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Beeman A, Gonzalez Marques C, Tang OY, Uwamahoro C, Jarmale S, Mutabazi Z, Ndebwanimana V, Uwamahoro D, Niyonsaba M, Stephen A, Aluisio AR. Factors associated with HIV testing among patients seeking emergent injury care in Kigali, Rwanda. Afr J Emerg Med 2022; 12:281-286. [PMID: 35782195 PMCID: PMC9240989 DOI: 10.1016/j.afjem.2022.05.001] [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: 09/30/2021] [Revised: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Emergency centres (ECs) can be important access points for HIV testing. In Rwanda, one in eight people with HIV are unaware of their infection status, which impedes epidemic control. This could be addressed via increased testing. This cross-sectional study evaluated factors associated with EC-based HIV testing among injured patients at the Centre Hospitalier Universitaire de Kigali (CHUK), in Kigali, Rwanda. Methods Adult injury patients were prospectively enrolled between January-June 2020. Trained study personnel collected data on demographics, injury aspects, treatments, HIV testing, and disposition. The primary outcome was the completion of EC-based HIV testing. Differences between those receiving and those not receiving testing were assessed. Regression models yielding adjusted odds ratios with associated 95% confidence intervals (CI) were calculated to quantify magnitudes of effect. Results Among 579 patients, the majority were under 45 years of age (78.1%) and male (74.4%). The most common mechanism of injury was road traffic accidents (50.3%). EC discharge occurred in 54.4% of cases. HIV testing was performed in 221 (38.2%) cases, of which 5.9% had a positive result. HIV testing was more likely among males (aOR=1.69, 95% CI: 1.02-2.78; p=0.04), cases transported by prehospital services (aOR=2.07, 95% CI: 1.28-3.35; p=0.003) and those receiving surgical consultation (aOR=3.13, 95% CI: 1.99-4.94; p<0.001). Cases with lower acuity were less likely to be tested (OR=0.70, 95% CI: 0.55-0.90; p=0.004), as were those discharged (OR=0.28, 95% CI: 0.18-0.43; p<0.001). Conclusion In the population studied, most patients did not undergo HIV testing. EC-based physician directed testing was more likely among male patients and patients with greater care needs. These results may inform approaches to increase EC-based testing services in Rwanda and other similar settings with high HIV burdens.
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Affiliation(s)
- Aly Beeman
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA,Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, KN 4 Ave, Kigali, Rwanda
| | | | - Oliver Y. Tang
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Chantal Uwamahoro
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, KN 4 Ave, Kigali, Rwanda,Corresponding author.
| | - Spandana Jarmale
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Zeta Mutabazi
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, KN 4 Ave, Kigali, Rwanda
| | - Vincent Ndebwanimana
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, KN 4 Ave, Kigali, Rwanda
| | - Doris Uwamahoro
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, KN 4 Ave, Kigali, Rwanda
| | - Mediatrice Niyonsaba
- Rwanda Biomedical Center, Kigali, Rwanda,Service d'Aide Médicale Urgente (SAMU), Rwanda Ministry of Health, Kigali, Rwanda
| | - Andrew Stephen
- Department of Surgery, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Adam R. Aluisio
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA,Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA, USA
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Colón-López V, Pérez-Guzmán D, Canario De La Torre MM, Centeno-Alvarado N, Agudelo-Salas IY, Rolón Y, Miranda S, Pabón M, Rodríguez-Lebrón J, Girona Lozada G. Provider-Initiated HIV Testing in Puerto Rico from Data of the National HIV Behavioral Surveillance-Heterosexual Cycle (NHBS-HET) 2016: National Cross-Sectional Survey (Preprint). JMIR Public Health Surveill 2021; 8:e29890. [PMID: 36287600 PMCID: PMC9647451 DOI: 10.2196/29890] [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: 04/25/2021] [Revised: 03/21/2022] [Accepted: 08/02/2022] [Indexed: 11/24/2022] Open
Abstract
Background According to the Centers for Disease Control and Prevention and World Health Organization guidelines, all individuals aged 13-64 years should get screened for HIV infection as part of their routine medical examinations. Individuals at high risk should get tested annually. Objective This study aimed to identify the sociodemographic, health care, and sexual behavioral characteristics of provider-initiated HIV testing using data from the Puerto Rico National HIV Behavioral Surveillance 2016 cycle, directed toward heterosexual individuals at increased risk of HIV infection. Methods A sample of 358 eligible participants were recruited through respondent-driven sampling, where sociodemographic characteristics, health care use, and HIV test referral were used to assess a description of the study sample. Pearson chi-square and Fisher tests were used to evaluate proportional differences. Multivariate logistic regression models were performed to determine the association between independent variables and HIV test referral. Adjusted prevalence ratios by sex and age with their 95% CIs were determined using a statistical significance level of .05. Results Despite 67.9% (243/358) of participants showing high-risk sexual behavioral practices and 67.4% (236/350) reporting a low perceived risk of HIV infection among those who visited a health care provider within the last 12 months, 80.7% (289/358) of the study sample did not receive an HIV test referral at a recent medical visit. Multivariate analysis showed that the estimated prevalence of the participants who received an HIV test referral among those who reported being engaged in high-risk sexual behaviors was 41% (adjusted prevalence ratio .59, 95% CI .39-.91; P=.02) lower than the estimated prevalence among those who did not engage in high-risk sexual behavior. Conclusions This sample of Puerto Rican adults reported a significantly lower prevalence of receiving an HIV test referral among heterosexual individuals at increased risk of HIV infection who engaged in high-risk behaviors. This study further emphasizes the need for health care providers to follow recommended guidelines for HIV test referrals in health care settings. Promotion practices in the future should include enhancing referral and access to HIV tests and implementing preventive measures to counteract the HIV epidemic in Puerto Rico.
