africa Health Research Institute (AHRI)MtubatubaSouth Africa
- Institute of Public HealthUniversity of HeidelbergHeidelbergGermany
| |
Collapse
|
27
|
Chang AY, Gómez-Olivé FX, Manne-Goehler J, Wade AN, Tollman S, Gaziano TA, Salomon JA. Multimorbidity and care for hypertension, diabetes and HIV among older adults in rural South Africa. Bull World Health Organ 2018; 97:10-23. [PMID: 30618461 PMCID: PMC6307505 DOI: 10.2471/blt.18.217000] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 09/29/2018] [Accepted: 10/08/2018] [Indexed: 11/27/2022] Open
Abstract
Objective To examine how multimorbidity might affect progression along the continuum of care among older adults with hypertension, diabetes and human immunodeficiency virus (HIV) infection in rural South Africa. Methods We analysed data from 4447 people aged 40 years or older who were enrolled in a longitudinal study in Agincourt sub-district. Household-based interviews were completed between November 2014 and November 2015. For hypertension and diabetes (2813 and 512 people, respectively), we defined concordant conditions as other cardiometabolic conditions, and discordant conditions as mental disorders or HIV infection. For HIV infection (1027 people) we defined any other conditions as discordant. Regression models were fitted to assess the relationship between the type of multimorbidity and progression along the care continuum and the likelihood of patients being in each stage of care for the index condition (four stages from testing to treatment). Findings People with hypertension or diabetes plus other cardiometabolic conditions were more like to progress through the care continuum for the index condition than those without cardiometabolic conditions (relative risk, RR: 1.14, 95% confidence interval, CI: 1.09-1.20, and RR: 2.18, 95% CI: 1.52-3.26, respectively). Having discordant comorbidity was associated with greater progression in care for those with hypertension but not diabetes. Those with HIV infection plus cardiometabolic conditions had less progress in the stages of care compared with those without such conditions (RR: 0.86, 95% CI: 0.80-0.92). Conclusion Patients with concordant conditions were more likely to progress further along the care continuum, while those with discordant multimorbidity tended not to progress beyond diagnosis.
Collapse
Affiliation(s)
- Angela Y Chang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, Massachusetts, United States of America (USA)
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Alisha N Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Thomas A Gaziano
- Department of Cardiovascular Medicine, Harvard Medical School, Boston, USA
| | - Joshua A Salomon
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
| |
Collapse
|
28
|
Rankin-Williams AC, Geoffroy EM, Schell ES, Mguntha AM. How can male rates of HIV testing be increased? Recommendations from a mixed methods study in southern Malawi. Int Health 2018; 9:367-373. [PMID: 29236985 DOI: 10.1093/inthealth/ihx042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 10/24/2017] [Indexed: 11/13/2022] Open
Abstract
Background In southern Malawi, 12.8% of adults are HIV positive. Men are less likely to have been tested than women. We investigated men's HIV knowledge and the attitudes, influencers, facilitators and barriers affecting HIV testing. Methods We conducted an explanatory mixed-methods study with analysis of secondary quantitative data from 425 rural men collected in January 2014 (time 1) and April 2015 (time 2) and qualitative interviews with 50 men in September 2015. All respondents lived in villages receiving HIV education and testing. Results Quantitative data revealed that comprehensive HIV knowledge increased and was associated with having been tested by time 2. Educational level was positively associated with having been tested. Men's reasons for not getting tested were fear of learning their HIV status, fear of rejection by partners and wives and fear of discrimination. Wives influenced men's opinions about healthcare. The qualitative results demonstrated that men feared being seen at test sites and feared discrimination. Wives had the greatest reported influence on male testing. Men perceived services as female-oriented and stigmatizing. They preferred door-to-door testing. Conclusions Providers can improve uptake by increasing men's HIV knowledge, leveraging the influence of spouses and offering door-to-door testing with male health workers.
Collapse
Affiliation(s)
- Amy C Rankin-Williams
- Department of Health Policy and Management, Gillings School of Global Pubic Health, University of North Carolina, Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Elizabeth M Geoffroy
- Global AIDS Interfaith Alliance, 2171 Francisco Blvd East, San Rafael, CA 94901, USA
| | - Ellen S Schell
- Global AIDS Interfaith Alliance, 2171 Francisco Blvd East, San Rafael, CA 94901, USA
| | | |
Collapse
|
29
|
Massaquoi TA, Burke RM, Yang G, Lakoh S, Sevalie S, Li B, Jia H, Huang L, Deen GF, Beynon F, Sahr F. Cross sectional study of chronic hepatitis B prevalence among healthcare workers in an urban setting, Sierra Leone. PLoS One 2018; 13:e0201820. [PMID: 30096162 PMCID: PMC6086405 DOI: 10.1371/journal.pone.0201820] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/23/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Hepatitis B is a serious public health problem across sub-Saharan Africa. Sierra Leone has no national hepatitis B strategy plan or high quality estimates of prevalence. Healthcare workers are perceived as an at-risk group for hepatitis B. We assessed the prevalence of hepatitis B among healthcare workers at two hospital sites in Freetown, Sierra Leone. METHODS In October 2017, healthcare workers were offered voluntary testing for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), hepatitis B core antibody (anti-HBc), hepatitis B e antigen (HBeAg) and hepatitis B e antibody (anti-HBe) using rapid lateral flow assay for all samples, followed by Enzyme Immunosorbent Assay to confirm positive results. Participants completed a questionnaire about knowledge, attitudes and practices concerning hepatitis B. HBsAg positive participants were invited to a clinic for further assessment. RESULTS Overall, 447 participants were tested for hepatitis B. Most (90.6%, 405/447) participants were nurses, 72.3% (323/447) were female and 71.6% (320/447) were 30 years or older. The prevalence of chronic hepatitis B (HBsAg positivity) was 8.7% (39 / 447, 95% CI 6.3-11.7%). There was no significant difference in prevalence by sex, age group, site of work or type of job. None of the 66.7% (26 / 39) of participants with chronic hepatitis B who attended the clinic met the 2015 WHO criteria to start treatment for hepatitis B on the basis of cirrhosis. Most participants (96.9% 432 / 446) stated that they were worried about their risk of hepatitis B at work. CONCLUSIONS Hepatitis B is highly prevalent among healthcare workers in Sierra Leone. It is unclear whether this reflects high community prevalence or is due to occupational risk. No participants with chronic hepatitis B needed to start treatment. In order to achieve the WHO target of elimination of viral hepatitis by 2030, introduction of birth dose vaccine for infants and catch-up vaccines for healthcare workers and healthcare students, together with a national hepatitis B screen and treat programme is advisable for Sierra Leone.
