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Sayinzoga F, Hirschhorn LR, Ntawukuriryayo JT, Beyer C, Donahoe KB, Binagwaho A. Understanding rapid implementation from discovery to scale: Rwanda's implementation of rotavirus vaccines and PMTCT in the quest to reduce under-5 mortality. BMC Pediatr 2024; 23:649. [PMID: 38413897 PMCID: PMC10900536 DOI: 10.1186/s12887-023-03888-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/03/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Over the last eight decades, many evidence-based interventions (EBIs) have been developed to reduce amenable under-5 mortality (U5M). Implementation research can help reduce the lag between discovery and delivery, including as new EBIs emerge, or as existing ones are adapted based on new research. Rwanda was the first low-income African country to implement the rotavirus vaccine (RTV) and also adopted Option B+ for effective prevention of mother-to-child transmission (PMTCT) before the World Health Organization's (WHO) recommendation. We use implementation research to identify contextual factors and strategies associated with Rwanda's rapid uptake of these two EBIs developed or adapted during the study period. METHODS We conducted a mixed methods case study informed by a hybrid implementation research framework to understand how Rwanda outperformed regional and economic peers in reducing U5M, focusing on the implementation of health system-delivered EBIs. The research included review of existing literature and data, and key informant interviews to identify implementation strategies and contextual factors that influenced implementation outcomes. We extracted relevant results from the broader case study and used convergent methods to understand successes and challenges of implementation of RTV, a newly introduced EBI, and PMTCT, an adapted EBI reflecting new research. RESULTS We found several cross-cutting strategies that supported the rapid uptake and implementation of PMTCT, RTV, and leveraging facilitating contextual factors and identifying and addressing challenging ones. Key implementation strategies included community and stakeholder involvement and education, leveraging of in-country research capacity to drive adoption and adaptation, coordination of donors and implementing partners, data audit and feedback of coverage, a focus on equity, and integration into pre-existing systems, including community health workers and primary care. The availability of donor funding, culture of evidence-based decision-making, preexisting accountability systems, and rapid adoption of innovation were facilitating contextual factors. CONCLUSION Implementation strategies which are generalizable to other settings were key to success in rapidly achieving high acceptability and coverage of both a new and an evolving EBI. Choosing strategies which leverage their facilitating factors and address barriers are important for other countries working to accelerate uptake of new EBIs and implement needed adaptations based on emerging evidence.
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Affiliation(s)
| | - Lisa R Hirschhorn
- University of Global Health Equity, Kigali, Rwanda
- Northwestern University Feinberg School of Medicine, Chicago, USA
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Deynu M, Nutor JJ. Determinants of comprehensive knowledge on mother-to-child transmission of HIV and its prevention among childbearing women in Rwanda: insights from the 2020 Rwandan Demographic and Health Survey. BMC Public Health 2023; 23:5. [PMID: 36593470 PMCID: PMC9809025 DOI: 10.1186/s12889-022-14925-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Maternal knowledge on mother-to-child transmission (MTCT) and its prevention has been identified to enhance maternal testing and adherence to antiretroviral therapy (ART) regimen. Examining prevalence and associated factors on MTCT and its prevention among women provides empirical evidence for design and implementation of health strategies aimed at increasing MTCT knowledge and its elimination. This study therefore examined women's comprehensive knowledge and associated factors on MTCT and its prevention among childbearing women in Rwanda. METHODS Analysis was conducted on a weighted sample of 14,634 women from the 2020 Rwanda Demographic and Health Survey (RDHS). Dataset cleaning and missing value analysis was conducted. Chi square, bivariate and multivariable regression was then conducted in complex samples in SPSS. Alpha level set at p < 0.05 and at 95% Confidence Interval (95% CI). All analysis were adjusted for unequal probability sampling using survey weights. Bivariate and multivariable results were reported with crude and adjusted odds ratios. RESULTS The mean age was 29.2 years, SD-9.1. Prevalence of HIV testing and comprehensive knowledge on MTCT and its prevention among women in Rwanda was 79.6% and 65.1% respectively. Findings from this study showed that married women have higher odds (aOR = 1.18, 95% CI = 1.04-1.35) of comprehensive knowledge on MTCT and its prevention compared to those unmarried. Women who were living in southern (aOR = 1.23, 95%CI = 1.02-1.48) and eastern (aOR = 1.37, 95% CI = 1.13-1.66) parts of Rwanda were more likely to have adequate knowledge on MTCT of HIV and its prevention than those in Kigali. Also, women who received post-test counselling (aOR = 1.26, 95% CI = 1.01-2.11) have increased knowledge on MTCT than those who did not. Women with access to radio (aOR = 1.18, 95% CI = 1.06-1.32) and television (aOR = 1.25, 95% CI = 1.07-1.45) at least once a week were more likely to have adequate knowledge on MTCT and its prevention compared to those who do not in Rwanda. CONCLUSION There is inadequate knowledge on MTCT and its elimination among women of reproductive age in Rwanda. Strategies to enhance knowledge on MTCT and its prevention among childbearing women should be adopted through rigorous educational sensitization campaigns using local media such as radio and television. Health services that focus on prevention of MTCT must emphasize post-test counselling.