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Affiliation(s)
- Vivian Colón-López
- Cancer Control and Population Sciences Program, Comprehensive Cancer Center, University of Puerto Rico, San Juan, Puerto Rico
- Evaluation Program, Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Derick Pérez-Guzmán
- Data Analysis and Publication Core, Comprehensive Cancer Center, University of Puerto Rico, San Juan, Puerto Rico
| | | | - Nadia Centeno-Alvarado
- Data Analysis and Publication Core, Comprehensive Cancer Center, University of Puerto Rico, San Juan, Puerto Rico
| | - Ivony Y Agudelo-Salas
- Data Analysis and Publication Core, Comprehensive Cancer Center, University of Puerto Rico, San Juan, Puerto Rico
| | - Yadira Rolón
- HIV/AIDS Surveillance Program, Puerto Rico Health Department, San Juan, Puerto Rico
| | - Sandra Miranda
- HIV/AIDS Surveillance Program, Puerto Rico Health Department, San Juan, Puerto Rico
| | - Maria Pabón
- HIV/AIDS Surveillance Program, Puerto Rico Health Department, San Juan, Puerto Rico
| | | | - Gladys Girona Lozada
- HIV/AIDS Surveillance Program, Puerto Rico Health Department, San Juan, Puerto Rico
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3
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Dzinamarira T, Mulindabigwi A, Mashamba-Thompson TP. Co-creation of a health education program for improving the uptake of HIV self-testing among men in Rwanda: nominal group technique. Heliyon 2020; 6:e05378. [PMID: 33163663 PMCID: PMC7610321 DOI: 10.1016/j.heliyon.2020.e05378] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/15/2020] [Accepted: 10/27/2020] [Indexed: 11/29/2022] Open
Abstract
Objective This study sought to collaborate with key stakeholders to reach a consensus regarding the predominant barriers preventing the uptake of HIV testing services (HTS) by men and co-create an acceptable educational program to improve the knowledge of HIV self-testing (HIVST) among men in Rwanda. Methods We employed the nominal group technique to identify a consensus regarding the predominant barriers currently impeding the male uptake of HTS. The health education program content was guided by the ranked barriers. We applied Mezirow's Transformational Learning Theory for curriculum development. Results Eleven key barriers currently impeding the male uptake of HTS were identified in the nominal group process. The stakeholders co-created an interactive, structured curriculum containing information on the health locus of control; HIV etiology, transmission, diagnosis, status disclosure benefits, care and treatment services; and an overview of the HIVST background and test procedure to address multiple barriers. Conclusion Key stakeholders co-created a comprehensive health education program tailored to men, which integrates education about health beliefs, HIV/AIDS and HIVST. Further studies to assess the effectiveness of the program are needed. It is anticipated that the intervention will improve the uptake of HIVST among men in Kigali, Rwanda.
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Affiliation(s)
- Tafadzwa Dzinamarira
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa
| | | | - Tivani Phosa Mashamba-Thompson
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.,CIHR Canadian HIV Trials Network, Vancouver, BC, Canada.,Department of Public Health, University of Limpopo, Polokwane, Limpopo Province, South Africa
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4
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Kyaw KWY, Kyaw NTT, Kyi MS, Aye S, Harries AD, Kumar AMV, Oo NL, Satyanarayana S, Aung ST. HIV testing uptake and HIV positivity among presumptive tuberculosis patients in Mandalay, Myanmar, 2014-2017. PLoS One 2020; 15:e0234429. [PMID: 32555731 PMCID: PMC7302489 DOI: 10.1371/journal.pone.0234429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/25/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction The World Health Organization’s framework for TB/HIV collaborative activities recommends provider-initiated HIV testing and counselling (PITC) of patients with presumptive TB. In Myanmar, PITC among presumptive TB patients was started at the TB outpatient department (TB OPD) in Mandalay in 2014. In this study, we assessed the uptake of PITC among presumptive TB patients and the number needed to screen to find one additional HIV positive case, stratified by demographic and clinical characteristics. Method This was a cross-sectional study using routinely collected data of presumptive TB patients who registered for PITC services at the TB OPD between August 2014 and December 2017 in Mandalay. Result Among 21,989 presumptive TB patients registered, 9,796 (44.5%) had known HIV status at registration and 2,763 (28.2%) were people already living with HIV (PLHIV). Of the remainder, 85.3% (10,401/12,193) were newly tested for HIV. Patients <55 years old, those registered in 2014, 2015 and 2017, those employed and those having a history of TB contact had higher uptakes of HIV testing. Among 10,401 patients tested for HIV, 213 (2.1%) patients were newly diagnosed with HIV and this included 147 (69.0%) who were not diagnosed as having TB. The overall prevalence of HIV (previously known and newly diagnosed) among presumptive TB patients was 14.8% (2,976/20,119). The number needed to screen to find one additional HIV case was 48: this number was lower (i.e., a higher yield) among patients aged 35–44 years and among those who were divorced or separated. Conclusion Uptake of HIV testing among eligible presumptive TB patients was high with four out of five presumptive TB patients being tested for HIV. This strategy detected many additional HIV-positive persons, and this included those who were not diagnosed with TB. We strongly recommend that this strategy be implemented nationwide in Myanmar.
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Affiliation(s)
- Khine Wut Yee Kyaw
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- * E-mail:
| | - Nang Thu Thu Kyaw
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Myo Su Kyi
- Department of Public Health, National Tuberculosis Programme, Myanmar
| | - Sandar Aye
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Anthony D. Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- London School of Hygiene and Tropical Medicine, London, England, United Kingdom
| | - Ajay M. V. Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- International Union Against Tuberculosis and Lung Disease, The Union South-East Asia Office, New Delhi, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India
| | - Nay Lynn Oo
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Si Thu Aung
- Disease Control Division, Department of Public Health, Nay Pyi Taw, Myanmar
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5
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Marwa R, Anaeli A. Perceived Barriers Toward Provider-Initiated HIV Testing and Counseling (PITC) in Pediatric Clinics: A Qualitative Study Involving Two Regional Hospitals in Dar-Es-Salaam, Tanzania. HIV AIDS (Auckl) 2020; 12:141-150. [PMID: 32280281 PMCID: PMC7127846 DOI: 10.2147/hiv.s235818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/14/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND According to Provider-Initiated HIV Testing and Counseling (PITC), healthcare providers recommend HIV testing and counseling to persons attending health care facilities as a standard component of medical care. In order to reduce the morbidity and mortality of late Human Immunodeficiency Virus (HIV) diagnosis, timely diagnosis and initiation of ARVs is necessary. This aims to accelerate universal access to HIV prevention, treatment, care, and support services for people living with HIV/AIDS. The present study aimed to explore perceived barriers toward PITC provision in pediatric clinics. METHODS The study had a cross-sectional exploratory study design. In-depth interviews were used to collect data from the informants in Mwananyamala and Temeke hospitals in Dar-es-Salaam. Nineteen informants were recruited purposely for in-depth interviews. All the interviews were audio recorded, transcribed verbatim, and translated from Swahili to English. Lastly, data were analyzed using a thematic analysis approach. RESULTS The study findings showed six barriers including inadequate training on PITC among healthcare providers, little practice of PITC provision, inability to properly counsel patients due to little knowledge, poor attitude of healthcare providers in providing PITC, shortage of healthcare providers, and little motivation and incentives among healthcare providers. Patient barriers included little understanding of PITC among parents/guardians of children and its importance in terms of their children's health, absence of parents, overcrowding at clinics, HIV/AIDS stigma, lack of privacy at clinics, and harsh language of some of the healthcare providers. Health facility barriers included inadequate space to provide PITC and shortage of medical equipment and medical supplies for HIV testing. Policy-related barriers included the absence of PITC guidelines in each consultation room. CONCLUSION Perceived barriers toward PITC must be understood for effective implementation of PITC to reach 90-90-90 goal. The study identified several barriers which need to be addressed in order to improve PITC provision.