Collapse
Affiliation(s)
- Thomas A. Massaquoi
- 34 Military Hospital, Wilberforce Barracks, Freetown, Sierra Leone
- * E-mail: (TAM); (LH)
| | - Rachael M. Burke
- Centre for Global Health and Health Partnerships, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- Kings Sierra Leone Partnership, Connaught Hospital, Freetown, Sierra Leone
| | - Guang Yang
- Chinese Military Medical Expert Group in Sierra Leone, 302 Military Hospital, Beijing, China
| | - Suliaman Lakoh
- University Sierra Leone Teaching Hospital Complex, Connaught Hospital, Freetown, Sierra Leone
| | - Stephen Sevalie
- 34 Military Hospital, Wilberforce Barracks, Freetown, Sierra Leone
| | - Bo Li
- Chinese Military Medical Expert Group in Sierra Leone, 302 Military Hospital, Beijing, China
| | - Hongjun Jia
- Chinese Military Medical Expert Group in Sierra Leone, 302 Military Hospital, Beijing, China
| | - Lei Huang
- Chinese Military Medical Expert Group in Sierra Leone, 302 Military Hospital, Beijing, China
- * E-mail: (TAM); (LH)
| | - Gibrilla F. Deen
- University Sierra Leone Teaching Hospital Complex, Connaught Hospital, Freetown, Sierra Leone
| | - Fenella Beynon
- Centre for Global Health and Health Partnerships, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- Kings Sierra Leone Partnership, Connaught Hospital, Freetown, Sierra Leone
| | - Foday Sahr
- 34 Military Hospital, Wilberforce Barracks, Freetown, Sierra Leone
| |
Collapse
|
30
|
Floyd S, Ayles H, Schaap A, Shanaube K, MacLeod D, Phiri M, Griffith S, Bock P, Beyers N, Fidler S, Hayes R. Towards 90-90: Findings after two years of the HPTN 071 (PopART) cluster-randomized trial of a universal testing-and-treatment intervention in Zambia. PLoS One 2018; 13:e0197904. [PMID: 30096139 PMCID: PMC6086421 DOI: 10.1371/journal.pone.0197904] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 05/10/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND HPTN071(PopART) is a 3-arm community-randomised study in 21 peri-urban/urban communities in Zambia and the Western Cape of South Africa, with high HIV prevalence and high mobility especially among young adults. In Arm A communities, from November 2013 community HIV care providers (CHiPs) have delivered the "PopART" universal-test-and-treat (UTT) package in annual rounds, during which they visit all households and offer HIV testing. CHiPs refer HIV-positive (HIV+) individuals to routine HIV clinic services, where universal ART (irrespective of CD4 count) is offered, with re-visits to support linkage to care. The overall goal is to reduce population-level adult HIV incidence, through achieving high HIV testing and treatment coverage. METHODS AND FINDINGS The second annual round was June 2015-October 2016. Included in analysis are all individuals aged ≥15 years who consented to participate, with extrapolation to the total population. Our three main outcomes are (1) knowledge of HIV+ status (2) ART coverage, by the end of Round 2 (R2) and compared with the start of R2, and (3) retention on ART on the day of consenting to participate in R2. We used "time-to-event" methods to estimate the median time to start ART after referral to care. CHiPs visited 45,631 households during R2, ~98% of the estimated total across the four communities, and for 94% (43,022/45,631) consent was given for all household members to be listed on the CHiPs' electronic register; 120,272 individuals aged ≥15 years were listed, among whom 64% of men (37,265/57,901) and 86% (53,516/62,371) of women consented to participate in R2. We estimated there were 6,521 HIV+ men and 10,690 HIV+ women in the total population of visited households; and that ~80% and ~90% of HIV+ men and women respectively knew their HIV+ status by the end of R2, fairly similar across age groups but lower among those who did not participate in Round 1 (R1). Among those who knew their HIV+ status, ~80% of both men and women were on ART by the end of R2, close to 90% among men aged ≥45 and women aged ≥35 years, but lower among younger adults, those who were resident in R1 but did not participate in R1, and those who were newly resident in the area of the community in which they were living in R2. Overall ART coverage was ~65% among HIV+ men and ~75% among HIV+ women, compared with the cumulative 90-90 target of 81%. Among those who reported ever taking ART, 93% of men and 95% of women self-reported they were on ART and missed 0 pills in the last 3 days. The median time to start ART after referral to care was ~6 months in R2, similar across the age range 25-54 years, compared with ~9.5 months in R1. The two main limitations to our findings were that a comparison with control-arm communities cannot be made until the end of the study; and that to extrapolate to the total population, assumptions were required about individuals who were resident, but did not participate, in R2. CONCLUSIONS Overall coverage against the 90-90 targets was high after two years of intervention, but was lower among men, individuals aged 18-34 years, and those who did not participate in R1. Our findings reflect the relative difficulties for CHiPs to contact men at home, compared with women, and that it is challenging to reach high levels of testing and treatment coverage in communities with substantial mobility and in-migration. The shortened time to start ART after referral to care in R2, compared with R1, was likely attributable to multiple factors including an increased focus of the CHiPs on linkage to care; increasing community acceptance and understanding of the CHiPs, and of ART and UTT, with time; increased coordination with the clinics to facilitate linkage; and clinic improvements.
Collapse
Affiliation(s)
- Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen Ayles
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Zambart, University of Zambia School of Medicine, Lusaka, Zambia
| | - Albertus Schaap
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Zambart, University of Zambia School of Medicine, Lusaka, Zambia
| | - Kwame Shanaube
- Zambart, University of Zambia School of Medicine, Lusaka, Zambia
| | - David MacLeod
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mwelwa Phiri
- Zambart, University of Zambia School of Medicine, Lusaka, Zambia
| | - Sam Griffith
- FHI 360, HIV Prevention Trials Network, Durham, North Carolina, United States of America
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Nulda Beyers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Sarah Fidler
- HIV Clinical Trials Unit, Imperial College London, London, United Kingdom
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | |
Collapse
|
31
|
Bekker LG, Alleyne G, Baral S, Cepeda J, Daskalakis D, Dowdy D, Dybul M, Eholie S, Esom K, Garnett G, Grimsrud A, Hakim J, Havlir D, Isbell MT, Johnson L, Kamarulzaman A, Kasaie P, Kazatchkine M, Kilonzo N, Klag M, Klein M, Lewin SR, Luo C, Makofane K, Martin NK, Mayer K, Millett G, Ntusi N, Pace L, Pike C, Piot P, Pozniak A, Quinn TC, Rockstroh J, Ratevosian J, Ryan O, Sippel S, Spire B, Soucat A, Starrs A, Strathdee SA, Thomson N, Vella S, Schechter M, Vickerman P, Weir B, Beyrer C. Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society-Lancet Commission. Lancet 2018; 392:312-358. [PMID: 30032975 PMCID: PMC6323648 DOI: 10.1016/s0140-6736(18)31070-5] [Citation(s) in RCA: 212] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/25/2018] [Accepted: 05/04/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Linda-Gail Bekker
- International AIDS Society, Geneva, Switzerland; Desmond Tutu HIV Centre, University of Cape Town, South Africa.