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Affiliation(s)
| | - Jerry John Nutor
- grid.266102.10000 0001 2297 6811Family Health Care Nursing Department, School of Nursing, University of California, San Francisco, 2 Koret Way, CA San Francisco, USA
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Nahirney M, Grist J, Namasopo S, Brophy J, Hawkes MT. Evolution of prevention of vertical
HIV
transmission in Uganda: 2008–2017. HIV Med 2022; 24:605-615. [PMID: 36451299 DOI: 10.1111/hiv.13449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES Uganda adapted its policy for prevention of vertical transmission (VT) of HIV transmission as the World Health Organization released Options A, B and B+. We assessed trends in diagnostic testing, breastfeeding practices, maternal and infant antiretroviral therapy (ART), mortality, VT and HIV-free survival (HFS) among Ugandan infants born to women living with HIV during this period of successive guideline changes. METHODS This is is a retrospective observational study of infants attending early infant diagnosis clinics at two Ugandan hospitals. RESULTS A total of 1885 infants (48% female) were managed from 2009 to 2017. DNA polymerase chain reaction (PCR) for early infant diagnosis was performed on 1719 infants (92%, one or more PCR tests) and 676 infants (36%, two PCR tests). HIV serology was performed on 90 infants (4.8%). Testing increased over the study period but remained suboptimal, due to high loss to follow-up (LTFU). A total of 93% of infants were breastfed, for a median of 9.5 months. The duration of breast milk exposure increased over the study period, consistent with guidelines that increasingly encouraged breastfeeding. Nine cases (0.48%) of suspected breast milk transmission were observed. The use of ART increased significantly over the study period. Mortality (3.5%, 2.7% and 1.1%; p = 0.0076) and VT (17%, 12% and 7.4%; p < 0.0001) decreased over the study period (2008-2010, 2011-2012 and 2013-2017, respectively). LTFU values were 31%, 49% and 59% at 6, 12 and 18 months of age, respectively, with only modest improvements over time. HFS could only be conclusively documented in 532 infants (28%) because of LTFU. CONCLUSIONS From 2009 to 2017, outcomes improved among HIV-exposed infants in Uganda. LTFU remains a barrier to optimal care.
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Affiliation(s)
- Marissa Nahirney
- Department of Pediatrics University of Alberta Edmonton Alberta Canada
| | - Jesse Grist
- Department of Pediatrics University of Alberta Edmonton Alberta Canada
| | | | - Jason Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario University of Ottawa Ottawa Ontario Canada
| | - Michael T. Hawkes
- Department of Pediatrics University of Alberta Edmonton Alberta Canada
- Department of Medical Microbiology and Immunology University of Alberta Edmonton Alberta Canada
- Department of Global Health, School of Public Health University of Alberta Edmonton Alberta Canada
- Distinguished Researcher, Stollery Science Lab University of Alberta Edmonton Alberta Canada
- Member, Women and Children's Health Research Institute University of Alberta Edmonton Alberta Canada
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Tang X, Chen W, Tang SQ, Zhao PZ, Ling L, Wang C. The evaluation of preventive and control measures on congenital syphilis in Guangdong Province, China: a time series modeling study. Infection 2022; 50:1179-1190. [PMID: 35301682 PMCID: PMC9522686 DOI: 10.1007/s15010-022-01791-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/24/2022] [Indexed: 11/18/2022]
Abstract
Purpose To evaluate the effectiveness of preventive and control measures for congenital syphilis (CS) implemented since 2012 in Guangdong Province, China, and assess the epidemic trend in the near future. Methods The interrupted time series analysis was conducted to compare changes in slope and level of CS notification rate from 2005 to 2020 in Guangdong Province and its three regions with different economic developmental levels. The ARIMA model was established to predict the new CS case number of Guangdong Province in 2021. Results A total of 12,687 CS cases were reported from 2005 to 2020. The CS notification rate of the province had been increasing until 2012 (128.55 cases per 100,000 live births) and then been decreasing constantly, hitting the lowest point in 2020 (5.76 cases per 100,000 live births). The severe epidemic cluster shifted from the developed region to underdeveloped ones over time. The effectiveness of the measures was proved by the significant change in the slope of the notification rate which was found in both of the provinces (− 18.18, 95% CI − 25.63 to − 10.75) and two less-developed regions (− 10.49, 95% CI − 13.13 to − 7.86 and − 32.89, 95% CI − 41.67 to − 24.10, respectively). In the developed region where the notification rate had already been decreasing in the pre-implementation period, implementing these measures also aided in hastening the rate of descent. The CS case number in 2021 was predicted to be 48, indicating a low-level epidemic. Conclusions The preventive and control measures have assisted Guangdong Province to control CS effectively, of which the supportive ones ensured a successful implementation. For resource-limited countries where CS is still endemic, especially guaranteeing the support in financial subsidy, professional training, supervision and so on might trigger the effectiveness of other measures and eventually make significant and sustainable progress. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-022-01791-1.