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Affiliation(s)
- Rose Marwa
- Department of Public Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar-es- Salaam, Tanzania
| | - Amani Anaeli
- Department of Public Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar-es- Salaam, Tanzania
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HIV self-testing in Rwanda: awareness and acceptability among male clinic attendees in Kigali, Rwanda: A cross-sectional survey. Heliyon 2020; 6:e03515. [PMID: 32181390 PMCID: PMC7063164 DOI: 10.1016/j.heliyon.2020.e03515] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/11/2020] [Accepted: 02/27/2020] [Indexed: 12/23/2022] Open
Abstract
Background The Rwandan Ministry of Health recently (in February 2017) recommended the use of HIV self-testing (HIVST) as an additional strategy for hard-to-reach populations such as men. However, the level of awareness and acceptability of this testing strategy among this population in Rwanda is not known. The main objective of this study is to assess the level of awareness and acceptability of HIVST among male clinic attendees in Kigali, Rwanda. Methods A cross-sectional survey was employed to systematically sample and interview 579 male health-facility attendees over a seven-week period. We employed a pretested interviewer questionnaire to collect data. The chi-square test was used to determine associations between explanatory variables. Univariate binary logistic regression analysis was carried out to obtain preliminary insight into the unconditional association of each independent variable and dependent variables (awareness and acceptability). Multiple logistic regression was employed to determine explanatory variables associated with awareness or acceptability status while adjusting for other study variables. All statistical analyses were performed using Stata version 11.2. Results Of the 579 men interviewed, only 21% were aware of HIVST, while 74% found it acceptable. Logistic regression analysis identified the following as factors significantly (p < 0.05) associated with HIVST awareness: having paid or received money for sex in the past month, health-seeking behavior, HIVST knowledge, HIVST attitude, and HIV risk perception. Factors associated with HIVST acceptability include the following: health-seeking behavior, HIVST knowledge, HIVST attitude, and condom use after taking drugs and alcohol. Conclusion The findings reveal low awareness and high acceptability of HIVST among men in Rwanda. Our findings accentuate the need to promote awareness of HIVST as an important intervention for improving the uptake of HIV testing among men, a traditionally hard-to-reach population in Rwanda.
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7
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Simon KR, Hartig M, Abrams EJ, Wetzel E, Ahmed S, Chester E, Chembezi C, Chavula B, Zinkanda S, Kavuta E, Chikoti C, Beyene T, Nkhono Z, Kabwinja A, Nyirenda R, Kazembe PN, Kim MH. The Tingathe Surge: a multi-strategy approach to accelerate HIV case finding in Malawi. Public Health Action 2019; 9:128-134. [PMID: 31803585 DOI: 10.5588/pha.18.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/20/2019] [Indexed: 11/10/2022] Open
Abstract
Setting Nineteen health facilities in rural, southeastern Malawi. Objective To describe the implementation and results of a 6-week intervention to accelerate human immunodeficiency virus (HIV) case finding. Design Six HIV testing strategies were simultaneously implemented. Routinely collected data from Ministry of Health registers were used to determine the number of HIV tests performed and of new cases identified. The weekly averages of the total number of tests and new cases before and during the intervention were compared. Testing by age group and sex was described. The percentage yield of new cases was compared by testing strategy. Results Of 29 703 HIV tests conducted, 1106 (3.7%) were positive. Of the total number of persons tested, 69.5% were women and 75.5% were aged >15 years. The yield of positive test results was 3.5% among women, 4.3% among men, 4.4% among those aged >15 years and 1.5% among those aged ⩽15 years. The average weekly number of tests increased 106.7% from 3337 to 6896 (P = 0.002). The average weekly number of positive cases identified increased 51.9% from 158 to 240 (P = 0.017). The testing strategy with the highest yield resulted in a 6.0% yield; the lowest was 1.3%. The yield for all strategies, except one, was highest in adult men. Conclusion A multi-strategy approach to HIV testing and counseling can be an effective means of accelerating HIV case finding.
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Affiliation(s)
- K R Simon
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Baylor College of Medicine International Pediatric AIDS Initiative, Houston, TX, USA
| | - M Hartig
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - E J Abrams
- ICAP at Columbia University, Mailman School of Public Health, and Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - E Wetzel
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Baylor College of Medicine International Pediatric AIDS Initiative, Houston, TX, USA
| | - S Ahmed
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Baylor College of Medicine International Pediatric AIDS Initiative, Houston, TX, USA
| | - E Chester
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Baylor College of Medicine International Pediatric AIDS Initiative, Houston, TX, USA
| | - C Chembezi
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - B Chavula
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - S Zinkanda
- Malawi Ministry of Health, Lilongwe, Malawi
| | - E Kavuta
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - C Chikoti
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - T Beyene
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Baylor College of Medicine International Pediatric AIDS Initiative, Houston, TX, USA
| | - Z Nkhono
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - A Kabwinja
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - R Nyirenda
- Malawi Ministry of Health, Lilongwe, Malawi
| | - P N Kazembe
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Baylor College of Medicine International Pediatric AIDS Initiative, Houston, TX, USA
| | - M H Kim
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Baylor College of Medicine International Pediatric AIDS Initiative, Houston, TX, USA
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Bochner AF, Tippett Barr BA, Makunike B, Gonese G, Wazara B, Mashapa R, Meacham E, Nyika P, Ncube G, Balachandra S, Levine R, Petracca F, Apollo T, Downer A, Wiktor SZ. Strengthening provider-initiated testing and counselling in Zimbabwe by deploying supplemental providers: a time series analysis. BMC Health Serv Res 2019; 19:351. [PMID: 31159809 PMCID: PMC6547585 DOI: 10.1186/s12913-019-4169-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 05/20/2019] [Indexed: 11/16/2022] Open
Abstract
Background Expansion of provider-initiated testing and counselling (PITC) is one strategy to increase accessibility of HIV testing services. Insufficient human resources was identified as a primary barrier to increasing PITC coverage in Zimbabwe. We evaluated if deployment of supplemental PITC providers at public facilities in Zimbabwe was associated with increased numbers of individuals tested and diagnosed with HIV. Methods From July 2016 to May 2017, International Training and Education Center for Health (I-TECH) deployed 138 PITC providers to supplement existing ministry healthcare workers offering PITC at 249 facilities. These supplemental providers were assigned to facilities on a weekly basis. Each week, I-TECH providers reported the number of HIV tests and positive diagnoses they performed. Using routine reporting systems, we obtained from each facility the number of clients tested and diagnosed with HIV per month. Including data both before and during the intervention period, and utilizing the weekly variability in placement locations of the supplemental PITC providers, we employed generalized estimating equations to assess if the placement of supplemental PITC providers at a facility was associated with a change in facility outputs. Results Supplemental PITC providers performed an average of 62 (SD = 52) HIV tests per week and diagnosed 4.4 (SD = 4.9) individuals with HIV per week. However, using facility reports from the same period, we found that each person-week of PITC provider deployment at a facility was associated with an additional 16.7 (95% CI, 12.2–21.1) individuals tested and an additional 0.9 (95% CI, 0.5–1.2) individuals diagnosed with HIV. We also found that staff placement at clinics was associated with a larger increase in HIV testing than staff placement at polyclinics or hospitals (24.0 vs. 9.8; p < 0.001). Conclusions This program resulted in increased numbers of individuals tested and diagnosed with HIV. The discrepancy between the average weekly HIV tests conducted by supplemental PITC providers (62) and the increase in facility-level HIV tests associated with one week of PITC provider deployment (16.7) suggests that supplemental PITC providers displaced existing staff who may have been reassigned to fulfil other duties at the facility.