| | - George Alleyne
- NCD Alliance, Office of the Director, Pan American Health Organization, Washington, DC, USA
| | - Stefan Baral
- Centre for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Javier Cepeda
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California-San Diego, San Diego, CA, USA
| | | | - David Dowdy
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Mark Dybul
- Centre for Global Health and Quality, Georgetown University School of Medicine, Washington, DC, USA
| | - Serge Eholie
- Department of Dermatology and Infectious Diseases, Medical School, Felix Houphouet Boigny Universty Abidjan, Cote d'Ivoire
| | - Kene Esom
- HIV, Health and Development Group, United Nations Development Programme, New York, NY, USA
| | - Geoff Garnett
- HIV Delivery, Bill & Melinda Gates Foundation, Washington, DC, USA
| | | | - James Hakim
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Diane Havlir
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California-San Francisco, San Fransisco, CA, USA
| | | | - Leigh Johnson
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Parastu Kasaie
- Department of Health, Behaviour and Society, Johns Hopkins University, Baltimore, MD, USA
| | - Michel Kazatchkine
- UNAIDS and Global Health Center, Graduate Institute, Geneva, Switzerland
| | - Nduku Kilonzo
- National AIDS Control Council for Kenya, Nairobi, Kenya
| | - Michael Klag
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA
| | - Marina Klein
- Division of Infectious Diseases, Faculty of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Sharon R Lewin
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Chewe Luo
- HIV/AIDS Section, United Nations Children's Fund, New York City, NY, USA
| | - Keletso Makofane
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California-San Diego, San Diego, CA, USA
| | - Kenneth Mayer
- The Fenway Institute, Harvard Medical School, Boston, MA, USA
| | | | - Ntobeko Ntusi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Loyce Pace
- Global Health Council, Washington, DC, USA
| | - Carey Pike
- Desmond Tutu HIV Centre, University of Cape Town, South Africa
| | - Peter Piot
- London School of Hygiene and Tropical Medicine, London, UK
| | - Anton Pozniak
- HIV Services, Chelsea and Westminster NHS Foundation Trust Hospital, London, UK
| | - Thomas C Quinn
- Centre for Global Health, Johns Hopkins University, Baltimore, MD, USA; International AIDS Society-National Institute for Drug Abuse, Johns Hopkins University, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institute of Health, MD, USA
| | - Jurgen Rockstroh
- HIV Clinic, Department of Medicine, University Hospital Bonn, Bonn, Germany
| | - Jirair Ratevosian
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Owen Ryan
- International AIDS Society, Geneva, Switzerland
| | - Serra Sippel
- Center for Health and Gender Equity, Washington DC, USA
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Agnes Soucat
- Health Systems, Governance and Financing, World Health Organisation, Geneva, Switzerland
| | | | - Steffanie A Strathdee
- Global Health Sciences, Department of Medicine, University of California-San Diego, San Diego, CA, USA
| | - Nicholas Thomson
- Centre for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Nossal Institute for Global Health, University of Melbourne, VIC, Australia
| | - Stefano Vella
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Mauro Schechter
- Department of Preventative Medicine, Universidade Federal do Rio de Janeiro, Rio de Janerio, Brazil
| | - Peter Vickerman
- School of Social and Community Medicine, Bristol Medical School, University of Bristol, Bristol, UK
| | - Brian Weir
- Department of Health, Behaviour and Society, Johns Hopkins University, Baltimore, MD, USA
| | - Chris Beyrer
- International AIDS Society, Geneva, Switzerland; Centre for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
32
|
Sabapathy K, Hensen B, Varsaneux O, Floyd S, Fidler S, Hayes R. The cascade of care following community-based detection of HIV in sub-Saharan Africa - A systematic review with 90-90-90 targets in sight. PLoS One 2018; 13:e0200737. [PMID: 30052637 PMCID: PMC6063407 DOI: 10.1371/journal.pone.0200737] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 05/25/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction We aimed to establish how effective community-based HIV testing services (HTS), including home and community location based (non-health facility) HIV testing services (HB-/CLB-HTS), are in improving care in sub-Saharan Africa (SSA), with a view to achieving the 90-90-90 targets. Methods We conducted a systematic review of published literature from 2007–17 which reported on the proportion of individuals who link-to-care and/or initiate ART after detection with HIV through community-based testing. A meta-analysis was deemed inappropriate due to heterogeneity in reporting. Results and discussion Twenty-five care cascades from 6 SSA countries were examined in the final review– 15 HB-HTS, 8 CLB-HTS, 2 combined HB-/CLB-HTS. Proportions linked-to-care over 1–12 months ranged from 14–96% for HB-HTS and 10–79% for CLB-HTS, with most studies reporting outcomes over short periods (3 months). Fewer studies reported ART-related outcomes following community-based testing and most of these studies included <50 HIV-positive individuals. Proportions initiating ART ranged from 23–93%. One study reported retention on ART (76% 6 months after initiation). Viral suppression 3–12 months following ART initiation was 77–85% in three studies which reported this. There was variability in definitions of outcomes, numerators/denominators and observation periods. Outcomes varied between studies even for similar time-points since HTS. The methodological inconsistencies hamper comparisons. Previously diagnosed individuals appear more likely to link-to-care than those who reported being newly-diagnosed. It appears that individuals diagnosed in the community need time before they are ready to link-to-care/initiate ART. Point-of-care (POC) CD4-counts at the time of HTS did not achieve higher proportions linking-to-care or initiating ART. Similarly, follow-up visits to HIV-positive individuals did not appear to enhance linkage to care overall. Conclusion This systematic review summarises the available data on linkage to care/ART initiation following community-based detection of HIV, to help researchers and policy makers evaluate findings. The available evidence suggests that different approaches to community-based HTS including HB-HTS and CLB-HTS, are equally effective in achieving linkage to care and ART initiation among those detected. Engagement and support for newly diagnosed individuals may be key to achieving all three UNAIDS 90-90-90 targets. We also recommend that standardised measures of reporting of steps on the cascade of care are needed, to measure progress against targets and compare across settings.
Collapse
Affiliation(s)
- Kalpana Sabapathy
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Bernadette Hensen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Olivia Varsaneux
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sian Floyd
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Richard Hayes
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
33
|
Njuguna B, Vorkoper S, Patel P, Reid MJ, Vedanthan R, Pfaff C, Park PH, Fischer L, Laktabai J, Pastakia SD. Models of integration of HIV and noncommunicable disease care in sub-Saharan Africa: lessons learned and evidence gaps. AIDS 2018; 32 Suppl 1:S33-S42. [PMID: 29952788 PMCID: PMC6779053 DOI: 10.1097/qad.0000000000001887] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe available models of HIV and noncommunicable disease (NCD) care integration in sub-Saharan Africa (SSA). DESIGN Narrative review of published articles describing various models of HIV and NCD care integration in SSA. RESULTS We identified five models of care integration across various SSA countries. These were integrated community-based screening for HIV and NCDs in the general population; screening for NCDs and NCD risk factors among HIV patients enrolled in care; integration of HIV and NCD care within clinics; differentiated care for patients with HIV and/or NCDs; and population healthcare for all. We illustrated these models with descriptive case studies highlighting the lessons learned and evidence gaps from the various models. CONCLUSION Leveraging existing HIV infrastructure for NCD care is feasible with various approaches possible depending on available program capacity. Process and clinical outcomes for existing models of care integration are not yet described but are urgently required to further advise policy decisions on HIV/NCD care integration.
Collapse
Affiliation(s)
- Benson Njuguna
- Department of Pharmacy, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Susan Vorkoper
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Pragna Patel
- Centers for Disease Control and Prevention, Center of Global Health, Division of Global HIV and TB, Atlanta, Georgia
| | - Mike J.A. Reid
- Institute for Global Health Delivery & Diplomacy, Global Health Sciences, UCSF & Divisions of HIV, Infectious Diseases and Global Health, UCSF, San Francisco, California
| | - Rajesh Vedanthan
- Department of Medicine, Department of Population Health Science and Policy, and Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Colin Pfaff
- Department of Family Medicine, College of Medicine, Dignitas International, Zomba, Malawi
| | - Paul H. Park
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lydia Fischer
- Department of Pediatrics and Psychiatry, Indiana University, Bloomington, Indiana, USA
| | - Jeremiah Laktabai
- Department of Family Medicine, College of Health Sciences, Moi University School of Medicine, Eldoret, Kenya
| | - Sonak D. Pastakia
- Department of Family Medicine, Purdue University College of Pharmacy, West Lafayette, Indiana, USA
| |
Collapse
|
34
|
Ochom E, Meyer AJ, Armstrong-Hough M, Kizito S, Ayakaka I, Turimumahoro P, Ggita JM, Katamba A, Davis JL. Integrating home HIV counselling and testing into household TB contact investigation: a mixed-methods study. Public Health Action 2018; 8:72-78. [PMID: 29946523 PMCID: PMC6012957 DOI: 10.5588/pha.18.0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/07/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: Community health workers (CHWs) increasingly deliver community-based human immunodeficiency virus (HIV) counselling and testing (HCT) services. Less is known about how this strategy performs when integrated with household tuberculosis (TB) contact investigations. Objective: We conducted a prospective mixed-methods study to evaluate the feasibility and quality of CHW-facilitated, home-based HCT among household TB contacts. Design: CHWs visited households of consenting TB patients to screen household contacts for TB and HIV. They performed HIV testing using a serial enzyme-linked immunosorbent assay rapid-antibody testing algorithm. Laboratory technicians at health facilities re-tested the samples and coordinated quarterly HIV panel testing for CHWs. We conducted focus group discussions (FGDs) with CHWs on their experiences in carrying out home-based HCT. Results: Of 114 household contacts who consented to and underwent HIV testing by CHWs, 5 (4%) tested positive, 108 (95%) tested negative, and 1 (1%) had indeterminate results; 110 (96%) samples had adequate volume for re-testing. Overall agreement between CHWs and laboratory technicians was 99.1% (κ = 0.90, 95%CI 0.71-1.00, P < 0.0001). In FGDs, CHWs described context-specific social challenges to performing HCT in a household setting, but said that their confidence grew with experience. Conclusion: Home-based HCT by CHWs was feasible among household TB contacts and produced high-quality results. Strategies to address social challenges are required to optimize yield.
