Antiretroviral therapy program expansion in Zambézia Province, Mozambique: geospatial mapping of community-based and health facility data for integrated health planning

Spatial Analysis of the Alcohol, Intimate Partner Violence, and HIV Syndemic Among Women in South Africa

The co-occurrence of and synergistic interactions between substance abuse, violence, and HIV, known as the "SAVA syndemic," is thought to be a driver of women's elevated risk for HIV in sub-Saharan Africa. This study uses data from the 2016 South African Demographic and Health Survey (DHS) and the 2016 South African Census to examine geospatial associations between alcohol use, intimate partner violence (IPV), unprotected sex, and HIV status among a population-based sample of 8528 South African women (age 15-49). Results support the geographic clustering of alcohol use, unprotected sex, and IPV, but not HIV, and geospatial clustering of HIV alone. This study highlights the need for geographically-tailored interventions to address syndemics through integrated interventions, such as those simultaneously focused on alcohol, IPV, and sexual risk reduction, and points to the need for more targeted research to link these factors to HIV from a place-based risk perspective.

A longitudinal qualitative evaluation of an economic and social empowerment intervention to reduce girls' vulnerability to HIV in rural Mozambique

PURPOSE

An intervention including business training and health education was implemented in Mozambique, where girls are at elevated risk for acquiring HIV. As part of a mixed-methods evaluation, we describe perceived effects of the intervention on girls' sexual behavior and school attendance.

METHODS

We conducted 49 in-depth interviews (IDIs) with girl intervention participants (ages 13-19), 24 IDIs with heads of girls' households, 36 IDIs with influential males identified by girls, and 12 focus group discussions with community members after the intervention ended and one year later.

RESULTS

Informants said the primary intervention benefit was realized when girls had money to stay in or return to school and/or to buy necessities for themselves and their households-reducing their need for transactional or intergenerational sex. However, some girls did not make a profit and some businesses were not sustainable. Sometimes the intervention appeared to be implemented in a way to reinforce inequitable gender norms resulting in some girls feeling shame when they reengaged in risky sex after their businesses failed.

CONCLUSIONS

Earning money enabled girls to potentially reduce their vulnerability to HIV. We offer recommendations for future multi-sector interventions, including the need to address potential harms in programs serving vulnerable girls.

Geographic Information Systems, spatial analysis, and HIV in Africa: A scoping review

INTRODUCTION

Geographic Information Systems (GIS) and spatial analysis are emerging tools for global health, but it is unclear to what extent they have been applied to HIV research in Africa. To help inform researchers and program implementers, this scoping review documents the range and depth of published HIV-related GIS and spatial analysis research studies conducted in Africa.

METHODS

A systematic literature search for articles related to GIS and spatial analysis was conducted through PubMed, EMBASE, and Web of Science databases. Using pre-specified inclusion criteria, articles were screened and key data were abstracted. Grounded, inductive analysis was conducted to organize studies into meaningful thematic areas.

RESULTS AND DISCUSSION

The search returned 773 unique articles, of which 65 were included in the final review. 15 different countries were represented. Over half of the included studies were published after 2014. Articles were categorized into the following non-mutually exclusive themes: (a) HIV geography, (b) HIV risk factors, and (c) HIV service implementation. Studies demonstrated a broad range of GIS and spatial analysis applications including characterizing geographic distribution of HIV, evaluating risk factors for HIV, and assessing and improving access to HIV care services.

CONCLUSIONS

GIS and spatial analysis have been widely applied to HIV-related research in Africa. The current literature reveals a diversity of themes and methodologies and a relatively young, but rapidly growing, evidence base.

Individual factors associated with time to non-adherence to ART pick-up within HIV care and treatment services in three health facilities of Zambézia Province, Mozambique

Introduction

Mozambique has made significant gains in addressing its HIV epidemic, yet adherence to visit schedules remains a challenge. HIV programmatic gains to date could be impaired if adherence and retention to ART remains low. We investigate individual factors associated with non-adherence to ART pick-up in Mozambique.

Methods

This was a retrospective cohort of patients initiating ART between January 2013 and June 2014. Non-adherence to ART pick-up was defined as a delay in pick-up ≥ 15 days. Descriptive statistics were used to calculate socio-demographic and clinical characteristics. Adherence to ART pick-up was assessed using Kaplan Meier estimates. Cox proportional hazards model was used to determine factors associated with non-adherence.

Results

1,413 participants were included (77% female). Median age was 30.4 years. 19% of patients remained adherent to ART pick-up during the evaluation period, while 81% of patients were non-adherent to ART pick-up. Probability of being non-adherent to ART pick-up by 166 days following initiation was 50%. In univariate analysis, being widowed was associated with higher adherence to ART pick-up than other marital status groups (p = 0.01). After adjusting, being ≥35 years (aHR: 0.843, 95% CI: 0.738–0.964, p = 0.012); receiving efavirenz (aHR: 0.932, 95% CI: 0.875–0.992, p = 0.026); and being urban (aHR: 0.754, 95% CI: 0.661–0.861, p<0.0001) were associated with improved adherence. Non-participation in a Community ART Support Group (CASG) was associated with a 43% increased hazard of non-adherence to ART pick-up (aHR 1.431, 1.192–1.717, p<0.0001)

Conclusions

Interventions should focus on the first 6 months following ARV initiation for improvements. Younger persons and widows are two target groups for better understanding facilitators and barriers to visit schedule adherence. Future strategies should explore the benefits of joining CASGs earlier in one´s treatment course. Finally, greater efforts should be made to accelerate the scale-up of viral load capacity and HIV resistance monitoring.