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Affiliation(s)
- Aaron F Bochner
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA. .,Department of Epidemiology, University of Washington, 325 9th Ave, Box 359932, Seattle, WA, 98104, USA.
| | | | - Batsirai Makunike
- International Training and Education Center for Health (I-TECH), Harare, Zimbabwe
| | - Gloria Gonese
- International Training and Education Center for Health (I-TECH), Harare, Zimbabwe
| | - Blessing Wazara
- International Training and Education Center for Health (I-TECH), Harare, Zimbabwe
| | - Richard Mashapa
- International Training and Education Center for Health (I-TECH), Harare, Zimbabwe
| | - Elizabeth Meacham
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA
| | - Ponesai Nyika
- U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | | | | | - Ruth Levine
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA
| | - Frances Petracca
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Ann Downer
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA
| | - Stefan Z Wiktor
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA
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Jacobs MG, Pelissari DM, Diaz-Quijano FA. Macrodetermined racial inequalities in diagnostic testing among tuberculosis patients in Brazil. Public Health 2019; 167:103-110. [PMID: 30654312 DOI: 10.1016/j.puhe.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 10/25/2018] [Accepted: 11/05/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To estimate the association between tuberculosis (TB) patients' race and patients' access to diagnostic testing in Brazil. In addition, we evaluated if the associations could be explained by a geographic codistribution between racial groups and diagnostic testing. STUDY DESIGN It is a cross-sectional study based on secondary data from a national surveillance system of new TB cases diagnosed in 2015. METHODS We evaluated the association between TB patients' race (independent variable) and the HIV testing and TB mycobacterial culture providing (dependent variables) with logistic regression models. We used multilevel models to consider different geopolitical levels (region, state and municipality). In addition, we used conditional logistic regressions matched by health-care unit. All models were adjusted by individual covariates associated with the outcomes. RESULTS Compared with non-Afro-Brazilian patients, Afro-Brazilian patients had significantly lower odds to have had HIV testing [odds ratio (OR): 0.72; 95% confidence interval (CI): 0.69-0.75] and mycobacterial culture performed (OR: 0.74; 95% CI: 0.71-0.77). However, these statistically significant negative associations between Afro-Brazilian racial category and testing disappeared when patients were considered as nested in geopolitical contexts or matched for health-care unit. CONCLUSIONS Afro-Brazilian TB patients had lower probability to have HIV test and mycobacterial culture performed. However, these associations seem to be macrodeterminated by the geographic distribution of both racial groups and diagnostic testing. Our findings can support the formulation of public policies aiming to mitigate regional disparities as a strategy to improve racial equity in access to healthcare. The approach presented can be applied in a range of scenarios to identify disparities, localize its source and support decision-making.
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Affiliation(s)
- M G Jacobs
- National Tuberculosis Programme, Ministry of Health, PO 700 - SRTVN 702, Via W 5 Norte, 6º Andar, Brasília, DF, Brazil.
| | - D M Pelissari
- National Tuberculosis Programme, Ministry of Health, PO 700 - SRTVN 702, Via W 5 Norte, 6º Andar, Brasília, DF, Brazil.
| | - F A Diaz-Quijano
- Department of Epidemiology, School of Public Health, University of São Paulo. Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, Brazil.
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Bandason T, Dauya E, Dakshina S, McHugh G, Chonzi P, Munyati S, Weiss HA, Simms V, Kranzer K, Ferrand RA. Screening tool to identify adolescents living with HIV in a community setting in Zimbabwe: A validation study. PLoS One 2018; 13:e0204891. [PMID: 30278064 PMCID: PMC6168137 DOI: 10.1371/journal.pone.0204891] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 09/17/2018] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION A simple cost-effective strategy to pre-screen for targeted HIV testing can have substantial benefit in high burden and resource limited settings. A 4-item (previous hospitalisation, orphanhood, poor health status, and recurring skin problems) screening tool to identify adolescents living with HIV has previously shown high sensitivity in healthcare facility settings. We validated this screening tool in a community setting, in Harare, Zimbabwe in a community-based HIV prevalence survey. METHODS A community-based HIV prevalence survey was conducted among individuals aged 8-17 years with guardian consent and child assent and residing in 7 communities during the period February 2015 to December 2015. Participants without previously diagnosed HIV were evaluated for the probability of having HIV using the screening tool. HIV status was defined using an anonymous HIV test which was done using Oral Mucosal Transudate (OMT). A questionnaire was also administered to ascertain self-reported HIV status and screening tool items. The validity of a 4-item screening tool was tested. Sensitivity and specificity of the screening tool was assessed against the HIV status based on OMT result. RESULTS Prevalence survey participants were 5386 children who had an HIV test result, aged 8-17 years. However, 5384, who did not report testing HIV positive and responded to all screening tool item questions were included in the validation. Their median age was 12 (IQR: 10-15) years, 2515 (46.7%) were male. HIV prevalence was 1.3% (95% CI:1.0-1.8%). The 4-item screening tool had poor accuracy with an area under the receiver operating curve of 0.65(95% CI: 0.60-0.72) at a cut-off score≥1. Its sensitivity was 56.3% (95% CI:44.0-68.1%) and specificity of 75.1% (95% CI:73.9-76.3%), PPV of 2.9% (95% CI:2.1-3.9%) and a NPV of 99.2% (95% CI:98.9-99.5%). The number needed to test to diagnose one child using the screening tool was 55% lower than universal testing for HIV. CONCLUSION Use of the 4-item screening tool could be a strategy that can be adopted to identify children living with HIV in a community setting in resource limited settings by reducing the number needed to test compared to universal testing since it is inexpensive, easy to administer and not harmful. However, screening items adapted to a community setting need to be explored to improve the performance of the screening tool.