Collapse
Affiliation(s)
- E Ochom
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - A J Meyer
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - M Armstrong-Hough
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - S Kizito
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - I Ayakaka
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - P Turimumahoro
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - J M Ggita
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - A Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - J L Davis
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
35
|
Olwanda E, Shen J, Kahn JG, Bryant-Comstock K, Huchko MJ. Comparison of patient flow and provider efficiency of two delivery strategies for HPV-based cervical cancer screening in Western Kenya: a time and motion study. Glob Health Action 2018; 11:1451455. [PMID: 29589991 PMCID: PMC5912439 DOI: 10.1080/16549716.2018.1451455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Improving patient flow and reducing over-crowding can improve quality, promptness of care, and patient satisfaction. Given low utilization of preventive care in low-resource countries, improved patient flows are especially important in these settings. Objective: Compare patient flow and provider efficiency between two cervical cancer screening strategies via self-collected human papillomavirus (HPV). Methods: We collected time and motion data for patients screened for cervical cancer in 12 communities in rural Migori County, Kenya as part of a larger cluster randomized trial. Six communities were randomized to screening in community health campaigns (CHCs) and six to screening at government clinics. We quantified patient flow: duration spent on each active stage of screening and wait times, and the number of patients arriving at CHCs and clinics each hour of the day. In addition, for four CHCs, we collected time and motion data for providers, and measured provider efficiency as a ratio of active (service delivery) time to total time spent at the clinic. Results: Total duration of screening visits, at CHCs and clinics was 42 and 87 minutes, respectively (p < 0.001 for difference). Total active time lasted longer at CHCs, with a mean of 28 minutes per patient versus 15 minutes at clinics, largely due to differences in duration for group education (p < 0.001). Wait time for registration at clinics was 36 minutes, explaining most of the difference between settings, but sometimes incorporated other health services. Conclusions: There is a substantial difference in patient flow at clinics compared to CHCs. Shorter duration at CHCs suggests that the model is favorable for patients in limiting time spent on screening. Future cervical cancer screening programs designed for scale-up should consider how this advantage may enhance satisfaction and uptake. For clinic-based screening programs, efforts could be made towards reducing registration wait times.
Collapse
Affiliation(s)
- Easter Olwanda
- a Center for Microbiology Research , Kenya Medical Research Institute , Nairobi , Kenya
| | - Jennifer Shen
- b Institute for Health Policy Studies , University of California , San Francisco , CA , USA
| | - James G Kahn
- b Institute for Health Policy Studies , University of California , San Francisco , CA , USA
| | | | - Megan J Huchko
- c Duke Global Health Institute , Duke University , Durham , NC , USA.,d Department of Obstetrics and Gynecology , Duke University , Durham , NC , USA
| |
Collapse
|
36
|
Perkins JM, Nyakato VN, Kakuhikire B, Mbabazi PK, Perkins HW, Tsai AC, Subramanian SV, Christakis NA, Bangsberg DR. Actual Versus Perceived HIV Testing Norms, and Personal HIV Testing Uptake: A Cross-Sectional, Population-Based Study in Rural Uganda. AIDS Behav 2018; 22:616-628. [PMID: 28233075 PMCID: PMC5568980 DOI: 10.1007/s10461-017-1691-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
HIV testing is an essential part of treatment and prevention. Using population-based data from 1664 adults across eight villages in rural Uganda, we assessed individuals' perception of the norm for HIV testing uptake in their village and compared it to the actual uptake norm. In addition, we examined how perception of the norm was associated with personal testing while adjusting for other factors. Although the majority of people had been tested for HIV across all villages, slightly more than half of men and women erroneously thought that the majority in their village had never been tested. They underestimated the prevalence of HIV testing uptake by 42 percentage points (s.d. = 17 percentage points), on average. Among men, perceiving that HIV testing was not normative was associated with never testing for HIV (AOR = 2.6; 95% CI 1.7-4.0, p < 0.001). Results suggest an opportunity for interventions to emphasize the commonness of HIV testing uptake.
Collapse
Affiliation(s)
- Jessica M Perkins
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Center for Population and Development Studies, Cambridge, MA, USA.
| | - Viola N Nyakato
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Pamela K Mbabazi
- Uganda National Council for Science & Technology, Kampala, Uganda
| | | | - Alexander C Tsai
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| |
Collapse
|
37
|
Zheng W, Balzer L, van der Laan M, Petersen M. Constrained binary classification using ensemble learning: an application to cost-efficient targeted PrEP strategies. Stat Med 2018; 37:261-279. [PMID: 28384841 PMCID: PMC5701877 DOI: 10.1002/sim.7296] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 02/27/2017] [Accepted: 03/09/2017] [Indexed: 11/10/2022]
Abstract
Binary classification problems are ubiquitous in health and social sciences. In many cases, one wishes to balance two competing optimality considerations for a binary classifier. For instance, in resource-limited settings, an human immunodeficiency virus prevention program based on offering pre-exposure prophylaxis (PrEP) to select high-risk individuals must balance the sensitivity of the binary classifier in detecting future seroconverters (and hence offering them PrEP regimens) with the total number of PrEP regimens that is financially and logistically feasible for the program. In this article, we consider a general class of constrained binary classification problems wherein the objective function and the constraint are both monotonic with respect to a threshold. These include the minimization of the rate of positive predictions subject to a minimum sensitivity, the maximization of sensitivity subject to a maximum rate of positive predictions, and the Neyman-Pearson paradigm, which minimizes the type II error subject to an upper bound on the type I error. We propose an ensemble approach to these binary classification problems based on the Super Learner methodology. This approach linearly combines a user-supplied library of scoring algorithms, with combination weights and a discriminating threshold chosen to minimize the constrained optimality criterion. We then illustrate the application of the proposed classifier to develop an individualized PrEP targeting strategy in a resource-limited setting, with the goal of minimizing the number of PrEP offerings while achieving a minimum required sensitivity. This proof of concept data analysis uses baseline data from the ongoing Sustainable East Africa Research in Community Health study. Copyright © 2017 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Wenjing Zheng
- Division of Biostatistics, School of Public Health, University of Calfornia, Berkeley
| | - Laura Balzer
- Dept of Biostatistics, Havard T.H. Chan School of Public Health
| | - Mark van der Laan
- Division of Biostatistics, School of Public Health, University of Calfornia, Berkeley
| | - Maya Petersen
- Division of Biostatistics, School of Public Health, University of Calfornia, Berkeley
| | | |
Collapse
|
38
|
Staveteig S, Croft TN, Kampa KT, Head SK. Reaching the 'first 90': Gaps in coverage of HIV testing among people living with HIV in 16 African countries. PLoS One 2017; 12:e0186316. [PMID: 29023510 PMCID: PMC5638499 DOI: 10.1371/journal.pone.0186316] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 09/28/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND UNAIDS has recently proposed a set of three ambitious targets that, if achieved, are predicted to end the AIDS epidemic by 2030. The targets, known as 90-90-90, call for 90% of people living with HIV (PLHIV) to know their status, 90% of PLHIV to receive antiretroviral therapy, and 90% of those on antiretroviral therapy to achieve viral suppression by the year 2020. We examine the first of these targets, focusing on sub-Saharan Africa, the region of the world most affected by HIV, to measure the proportion of PLHIV estimated to know their HIV status, and to identify background and behavioral characteristics significantly associated with gaps in ever testing among PLHIV. METHODS AND FINDINGS We analyze cross-sectional population-based data from the Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS) fielded since 2010 in 16 sub-Saharan African countries where voluntary serological testing was recently conducted: Burkina Faso, Cameroon, Chad, Cote d'Ivoire, Ethiopia, Gabon, Lesotho, Malawi, Namibia, Rwanda, Sierra Leone, Tanzania, Togo, Uganda, Zambia, and Zimbabwe. Survey response rates averaged 95.0% (range 89.3-99.5%), while consent to serotesting averaged 94.9% (range 88.7-99.6%). This study, which includes more than 14,000 respondents living with HIV, finds that 69% of PLHIV in the average study country have ever been tested for HIV (range 34-95%). Based on timing of the last test and on ART coverage, we estimate that 54% of PLHIV in the average country are aware of their status (range 26-84%). Adjusted logistic regression finds that men (median adjusted odds ratio [AOR] = 0.38), adults with less than primary education (median AOR = 0.31), and adolescents (median AOR = 0.32) are consistently less likely to have ever been tested for HIV than women, adults with secondary and above education, and adults age 30-39, respectively. In most countries unadjusted logistic regression also finds significant gaps in testing among the poorest groups and those reporting never having had sex. CONCLUSION The fact that an average of 54% of PLHIV in these 16 countries are estimated to know their status reflects encouraging progress. However, not only is this average far short of the 90% target set by UNAIDS for 2020, but it also implies that in the average study country nearly one-half of PLHIV are unable to access lifesaving care and treatment because they are unaware that they are HIV-positive. Several gaps in HIV testing coverage exist, particularly among adolescents, the least educated, and men. While the need to target demographic groups at greatest risk of HIV continues, additional interventions focused on reaching men and on reaching socially vulnerable populations such as adolescents, the poorest, and the least educated are essential.