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Affiliation(s)
- Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Grace McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Helen A. Weiss
- MRC Tropical Epidemiology Group, LSHTM, London, United Kingdom
| | - Victoria Simms
- MRC Tropical Epidemiology Group, LSHTM, London, United Kingdom
| | - Katharina Kranzer
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Research Centre Borstel, Borstel, Germany
| | - Rashida Abbas Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Kalisa R, Smeele P, van Elteren M, van den Akker T, van Roosmalen J. Facilitators and barriers to birth preparedness and complication readiness in rural Rwanda among community health workers and community members: a qualitative study. Matern Health Neonatol Perinatol 2018; 4:11. [PMID: 29992035 PMCID: PMC5989363 DOI: 10.1186/s40748-018-0080-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/26/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Birth preparedness and complication readiness (BP/CR) comprise a strategy to make women plan for birth and encourage them to seek professional care in order to reduce poor pregnancy outcome. We aimed to understand the facilitators and barriers to BP/CR among community health workers (CHWs) and community members in rural Rwanda. METHODS Eight focus group discussions were conducted with 88 participants comprising of CHWs, elderly women aged 45-68 and men aged 18-59, as well as two key informant interviews in Musanze district, Rwanda, between November and December 2015. Qualitative data were digitally recorded, transcribed verbatim and analysed using content analysis. RESULTS Participants perceived the importance of family assistance, medical insurance and attending antenatal care (ANC) to facilitate BP/CR and enhance professional care at birth. CHWs reinforced BP/CR messages by SMS alerts and during community gatherings. 'Ubudehe (collective action to combat poverty)' was known as a tool to identify the poorest families in need of government aid to pay for medical care. Disrespect and abuse of women during labor by health workers were perceived as important barriers to access professional care, as well as conflicting health policies such as user fees for ANC and family planning services, and imposing fines on women giving birth outside health facilities. CONCLUSION CHWs, ANC and medical insurance are perceived to be important facilitators of BP/CR. Respectful care is paramount for improved maternal health. There is a need for addressing inconsistent health policies hindering the intention to access professional care.
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Affiliation(s)
- Richard Kalisa
- Department of Obstetrics and Gynecology, Ruhengeri Hospital, Musanze, Rwanda
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - Patrick Smeele
- Department of Medical Humanities, VU University Medical Center, Amsterdam, The Netherlands
| | - Marianne van Elteren
- Department of Medical Humanities, VU University Medical Center, Amsterdam, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos van Roosmalen
- Athena Institute, VU University, Amsterdam, The Netherlands
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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Community burden of undiagnosed HIV infection among adolescents in Zimbabwe following primary healthcare-based provider-initiated HIV testing and counselling: A cross-sectional survey. PLoS Med 2017; 14:e1002360. [PMID: 28742829 PMCID: PMC5526522 DOI: 10.1371/journal.pmed.1002360] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/16/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Children living with HIV who are not diagnosed in infancy often remain undiagnosed until they present with advanced disease. Provider-initiated testing and counselling (PITC) in health facilities is recommended for high-HIV-prevalence settings, but it is unclear whether this approach is sufficient to achieve universal coverage of HIV testing. We aimed to investigate the change in community burden of undiagnosed HIV infection among older children and adolescents following implementation of PITC in Harare, Zimbabwe. METHODS AND FINDINGS Over the course of 2 years (January 2013-January 2015), 7 primary health clinics (PHCs) in southwestern Harare implemented optimised, opt-out PITC for all attendees aged 6-15 years. In February 2015-December 2015, we conducted a representative cross-sectional survey of 8-17-year-olds living in the 7 communities served by the study PHCs, who would have had 2 years of exposure to PITC. Knowledge of HIV status was ascertained through a caregiver questionnaire, and anonymised HIV testing was carried out using oral mucosal transudate (OMT) tests. After 1 participant taking antiretroviral therapy was observed to have a false negative OMT result, from July 2015 urine samples were obtained from all participants providing OMTs and tested for antiretroviral drugs to confirm HIV status. Children who tested positive through PITC were identified from among survey participants using gender, birthdate, and location. Of 7,146 children in 4,251 eligible households, 5,486 (76.8%) children in 3,397 households agreed to participate in the survey, and 141 were HIV positive. HIV prevalence was 2.6% (95% CI 2.2%-3.1%), and over a third of participants with HIV were undiagnosed (37.7%; 95% CI 29.8%-46.2%). Similarly, among the subsample of 2,643 (48.2%) participants with a urine test result, 34.7% of those living with HIV were undiagnosed (95% CI 23.5%-47.9%). Based on extrapolation from the survey sample to the community, we estimated that PITC over 2 years identified between 18% and 42% of previously undiagnosed children in the community. The main limitation is that prevalence of undiagnosed HIV was defined using a combination of 3 measures (OMT, self-report, and urine test), none of which were perfect. CONCLUSIONS Facility-based approaches are inadequate in achieving universal coverage of HIV testing among older children and adolescents. Alternative, community-based approaches are required to meet the Joint United Nations Programme on HIV/AIDS (UNAIDS) target of diagnosing 90% of those living with HIV by 2020 in this age group.
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Ogbo FA, Mogaji A, Ogeleka P, Agho KE, Idoko J, Tule TZ, Page A. Assessment of provider-initiated HIV screening in Nigeria with sub-Saharan African comparison. BMC Health Serv Res 2017; 17:188. [PMID: 28279209 PMCID: PMC5345139 DOI: 10.1186/s12913-017-2132-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 03/04/2017] [Indexed: 01/01/2023] Open
Abstract
Background Despite Nigeria’s high HIV prevalence, voluntary testing and counselling rates remain low. UNAIDS/WHO/CDC recommends provider-initiated testing and counselling (PITC) for HIV in settings with high HIV prevalence. We aimed to assess the acceptability and logistical feasibility of the PITC strategy among adolescents and adults in a secondary health care centre in Idekpa Benue state, Nigeria. Method All patients (aged ≥ 13 years) who visited the out-patient department and antenatal care unit of General Hospital Idekpa, Benue state, Nigeria were offered PITC for HIV. The intervention was implemented by trained health professionals for the period spanning (June to December 2010). Results Among the 212 patients who were offered PITC for HIV, 199 (94%) accepted HIV testing, 10 patients (4.7%) opted out and 3 patients (1.4%) were undecided. Of the 199 participants who were tested for HIV, 9% were HIV seropositive. The PITC strategy was highly acceptable and feasible, and increased the number of patients who tested for HIV by 5% compared to voluntary counselling and testing. Findings from this assessment were consistent with those from other sub-Saharan African countries (such as Uganda and South Africa). Conclusion PITC for HIV was highly acceptable and logistically feasible, and resulted in an increased rate of HIV testing among patients. Public health initiatives (such as the PITC strategy) that facilitate early detection of HIV and referral for early treatment should be encouraged for broader HIV control and prevention in Nigerian communities.
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Affiliation(s)
- Felix A Ogbo
- Centre for Health Research, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia. .,General Hospital Idekpa, Ohimini Local Government Area, Benue State Hospitals Management Board, Makurdi, Benue State, Nigeria.
| | - Andrew Mogaji
- Departement of Psychology, Faculty of Social Science, Benue State University, PMB 102119, Makurdi, Nigeria
| | - Pascal Ogeleka
- Department of Public Health, School of Public Health, College of Science, Health and Engineering La Trobe University, Bundoora, VIC, 3083, Australia
| | - Kingsley E Agho
- School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
| | - John Idoko
- Department of Medicine, Faculty of Medical Sciences, University of Jos, P.M.B 2084, Jos, Plateau State, Nigeria
| | - Terver Zua Tule
- Prevention of Maternal-to-Child Transmission of HIV Unit, Benue State Ministry of Health, State Secretariat, High Level, PMB 102093, Makurdi, Benue State, Nigeria
| | - Andrew Page
- Centre for Health Research, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
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Franse CB, Kayigamba FR, Bakker MI, Mugisha V, Bagiruwigize E, Mitchell KR, Asiimwe A, Schim van der Loeff MF. Linkage to HIV care before and after the introduction of provider-initiated testing and counselling in six Rwandan health facilities. AIDS Care 2016; 29:326-334. [PMID: 27539782 DOI: 10.1080/09540121.2016.1220475] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HIV testing and counselling forms the gateway to the HIV care and treatment continuum. Therefore, the World Health Organization recommends provider-initiated testing and counselling (PITC) in countries with a generalized HIV epidemic. Few studies have investigated linkage-to-HIV-care among out-patients after PITC. Our objective was to study timely linkage-to-HIV-care in six Rwandan health facilities (HFs) before and after the introduction of PITC in the out-patient departments (OPDs). Information from patients diagnosed with HIV was abstracted from voluntary counselling and testing, OPD and laboratory registers of six Rwandan HFs during three-month periods before (March-May 2009) and after (December 2009-February 2010) the introduction of PITC in the OPDs of these facilities. Information on patients' subsequent linkage-to-pre-antiretroviral therapy (ART) care and ART was abstracted from ART clinic registers of each HF. To triangulate the findings from HF routine, a survey was held among patients to assess reasons for non-enrolment. Of 635 patients with an HIV diagnosis, 232 (36.5%) enrolled at the ART clinic within 90 days of diagnosis. Enrolment among out-patients decreased after the introduction of PITC (adjusted odds ratio, 2.0; 95% confidence interval, 1.0-4.2; p = .051). Survey findings showed that retesting for HIV among patients already diagnosed and enrolled into care was not uncommon. Patients reported non-acceptance of disease status, stigma and problems with healthcare services as main barriers for enrolment. Timely linkage-to-HIV-care was suboptimal in this Rwandan study before and after the introduction of PITC; the introduction of PITC in the OPD may have had a negative impact on linkage-to-HIV-care. Healthier patients tested through PITC might be less ready to engage in HIV care. Fear of HIV stigma and mistrust of test results appear to be at the root of these problems.
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Affiliation(s)
- Carmen B Franse
- a Royal Tropical Institute, KIT Biomedical Research , Amsterdam , The Netherlands
| | | | - Mirjam I Bakker
- a Royal Tropical Institute, KIT Biomedical Research , Amsterdam , The Netherlands
| | - Veronicah Mugisha
- c ICAP, Mailman School of Public Health, Columbia University , Kigali , Rwanda
| | | | | | - Anita Asiimwe
- f College of Medicine and Health Sciences , University of Rwanda , Kigali , Rwanda
| | - Maarten F Schim van der Loeff
- g Amsterdam Institute of Global Health and Development (AIGHD) , Amsterdam , The Netherlands.,h Center for Infection and Immunity Amsterdam (CINIMA), AMC , Amsterdam , The Netherlands.,i Public Health Service of Amsterdam (GGD) , Amsterdam , The Netherlands
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15
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Okechukwu AA, Ekop E, Ndukwe CD, Olateju KE. Acceptance of provider-initiated testing and counseling for HIV infection by caregivers in a tertiary health institution in Abuja, Nigeria: a cross sectional study. Pan Afr Med J 2016; 24:245. [PMID: 27800100 PMCID: PMC5075462 DOI: 10.11604/pamj.2016.24.245.9057] [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: 02/06/2016] [Accepted: 06/21/2016] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Less than 10% of HIV positive children are enrolled into antiretroviral treatment program in the country. Provider-initiated testing and counseling was introduced to increasing uptake of HIV testing. The aim of this study is to determine the acceptability and factors undermining the acceptance of this laudable initiative by parents/caregivers of children attending paediatric out patient clinical services in our health institution. METHODS A cross sectional study of children aged 18 months to 18 years and their parents/caregivers attending paediatric outpatient clinic of the hospital was undertaken for the above objectives. RESULTS There were statistically more female parents/caregivers (82.5%, p=0.00), more male patients (52.9 %, p= 0.02), and 11.9% adolescents in this study. While 91.7% of parents/caregivers admitted not having knowledge of provider-initiated testing and counseling, 95.6% knew what HIV was. Acceptance of the program was high (98.7%), majority (89.7%) wanting to know the HIV status of their children/wards. Non-acceptance was small (1.2%), there main reason being prior knowledge of their HIV status. Prevalence of HIV among tested children was 1.7%. There was a strong relationship between having willingness to test for HIV and many of the study variables with religion of the parents/caregivers having the strongest relationship [OR: 13.94, (CI 1.82, 55.34)], and tribe having list association, [OR: 3.60, (CI 1.85, 17.14)]. CONCLUSION There was general wiliness to accept HIV test for children by their parents/caregiver in this study, and HIV prevalence in children is on a downward trend; its sustenance to be continued and adolescent clinics need to be created.