Collapse
Affiliation(s)
- Sarah Staveteig
- Avenir Health, Glastonbury, Connecticut, United States of America
- The Demographic and Health Surveys (DHS) Program, Rockville, Maryland, United States of America
- * E-mail:
| | - Trevor N. Croft
- The Demographic and Health Surveys (DHS) Program, Rockville, Maryland, United States of America
- International Health and Development Division, ICF, Rockville, Maryland, United States of America
| | - Kathryn T. Kampa
- Health, Research, Informatics & Technology Division, ICF, Atlanta, Georgia, United States of America
| | - Sara K. Head
- Independent Researcher, Washington, DC, United States of America
| |
Collapse
|
39
|
Asiimwe S, Ross JM, Arinaitwe A, Tumusiime O, Turyamureeba B, Roberts DA, O’Malley G, Barnabas RV. Expanding HIV testing and linkage to care in southwestern Uganda with community health extension workers. J Int AIDS Soc 2017; 20:21633. [PMID: 28770598 PMCID: PMC5577731 DOI: 10.7448/ias.20.5.21633] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 04/25/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Achieving the UNAIDS goals of 90-90-90 will require more than doubling the number of people accessing HIV care in Uganda. Community-based programmes for entry into HIV care are effective strategies to expand access to HIV care, but few programmes have been evaluated with a particular focus on scale-up. METHODS Integrated Community Based Initiatives, a Uganda-based non-governmental organization, designed and implemented a programme of community-based HIV counselling and testing and facilitated linkage to care utilizing community health extension workers (CHEWs) in rural Sheema District, Uganda. CHEWs performed programme activities during 1 October 2015 through 31 March 2016. Outcomes for this evaluation were (1) the number of people tested for HIV, and (2) the proportion of those testing positive who were seen at an ART clinic within three months of their positive test, and (3) the cost of the programme per person newly diagnosed with HIV. Microcosting methods were used to calculate the programme costs. Program scalability factors were evaluated using a published framework. RESULTS Sixty-two CHEWs attended a five-day training that introduced the biology of HIV, the conduct of confidential HIV testing, HIV prevention messages, and linkage, referral, and reporting requirements. CHEWs received a $30 monthly stipend and a field testing kit that included a bicycle, field bag, umbrella, gumboots, reporting booklet, pens, and HIV testing materials. Trained CHEWs tested 43,696 persons for HIV infection during the six-month programme period. Nine-hundred seventy-four participants (2.2%) were identified as HIV positive, and 623 participants (64%) were linked to HIV care. An estimated 69% of adult residents received testing as part of this campaign. The programme cost $3.02 per person test, $135.70 per positive person identified, and $212.15 per HIV-positive person linked to care. CONCLUSIONS Lay community health extension workers (CHEWs) can be rapidly trained to scale-up home-based HIV testing and counselling (HTC) and linkage to care in a high-quality and low-cost manner to large numbers of people in a rural, high burden setting. A combination HIV testing approach, such as adding partner testing to community-based testing, could increase the proportion of HIV-positive persons identified.
Collapse
Affiliation(s)
| | - Jennifer M. Ross
- Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Ruanne V. Barnabas
- Departments of Global Health, Medicine (Allergy and Infectious Disease), and Epidemiology, University of Washington, Seattle, WA, USA
| |
Collapse
|
40
|
Abstract
Objective: To determine the uptake of home-based HIV counselling and testing (HCT) in four HPTN 071 (PopART) trial communities (implementing a ‘full’ combination HIV prevention package that includes universal HIV testing and treatment) in Zambia. We also explore factors associated with uptake of HCT in these communities. Design: HPTN 071 (PopART) is a three-arm community-randomized trial in 12 communities in Zambia and nine communities in South Africa evaluating the impact of a combination HIV prevention package, including universal HIV testing and treatment, on HIV incidence. Methods: Using a door-to-door approach that includes systematically revisiting households, individuals were offered participation in the intervention, and verbal consent was obtained. Data were analysed for the first 18 months of the intervention, December 2013 to June 2015 for individuals 18 years and older. Results: Among 121 130 enumerated household members, 101 102 (83.5%) accepted the intervention. HCT uptake was 72.2% (66 894/92 612), similar by sex but varied across communities. HCT uptake was associated with younger age, sex, community, being symptomatic for TB and sexually transmitted infections and longer time since previous HIV test. Knowledge of HIV status due to the intervention increased by 36% overall and by 66% among HIV positive participants; the highest impact was among 18–24 years old. Conclusion: Overall acceptance of HIV-testing through offering a door-to-door-based combination HIV prevention package was 72.2%. The intervention increased knowledge of HIV status from ∼50 to ∼90%. However, challenges still remain and a one-off intervention is unlikely to be successful but will require repeated visits and multiple strategies.
Collapse
|
41
|
Evaluating the feasibility and uptake of a community-led HIV testing and multi-disease health campaign in rural Uganda. J Int AIDS Soc 2017; 20:21514. [PMID: 28406269 PMCID: PMC5515014 DOI: 10.7448/ias.20.1.21514] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Multi-disease community health campaigns can be effective for population-wide HIV testing in a research setting (SEARCH: NCT01864603). We sought to evaluate feasibility and uptake of a community-led health campaign (CLHC) planned and implemented by village leaders and local clinic workers in Uganda. Methods: Over five months in 2014, locally elected village leaders and Ministry of Health (MoH) clinic staff in a rural parish in Uganda planned a census followed by a CLHC, after training by two SEARCH trial consultants and by leaders from a neighbouring parish that had previously participated in a SEARCH health campaign. We defined feasibility as: (1) elected leaders’ participation in training and implementation of pre-campaign census and mobilization activities; (2) implementation of all campaign activities by MoH-funded, local clinic staff; and (3) community participation in the campaign, including point-of-care screening for HIV, malaria, hypertension and diabetes, and same-day referral for male circumcision and family planning (FP). Costing of all salaries and supplies was conducted. Results: Elected leaders from all eight villages in the parish participated in CLHC training. They and local clinic staff met monthly to select and plan CLHC services. Village leaders then leveraged existing volunteer health teams to perform a door-to-door census, enumerating 5,202 parish residents over 2 weeks. 2,753 (53%) residents participated in the 6-day CLHC. Of 1,584 adult participants, 1,474 (93%) tested for HIV: 105/1,474 (7.1%) tested HIV positive. 27% (751/2,753) of participants reported fever and underwent malaria rapid diagnostic testing: 5.3% (40/751) tested positive. Among adults screened, 19% (271/1,452) were hypertensive, and 3% (18/637) had a random blood sugar >11.1 mmol/L. Of 805 men and boys (>10 years), 91 (11%) accepted same-day clinic referral and underwent medical circumcision. Of 900 women offered same-day long-term FP referrals, 25 accepted. The CLHC cost, including census, mobilization and testing services, was $23,597 ($8.57/participant). Conclusions: Elected village leaders successfully planned and conducted a 6-day multi-disease health campaign with service provision by local clinic staff that reached over half of a rural Ugandan community. These data suggest it is feasible for local leaders and clinics to adopt a multi-disease health campaign approach to scale-up HIV testing in rural Africa.