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Affiliation(s)
| | - Eno Ekop
- Department of Paediatrics, University of Abuja Teaching Hospital, Gwagwalada, Abuja
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16
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Validation of a screening tool to identify older children living with HIV in primary care facilities in high HIV prevalence settings. AIDS 2016; 30:779-85. [PMID: 26588175 PMCID: PMC4937807 DOI: 10.1097/qad.0000000000000959] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective: We previously proposed a simple tool consisting of five items to screen for risk of HIV infection in adolescents (10–19 years) in Zimbabwe. The objective of this study is to validate the performance of this screening tool in children aged 6–15 years attending primary healthcare facilities in Zimbabwe. Methods: Children who had not been previously tested for HIV underwent testing with caregiver consent. The screening tool was modified to include four of the original five items to be appropriate for the younger age range, and was administered. A receiver operator characteristic analysis was conducted to determine a suitable cut-off score. The sensitivity, specificity and predictive value of the modified tool were assessed against the HIV test result. Results: A total of 9568 children, median age 9 (interquartile, IQR: 7–11) years and 4971 (52%) men, underwent HIV testing. HIV prevalence was 4.7% (95% confidence interval, CI:4.2–5.1%) and increased from 1.4% among those scoring zero on the tool to 63.6% among those scoring four (P < 0.001). Using a score of not less than one as the cut-off for HIV testing, the tool had a sensitivity of 80.4% (95% CI:76.5–84.0%), specificity of 66.3% (95% CI:65.3–67.2%), positive predictive value of 10.4% and a negative predictive value of 98.6%. The number needed to screen to identify one child living with HIV would drop from 22 to 10 if this screening tool was used. Conclusion: The screening tool is a simple and sensitive method to identify children living with HIV in this setting. It can be used by lay healthcare workers and help prioritize limited resources.
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Ahmed S, Schwarz M, Flick RJ, Rees CA, Harawa M, Simon K, Robison JA, Kazembe PN, Kim MH. Lost opportunities to identify and treat HIV-positive patients: results from a baseline assessment of provider-initiated HIV testing and counselling (PITC) in Malawi. Trop Med Int Health 2016; 21:479-85. [PMID: 26806378 PMCID: PMC4881304 DOI: 10.1111/tmi.12671] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To assess implementation of provider-initiated testing and counselling (PITC) for HIV in Malawi. METHODS A review of PITC practices within 118 departments in 12 Ministry of Health (MoH) facilities across Malawi was conducted. Information on PITC practices was collected via a health facility survey. Data describing patient visits and HIV tests were abstracted from routinely collected programme data. RESULTS Reported PITC practices were highly variable. Most providers practiced symptom-based PITC. Antenatal clinics and maternity wards reported widespread use of routine opt-out PITC. In 2014, there was approximately 1 HIV test for every 15 clinic visits. HIV status was ascertained in 94.3% (5293/5615) of patients at tuberculosis clinics, 92.6% (30,675/33,142) of patients at antenatal clinics and 49.4% (6871/13,914) of patients at sexually transmitted infection clinics. Reported challenges to delivering PITC included test kit shortages (71/71 providers), insufficient physical space (58/71) and inadequate number of HIV counsellors (32/71) while providers from inpatient units cited the inability to test on weekends. CONCLUSIONS Various models of PITC currently exist at MoH facilities in Malawi. Only antenatal and maternity clinics demonstrated high rates of routine opt-out PITC. The low ratio of facility visits to HIV tests suggests missed opportunities for HIV testing. However, the high proportion of patients at TB and antenatal clinics with known HIV status suggests that routine PITC is feasible. These results underscore the need to develop clear, standardised PITC policy and protocols, and to address obstacles of limited health commodities, infrastructure and human resources.
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Affiliation(s)
- Saeed Ahmed
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Monica Schwarz
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Robert J Flick
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,University of Colorado School of Medicine, Denver, CO, USA.,University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Chris A Rees
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Mwelura Harawa
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Katie Simon
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Jeff A Robison
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Peter N Kazembe
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Maria H Kim
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Kayigamba FR, Van Santen D, Bakker MI, Lammers J, Mugisha V, Bagiruwigize E, De Naeyer L, Asiimwe A, Schim Van Der Loeff MF. Does provider-initiated HIV testing and counselling lead to higher HIV testing rate and HIV case finding in Rwandan clinics? BMC Infect Dis 2016; 16:26. [PMID: 26809448 PMCID: PMC4727293 DOI: 10.1186/s12879-016-1355-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 01/18/2016] [Indexed: 11/10/2022] Open
Abstract
Background Provider-initiated HIV testing and counselling (PITC) is promoted as a means to increase HIV case finding. We assessed the effectiveness of PITC to increase HIV testing rate and HIV case finding among outpatients in Rwandan health facilities (HF). Methods PITC was introduced in six HFs in 2009-2010. HIV testing rate and case finding were compared between phase 1 (pre-PITC) and phase 3 (PITC period) for outpatient-department (OPD) attendees only, and for OPD and voluntary counseling & testing (VCT) departments combined. Results Out of 26,367 adult OPD attendees in phase 1, 4.7 % were tested and out of 29,864 attendees in phase 3, 17.0 % were tested (p < 0.001). The proportion of HIV cases diagnosed was 0.25 % (67/26,367) in phase 1 and 0.46 % (136/29864) in phase 3 (p < 0.001). In multivariable analysis, both testing rate and case finding were significantly higher in phase 3 for OPD attendees. In phase 1 most of the HIV testing was done in VCT departments rather than at the OPD (78.6 % vs 21.4 % respectively); in phase 3 this was reversed (40.0 % vs 60.0 %; p < 0.001). In a combined analysis of VCT and OPD attendees, testing rate increased from 18.7 % in phase 1 to 25.4 % in phase 3, but case finding did not increase. In multivariable analysis, testing rate was significantly higher in phase 3 (OR 1.67; 95 % CI 1.60-1.73), but case finding remained stable (OR 1.09; 95 % CI 0.93-1.27). Conclusion PITC led to a shift of HIV testing from VCT department to the OPD, a higher testing rate, but no additional HIV case finding. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1355-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Daniëla Van Santen
- KIT Biomedical Research, Royal Tropical Institute (KIT), Amsterdam, The Netherlands. .,Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands.
| | - Mirjam I Bakker
- KIT Biomedical Research, Royal Tropical Institute (KIT), Amsterdam, The Netherlands.
| | - Judith Lammers
- Academic Medical Center (AMC), Amsterdam, The Netherlands.
| | - Veronicah Mugisha
- ICAP, Mailman School of Public Health, Columbia University, Kigali, Rwanda.
| | | | | | | | - Maarten F Schim Van Der Loeff
- Amsterdam Institute of Global Health and Development (AIGHD), Academic Medical Center (AMC), Amsterdam, The Netherlands. .,Center for Infection and Immunity Amsterdam (CINIMA), AMC, Amsterdam, The Netherlands. .,Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands.
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Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature 2015; 528:S77-85. [PMID: 26633769 DOI: 10.1038/nature16044] [Citation(s) in RCA: 379] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
HIV testing and counselling is the first crucial step for linkage to HIV treatment and prevention. However, despite high HIV burden in sub-Saharan Africa, testing coverage is low, particularly among young adults and men. Community-based HIV testing and counselling (testing outside of health facilities) has the potential to reduce coverage gaps, but the relative impact of different modalities is not well assessed. We conducted a systematic review of HIV testing modalities, characterizing community (home, mobile, index, key populations, campaign, workplace and self-testing) and facility approaches by population reached, HIV positivity, CD4 count at diagnosis and linkage. Of 2,520 abstracts screened, 126 met eligibility criteria. Community HIV testing and counselling had high coverage and uptake and identified HIV-positive people at higher CD4 counts than facility testing. Mobile HIV testing reached the highest proportion of men of all modalities examined (50%, 95% confidence interval (CI) = 47-54%) and home with self-testing reached the highest proportion of young adults (66%, 95% CI = 65-67%). Few studies evaluated HIV testing for key populations (commercial sex workers and men who have sex with men), but these interventions yielded high HIV positivity (38%, 95% CI = 19-62%) combined with the highest proportion of first-time testers (78%, 95% CI = 63-88%), indicating service gaps. Community testing with facilitated linkage (for example, counsellor follow-up to support linkage) achieved high linkage to care (95%, 95% CI = 87-98%) and antiretroviral initiation (75%, 95% CI = 68-82%). Expanding home and mobile testing, self-testing and outreach to key populations with facilitated linkage can increase the proportion of men, young adults and high-risk individuals linked to HIV treatment and prevention, and decrease HIV burden.
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Påfs J, Musafili A, Binder-Finnema P, Klingberg-Allvin M, Rulisa S, Essén B. 'They would never receive you without a husband': Paradoxical barriers to antenatal care scale-up in Rwanda. Midwifery 2015; 31:1149-56. [PMID: 26471934 DOI: 10.1016/j.midw.2015.09.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 08/30/2015] [Accepted: 09/21/2015] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To explore perspectives and experiences of antenatal care and partner involvement among women who nearly died during pregnancy ('near-miss'). DESIGN A study guided by naturalistic inquiry was conducted, and included extended in-community participant observation, semi-structured interviews, and focus group discussions. Qualitative data were collected between March 2013 and April 2014 in Kigali, Rwanda. FINDINGS All informants were aware of the recommendations of male involvement for HIV-testing at the first antenatal care visit. However, this recommendation was seen as a clear link in the chain of delays and led to severe consequences, especially for women without engaged partners. The overall quality of antenatal services was experienced as suboptimal, potentially missing the opportunity to provide preventive measures and essential health education intended for both parents. This seemed to contribute to women's disincentive to complete all four recommended visits and men's interest in attending to ensure their partners' reception of care. However, the participants experienced a restriction of men's access during subsequent antenatal visits, which made men feel denied to their increased involvement during pregnancy. CONCLUSIONS 'Near-miss' women and their partners face paradoxical barriers to actualise the recommended antenatal care visits. The well-intended initiative of male partner involvement counterproductively causes delays or excludes women whereas supportive men are turned away from further health consultations. Currently, the suboptimal quality of antenatal care misses the opportunity to provide health education for the expectant couple or to identify and address early signs of complications IMPLICATIONS FOR PRACTICE These findings suggest a need for increased flexibility in the antenatal care recommendations to encourage women to attend care with or without their partner, and to create open health communication about women's and men's real needs within the context of their social situations. Supportive partners should not be denied involvement at any stage of pregnancy, but should be received only upon consent of the expectant mother.
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Affiliation(s)
- Jessica Påfs
- Department of Women's and Children's Health/IMCH, Uppsala University, Akademiska Sjukhuset, SE-751 85 Uppsala, Sweden.
| | - Aimable Musafili
- Department of Women's and Children's Health/IMCH, Uppsala University, Akademiska Sjukhuset, SE-751 85 Uppsala, Sweden; Department of Pediatrics and Child Health, College of Medicine and Health Sciences, School of Medicine, University of Rwanda, P.O. Box 217, Butare, Huye, Rwanda
| | - Pauline Binder-Finnema
- Department of Women's and Children's Health/IMCH, Uppsala University, Akademiska Sjukhuset, SE-751 85 Uppsala, Sweden
| | - Marie Klingberg-Allvin
- School of Education, Health and Social Studies, Dalarna University, SE-791 88 Falun, Sweden
| | - Stephen Rulisa
- Department of Obstetrics & Gynecology, College of Medicine and Health Sciences, School of Medicine, University of Rwanda, P.O. Box 3286, Kigali, Rwanda; Department of Clinical Research, University Teaching Hospital of Kigali, BP 655 Kigali, Rwanda
| | - Birgitta Essén
- Department of Women's and Children's Health/IMCH, Uppsala University, Akademiska Sjukhuset, SE-751 85 Uppsala, Sweden
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Leidel S, Wilson S, McConigley R, Boldy D, Girdler S. Health-care providers' experiences with opt-out HIV testing: a systematic review. AIDS Care 2015; 27:1455-67. [PMID: 26272473 DOI: 10.1080/09540121.2015.1058895] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
HIV is now a manageable chronic disease with a good prognosis, but early detection and referral for treatment are vital. In opt-out HIV testing, patients are informed that they will be tested unless they decline. This qualitative systematic review explored the experiences, attitudes, barriers, and facilitators of opt-out HIV testing from a health-care provider (HCP) perspective. Four articles were included in the synthesis and reported on findings from approximately 70 participants, representing diverse geographical regions and a range of human development status and HIV prevalence. Two synthesized findings emerged: HCP attitudes and systems. The first synthesized finding encompassed HCP decision-making attitudes about who and when to test for HIV. It also included the assumptions the HCPs made about patient consequences. The second synthesized finding related to systems. System-related barriers to opt-out HIV testing included lack of time, resources, and adequate training. System-related facilitators included integration into standard practice, support of the medical setting, and electronic reminders. A common attitude among HCPs was the outdated notion that HIV is a terrible disease that equates to certain death. Some HCPs stated that offering the HIV test implied that the patient had engaged in immoral behaviour, which could lead to stigma or disengagement with health services. This paternalism diminished patient autonomy, because patients who were excluded from opt-out HIV testing could have benefited from it. One study highlighted the positive aspects of opt-out HIV testing, in which participants underscored the professional satisfaction that arose from making an HIV diagnosis, particularly when marginalized patients could be connected to treatment and social services. Recommendations for opt-out HIV testing should be disseminated to HCPs in a broad range of settings. Implementation of system-related factors such as electronic reminders and care coordination procedures should be considered, and a social-justice commitment among HCPs should be encouraged.
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Affiliation(s)
- Stacy Leidel
- a School of Nursing and Midwifery , Curtin University , Perth , Australia
| | - Sally Wilson
- a School of Nursing and Midwifery , Curtin University , Perth , Australia
| | - Ruth McConigley
- a School of Nursing and Midwifery , Curtin University , Perth , Australia
| | - Duncan Boldy
- a School of Nursing and Midwifery , Curtin University , Perth , Australia
| | - Sonya Girdler
- b School of Occupational Therapy and Social Work , Curtin University , Perth , Australia
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