Collapse
|
42
|
Sharma M, Barnabas RV, Celum C. Community-based strategies to strengthen men's engagement in the HIV care cascade in sub-Saharan Africa. PLoS Med 2017; 14:e1002262. [PMID: 28399122 PMCID: PMC5388461 DOI: 10.1371/journal.pmed.1002262] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Monica Sharma and colleagues discuss evidence-based approaches to improving HIV services for men in sub-Saharan Africa.
Collapse
Affiliation(s)
- Monisha Sharma
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Ruanne V. Barnabas
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- School of Medicine, University of Washington, Seattle, Washington, United States of America
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Connie Celum
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- School of Medicine, University of Washington, Seattle, Washington, United States of America
| |
Collapse
|
43
|
Lubogo M, Anguzu R, Wanzira H, Namugwanya I, Namuddu O, Ssali D, Nanyonga S, Ssentongo J, Seeley J. Willingness by people living with HIV/AIDS to utilize HIV services provided by Village Health team workers in Kalungu district, central Uganda. Afr Health Sci 2017; 17:216-224. [PMID: 29026396 DOI: 10.4314/ahs.v17i1.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Less than one quarter of people in need have access to HIV services in Uganda. This study assessed willingness of people living with HIV/AIDS (PLWHAs) to utilize HIV services provided by Village Health Teams (VHTs) in Kalungu district, central Uganda. METHODS A cross-sectional study conducted in two health facilities providing anti-retroviral therapy enrolled 312 PLWHAs. Pre-tested semi-structured questionnaires were administered to participants at household level. A forward fitting logistic regression model computed the predictors of willingness of PLWHAs to utilize services provided by VHTs. RESULTS Overall, 49% were willing to utilize HIV services provided by VHTs increasing to 75.6% if the VHT member was HIV positive. PLWHAs who resided in urban areas were more likely to utilize HIV services provided by VHTs (AOR 0.24, 95%CI 0.06-0.87). Barriers to utilizing HIV services provided by VHTs were: income level > 40 USD (AOR 6.43 95%CI 1.19-34.68), being a business person (AOR 8.71 95%CI 1.23-61.72), peasant (AOR 7.95 95%CI 1.37-46.19), lack of encouragement from: peers (AOR 6.33 95%CI 1.43-28.09), spouses (AOR 4.93 95%CI 1.23-19.82) and community leader (AOR 9.67 95%CI 3.35-27.92). CONCLUSION Social support could improve willingness by PLWHAs to utilize HIV services provided by VHTs for increased access to HIV services by PLWHA.
Collapse
Affiliation(s)
| | - Ronald Anguzu
- Makerere University School of Public Health (MakSPH)
- El-Channun Community Health Initiatives, Uganda (ELCOHIN)
| | | | | | | | - Denis Ssali
- District Health Team, Kalungu District Local Government
| | | | - Josephine Ssentongo
- Medical Research Council / Uganda Virus Research Institute (MRC/UVRI), Uganda
| | - Janet Seeley
- Medical Research Council / Uganda Virus Research Institute (MRC/UVRI), Uganda
| |
Collapse
|
44
|
Nannozi V, Wobudeya E, Matsiko N, Gahagan J. Motivators of couple HIV counseling and testing (CHCT) uptake in a rural setting in Uganda. BMC Public Health 2017; 17:104. [PMID: 28114968 PMCID: PMC5259987 DOI: 10.1186/s12889-017-4043-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Couple HIV Counseling and Testing (CHCT) is one of the key preventive strategies used to reduce the spread of HIV. In Uganda, HIV prevalence among married/living together is 7.2% among women and 7.6% among men. CHCT can help ease disclosure of HIV-positive status, which in turn may help increase opportunities to get social support and reduce new infections. The uptake of CHCT among attendees of health facilities in rural Uganda is as high as 34%. The purpose of this study was to explore the motivators of CHCT uptake in Mukono district, a rural setting in Uganda. METHODS The study was conducted in two sub-counties in a rural district (Mukono district) about 28 km east of the capital Kampala, using a descriptive and explorative qualitative research design. Specifically, we conducted focus group discussions and key informant interviews with HIV focal persons, village health team (VHT) members, religious leaders and political leaders. We also interviewed persons in couple relationships. Data was analysed using NVivo 8 software. Ethical clearance was received from the Mengo Hospital Research Review Board and from the Uganda National Council of Science and Technology. RESULTS The study was conducted from June 2013 to July 2013 We conducted 4 focus group discussions, 10 key informant interviews and interviewed 53 persons in couple relationships. None of the participants were a couple. The women were 68% (36/53) and 49% (26/53) of them were above 29 years old. The motivators of CHCT uptake were; perceived benefit of HIV testing, sickness of a partner or child in the family and suspicion of infidelity. Other important motivators were men involvement in antenatal care (ANC) attendance and preparation for marriage. CONCLUSION The motivators for CHCT uptake included the perceived benefit of HIV testing, sickness of a partner or child, preparation for marriage, lack of trust among couples and men involvement in antenatal care. Greater attention to enhancers of CHCT programming is needed in trying to strengthen its uptake.
Collapse
Affiliation(s)
- Victoria Nannozi
- Makerere University Joint AIDS program, P. O. Box 7071, Kampala, Uganda
| | - Eric Wobudeya
- Mulago National Referral Hospital, P. O. Box 7051, Kampala, Uganda.
| | - Nicholas Matsiko
- Joint Clinical Research Center, P. O. Box 10005, Kampala, Uganda
| | - Jacqueline Gahagan
- Gender & Health Promotion studies unit (GAHPS unit), Dalhousie University School of Health & Human Performance, 6230 South Street, Halifax, NS, B3H 3J5, Canada
| |
Collapse
|
45
|
From policy to action: how to operationalize the treatment for all agenda. J Int AIDS Soc 2016; 19:21185. [PMID: 27989270 PMCID: PMC5165084 DOI: 10.7448/ias.19.1.21185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/09/2016] [Accepted: 11/14/2016] [Indexed: 12/30/2022] Open
|
46
|
Chamla D, Luo C, Adjorlolo-Johnson G, Vandelaer J, Young M, Costales MO, McClure C. Integration of HIV infant testing into immunization programmes: a systematic review. Paediatr Int Child Health 2016; 35:298-304. [PMID: 26744153 DOI: 10.1080/20469047.2015.1109233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Integration of HIV infant testing into immunization sessions is one of the strategies designed to increase coverage of early infant diagnosis. OBJECTIVE To determine the evidence on the outcomes of such integration. METHODS A systematic review of peer-reviewed and grey literature was undertaken from electronic sources such as MEDLINE, Google Scholar, websites of international agencies, past conferences and ministries of health reports published between year 2002 and 2013. Randomized controlled trials, observational and qualitative studies were searched and those meeting selection criteria were selected and relevant information extracted using structured tool. Statistical pooling was not possible owing to the heterogeneity of the study designs and outcome measures. RESULTS Of the nine articles which met the selection criteria, none used a randomized controlled design. Of these, five articles measured mother's acceptability of their infants being tested for HIV during its first pentavalent or DPT vaccination visit, and 89·5-100% accepted. Four articles reported the proportion of mothers who returned for HIV test results, ranging from 56·8% to 86·0%. Increased uptake of HIV testing following integration was confirmed by two articles. Only one study in Tanzania determined the uptake of vaccinations following integration, with urban facilities showing stable or slight increase of monthly vaccine uptake while decreases were observed across the rural sites. In two articles, stigma was perceived by service-providers and mothers as the potential risk following integration, particularly in rural settings. DISCUSSION Despite the limited number of articles, the findings in this systematic review suggest that HIV testing during immunization clinic visits is acceptable and feasible as a possible model for service delivery. However, the impact on vaccination uptake needs further study.
Collapse
|
47
|
Lemoine M, Shimakawa Y, Njie R, Taal M, Ndow G, Chemin I, Ghosh S, Njai HF, Jeng A, Sow A, Toure-Kane C, Mboup S, Suso P, Tamba S, Jatta A, Sarr L, Kambi A, Stanger W, Nayagam S, Howell J, Mpabanzi L, Nyan O, Corrah T, Whittle H, Taylor-Robinson SD, D'Alessandro U, Mendy M, Thursz MR. Acceptability and feasibility of a screen-and-treat programme for hepatitis B virus infection in The Gambia: the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) study. Lancet Glob Health 2016; 4:e559-67. [PMID: 27443781 DOI: 10.1016/s2214-109x(16)30130-9] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 05/05/2016] [Accepted: 06/07/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite the introduction of immunisation for hepatitis B virus (HBV) in the 1990s, HBV-related morbidity and mortality remain high in sub-Saharan Africa. Identification and treatment of asymptomatic people with chronic HBV infection should reduce the disease burden. We therefore assessed the feasibility of a screen-and-treat programme for HBV infection in The Gambia, west Africa, and estimated the proportion of HBV-infected people who had significant liver disease in need of treatment. METHODS Between Dec 7, 2011, and Jan 24, 2014, individuals living in randomly selected communities in western Gambia were offered hepatitis B surface antigen (HBsAg) screening via a point-of-care test. The test was also offered to potential blood donors attending the central hospital in the capital, Banjul. HBsAg-positive individuals were invited for a comprehensive liver assessment and were offered treatment according to international guidelines. We defined linkage to care as visiting the liver clinic at least once. Eligibility for treatment was judged in accordance with the 2012 European Association for the Study of the Liver guidelines. FINDINGS HBsAg screening was accepted by 5980 (weighted estimate 68·9%, 95% CI 65·0-72·4) of 8170 adults from 27 rural and 27 urban communities and 5559 (81·4%, 80·4-82·3) of 6832 blood donors. HBsAg was detected in 495 (8·8%, 7·9-9·7) individuals in communities and 721 (13·0%, 12·1-13·9) blood donors. Prevalence was higher in men (239 [10·5%, 8·9-12·1] of 2328 men vs 256 [7·6%, 6·5-8·7] of 3652 women; p=0·004) and middle-aged participants. Linkage to care was high in the communities, with 402 (81·3%) of 495 HBsAg-positive individuals attending the clinic. However, only 300 (41·6%) of 721 HBsAg-positive people screened at the blood bank linked into care. Of those who attended the clinic, 18 (4·4%, 2·5-7·7) patients from the communities and 29 (9·7%, 6·8-13·6) from the blood bank were eligible for treatment. Male sex was strongly associated with treatment eligibility (odds ratio 4·35, 1·50-12·58; p=0·007). INTERPRETATION HBV infection remains highly prevalent in The Gambia. The high coverage of community-based screening, good linkage into care, and the small proportion of HBsAg carriers who need treatment suggest that large-scale screening and treatment programmes are feasible in sub-Saharan Africa. FUNDING European Commission (FP7).
Collapse
Affiliation(s)
- Maud Lemoine
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia; Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK
| | - Yusuke Shimakawa
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia; Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Ramou Njie
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Makie Taal
- Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Gibril Ndow
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia; Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK
| | - Isabelle Chemin
- INSERM U1052, CNRS UMR5286, Centre de Recherche en Cancérologie, Université Claude Bernard, Lyon, France
| | - Sumantra Ghosh
- INSERM U1052, CNRS UMR5286, Centre de Recherche en Cancérologie, Université Claude Bernard, Lyon, France
| | - Harr F Njai
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Adam Jeng
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Amina Sow
- Department of bacteriology and Virology, CHU Le Dantec, Dakar, Senegal
| | - Coumba Toure-Kane
- Department of bacteriology and Virology, CHU Le Dantec, Dakar, Senegal
| | - Souleymane Mboup
- Department of bacteriology and Virology, CHU Le Dantec, Dakar, Senegal
| | - Penda Suso
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Saydiba Tamba
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Abdullah Jatta
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Louise Sarr
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Aboubacar Kambi
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - William Stanger
- Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK
| | - Shevanthi Nayagam
- Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK
| | - Jessica Howell
- Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK
| | - Liliane Mpabanzi
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Netherlands; NUTRIM School of Nutrition, Toxicology and Metabolism, Maastricht University, Netherlands; Hepato-Pancreato-Biliary and Liver Transplant Surgery, Royal Free Hospital, University College London, London, UK
| | - Ousman Nyan
- Edward Francis Small Teaching Hospital (EFSTH), Banjul, The Gambia
| | - Tumani Corrah
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Hilton Whittle
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Maimuna Mendy
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Mark R Thursz
- Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK.
| |
Collapse
|
48
|
Kwarisiima D, Balzer L, Heller D, Kotwani P, Chamie G, Clark T, Ayieko J, Mwangwa F, Jain V, Byonanebye D, Petersen M, Havlir D, Kamya MR. Population-Based Assessment of Hypertension Epidemiology and Risk Factors among HIV-Positive and General Populations in Rural Uganda. PLoS One 2016; 11:e0156309. [PMID: 27232186 PMCID: PMC4883789 DOI: 10.1371/journal.pone.0156309] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/12/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Antiretroviral therapy scale-up in Sub-Saharan Africa has created a growing, aging HIV-positive population at risk for non-communicable diseases such as hypertension. However, the prevalence and risk factors for hypertension in this population remain incompletely understood. METHODS We measured blood pressure and collected demographic data on over 65,000 adults attending multi-disease community health campaigns in 20 rural Ugandan communities (SEARCH Study: NCT01864603). Our objectives were to determine (i) whether HIV is an independent risk factor for hypertension, and (ii) awareness and control of hypertension in HIV-positive adults and the overall population. RESULTS Hypertension prevalence was 14% overall, and 11% among HIV-positive individuals. 79% of patients were previously undiagnosed, 85% were not taking medication, and 50% of patients on medication had uncontrolled blood pressure. Multivariate predictors of hypertension included older age, male gender, higher BMI, lack of education, alcohol use, and residence in Eastern Uganda. HIV-negative status was independently associated with higher odds of hypertension (OR 1.2, 95% CI: 1.1-1.4). Viral suppression of HIV did not significantly predict hypertension among HIV-positives. SIGNIFICANCE The burden of hypertension is substantial and inadequately controlled, both in HIV-positive persons and overall. Universal HIV screening programs could provide counseling, testing, and treatment for hypertension in Sub-Saharan Africa.
Collapse
Affiliation(s)
| | - Laura Balzer
- Harvard University, Boston, Massachusetts, United States of America
- University of California, San Francisco, San Francisco, California, United States of America
| | - David Heller
- University of California, San Francisco, San Francisco, California, United States of America
| | - Prashant Kotwani
- University of California, San Francisco, San Francisco, California, United States of America
| | - Gabriel Chamie
- University of California, San Francisco, San Francisco, California, United States of America
| | - Tamara Clark
- University of California, San Francisco, San Francisco, California, United States of America
| | - James Ayieko
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Vivek Jain
- University of California, San Francisco, San Francisco, California, United States of America
| | | | - Maya Petersen
- University of California, Berkeley, California, United States of America
| | - Diane Havlir
- University of California, San Francisco, San Francisco, California, United States of America
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| |
Collapse
|
49
|
Barnabas RV, van Rooyen H, Tumwesigye E, Brantley J, Baeten JM, van Heerden A, Turyamureeba B, Joseph P, Krows M, Thomas KK, Schaafsma TT, Hughes JP, Celum C. Uptake of antiretroviral therapy and male circumcision after community-based HIV testing and strategies for linkage to care versus standard clinic referral: a multisite, open-label, randomised controlled trial in South Africa and Uganda. Lancet HIV 2016; 3:e212-20. [PMID: 27126488 DOI: 10.1016/s2352-3018(16)00020-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Male circumcision decreases HIV acquisition by 60%, and antiretroviral therapy (ART) almost eliminates HIV transmission from HIV-positive people who are virally suppressed; however, coverage of these interventions has lagged behind targets. We aimed to assess whether community-based HIV testing with counsellor support and point-of-care CD4 cell count testing would increase uptake of ART and male circumcision. METHODS We did this multisite, open-label, randomised controlled trial in six research-naive communities in rural South Africa and Uganda. Eligible HIV-positive participants (aged ≥16 years) were randomly assigned (1:1:1) in a factorial design to receive lay counsellor clinic linkage facilitation, lay counsellor follow-up home visits, or standard-of-care clinic referral, and then (1:1) either point-of-care CD4 cell count testing or referral for CD4 testing. HIV-negative uncircumcised men (aged 16-49 years) who could receive secure mobile phone text messages were randomly assigned (1:1:1) to receive text message reminders, lay counsellor visits, or standard clinic referral. The study biostatistician generated the randomisation schedule via a computer-generated random number program with varying block sizes (multiples of six or three) stratified by country. Primary outcomes for HIV-positive people were obtaining a CD4 cell count, linkage to an HIV clinic, ART initiation, and viral suppression at 9 months, and for HIV-negative uncircumcised men were visiting a circumcision facility and uptake of male circumcision at 3 months. We assessed social harms as a safety outcome throughout the study. We did the primary analyses by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02038582. FINDINGS Between June 6, 2013, and March 11, 2015, 15 332 participants were tested. 2339 (15%) participants tested HIV positive, of whom 1325 (57%) were randomly assigned to receive lay counsellor clinic linkage facilitation (n=437), lay counsellor follow-up home visits (n=449), or standard clinic referral (n=439), and then point-of-care CD4 cell testing (n=206, n=220, and n=213, respectively) or referral for CD4 testing (n=231, n=229, and n=226, respectively). 12 993 (85%) participants tested HIV negative, of whom 750 (6%) uncircumcised men were randomly assigned to receive clinic referral (n=230), text message reminders (n=288), or lay counsellor follow-up visits (n=232). 1218 (93%) of 1303 HIV-positive participants were linked to care, but only 488 (37%) participants initiated ART. Overall, 635 (50%) of 1272 HIV-positive individuals achieved viral suppression at 9 months: 219 (52%) of 419 participants in the clinic facilitation group, 202 (47%) of 431 participants in the lay counsellor follow-up group, and 214 (51%) of 422 participants in the clinic referral group, with no significant differences between groups (p=0·668 for clinic facilitation and p=0·273 for lay counsellor follow-up vs clinic referral). 523 (72%) of 734 HIV-negative men visited a circumcision facility, with no difference between groups. 62 (28%) of 224 men were circumcised in the male circumcision clinic referral group compared with 137 (48%) of 284 men in the text message reminder group (relative risk 1·72, 95% CI 1·36-2·17; p<0·0001) and 106 (47%) of 226 men in the lay counsellor follow-up group (1·67, 1·29-2·14; p=0·0001). No cases of study-related social harm were reported, including probing about partnership separation, unintended disclosure, gender-based violence, and stigma. INTERPRETATION All the community-based strategies achieved high rates of linkage of HIV-positive people to HIV clinics, roughly a third of whom initiated ART, and of those more than 80% were virally suppressed at 9 months. Uptake of male circumcision was almost two-times higher in men who received text message reminders or lay counsellor visits than in those who received standard-of-care clinic referral. Clinic barriers to ART initiation should be addressed in future strategies to increase the proportion of HIV-positive people accessing treatment and achieving viral suppression. FUNDING National Institute of Allergy and Infectious Diseases, National Institutes of Health.
Collapse
Affiliation(s)
- Ruanne V Barnabas
- Department of Global Health, University of Washington, Seattle, WA, USA; School of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Heidi van Rooyen
- Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa
| | | | - Justin Brantley
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA; School of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Alastair van Heerden
- Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa; Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Philip Joseph
- Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa
| | - Meighan Krows
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Torin T Schaafsma
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - James P Hughes
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, WA, USA; School of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| |
Collapse
|
50
|
Chamie G, Clark TD, Kabami J, Kadede K, Ssemmondo E, Steinfeld R, Lavoy G, Kwarisiima D, Sang N, Jain V, Thirumurthy H, Liegler T, Balzer LB, Petersen ML, Cohen CR, Bukusi EA, Kamya MR, Havlir DV, Charlebois ED. A hybrid mobile approach for population-wide HIV testing in rural east Africa: an observational study. Lancet HIV 2016; 3:e111-9. [PMID: 26939734 PMCID: PMC4780220 DOI: 10.1016/s2352-3018(15)00251-9] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/10/2015] [Accepted: 12/11/2015] [Indexed: 11/17/2022]
Abstract
Background Despite large investments in HIV testing, only 45% of HIV-infected persons in sub-Saharan Africa are estimated to know their status. Optimal methods for maximizing population-level testing remain unknown. We sought to demonstrate the effectiveness at achieving population-wide testing coverage of a hybrid mobile HIV testing approach. Methods From 2013–2014, we enumerated 168,772 adult (≥15 years) residents of 32 communities in Uganda (N=20), and Kenya (N=12) using a door-to-door census. “Stable” residence was defined as living in community for ≥6 months over the past year. In each community we performed 2-week multi-disease community health campaigns (CHC) that included HIV testing, counseling, and referral to care if HIV-infected; CHC non-participants were approached for home-based testing (HBT) over 1–2 months. We determined population HIV testing coverage, and predictors of testing via HBT (vs. CHC) and non-testing. Findings HIV testing was achieved in 89% of stable adult residents (131,307/146,906). HIV prevalence was 9.6% (13,043/136,033 stable and non-stable adults); median CD4+ T-cell count was 514 cells/μL (IQR: 355–703). Among stable adults tested, 43% (56,106/131,307) reported no prior testing. Among HIV-infected adults, 38% (4,932/13,043) were unaware of their status. Among stable CHC attendees, 99.5% (104,635/105,170) accepted HIV testing. Of stable adults tested, 80% (104,635/131,307, range: 60–93%) tested via CHCs. In multivariable analyses of stable adults, predictors of non-testing included male gender (risk ratio [RR]: 1.52, 95% CI: 1.48–1.56), single marital status (RR: 1.70, 95% CI: 1.66–1.75), Kenyan residence (RR: 1.46, 95% CI: 1.41–1.50, vs. Ugandan), and out-of-community migration for ≥1 month in past year (RR: 1.60, 95% CI: 1.53–1.68). Testing was more common among farmers (RR: 0.73, 95% CI: 0.67–0.79) and adults with primary education (RR: 0.84, 95% CI: 0.80–0.89). Interpretation High HIV testing coverage was achieved in rural Ugandan and Kenyan communities using a hybrid, mobile approach of multi-disease CHCs followed by HBT. This approach allowed for flexibility at the community and individual level in reaching testing coverage goals. Men and mobile populations remain challenges for universal testing.
Collapse
Affiliation(s)
- Gabriel Chamie
- Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA.
| | - Tamara D Clark
- Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA
| | - Jane Kabami
- Makerere University-University of California Research Collaboration, Kampala, Uganda
| | - Kevin Kadede
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Emmanuel Ssemmondo
- Makerere University-University of California Research Collaboration, Kampala, Uganda
| | - Rachel Steinfeld
- Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA
| | - Geoff Lavoy
- Makerere University-University of California Research Collaboration, Kampala, Uganda
| | - Dalsone Kwarisiima
- Makerere University-University of California Research Collaboration, Kampala, Uganda
| | - Norton Sang
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Vivek Jain
- Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA
| | - Harsha Thirumurthy
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Teri Liegler
- Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA
| | - Laura B Balzer
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Maya L Petersen
- University of California Berkeley School of Public Health, Berkeley, CA, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Moses R Kamya
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Diane V Havlir
- Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA
| | - Edwin D Charlebois
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|