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Affiliation(s)
- XiJia Tang
- School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Wen Chen
- School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Shang Qing Tang
- School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.,Sun-Yat Sen University Cancer Center, Guangzhou, 510080, Guangdong, China
| | - Pei Zhen Zhao
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China.,Institute for Global Health and Sexually Transmitted Disease, Southern Medical University, Guangzhou, 510091, Guangdong, China
| | - Li Ling
- School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.
| | - Cheng Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China. .,Institute for Global Health and Sexually Transmitted Disease, Southern Medical University, Guangzhou, 510091, Guangdong, China.
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Chopra K, Yadav R, Jaiswal N. Study of impact of WHO option B+ on maternal and perinatal outcome in HIV-positive women delivering at a tertiary care hospital, Delhi. Indian J Sex Transm Dis AIDS 2022; 43:90-91. [PMID: 35846524 PMCID: PMC9282693 DOI: 10.4103/ijstd.ijstd_24_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/17/2021] [Accepted: 09/16/2021] [Indexed: 11/15/2022] Open
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Remera E, Chammartin F, Nsanzimana S, Forrest JI, Smith GE, Mugwaneza P, Malamba SS, Semakula M, Condo JU, Ford N, Riedel DJ, Nisingizwe MP, Binagwaho A, Mills EJ, Bucher H. Child mortality associated with maternal HIV status: a retrospective analysis in Rwanda, 2005-2015. BMJ Glob Health 2021; 6:e004398. [PMID: 33975886 PMCID: PMC8118007 DOI: 10.1136/bmjgh-2020-004398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Child mortality remains highest in regions of the world most affected by HIV/AIDS. The aim of this study was to assess child mortality rates in relation to maternal HIV status from 2005 to 2015, the period of rapid HIV treatment scale-up in Rwanda. METHODS We used data from the 2005, 2010 and 2015 Rwanda Demographic Health Surveys to derive under-2 mortality rates by survey year and mother's HIV status and to build a multivariable logistic regression model to establish the association of independent predictors of under-2 mortality stratified by mother's HIV status. RESULTS In total, 12 010 live births were reported by mothers in the study period. Our findings show a higher mortality among children born to mothers with HIV compared with HIV negative mothers in 2005 (216.9 vs 100.7 per 1000 live births) and a significant reduction in mortality for both groups in 2015 (72.0 and 42.4 per 1000 live births, respectively). In the pooled reduced multivariable model, the odds of child mortality was higher among children born to mothers with HIV, (adjusted OR, AOR 2.09; 95% CI 1.57 to 2.78). The odds of child mortality were reduced in 2010 (AOR 0.69; 95% CI 0.59 to 0.81) and 2015 (AOR 0.35; 95% CI 0.28 to 0.44) compared with 2005. Other independent predictors of under-2 mortality included living in smaller families of 1-2 members (AOR 5.25; 95% CI 3.59 to 7.68), being twin (AOR 4.93; 95% CI 3.51 to 6.92) and being offspring from mothers not using contraceptives at the time of the survey (AOR 1.6; 95% CI 1.38 to 1.99). Higher education of mothers (completed primary school: (AOR 0.74; 95% CI 0.64 to 0.87) and secondary or higher education: (AOR 0.53; 95% CI 0.38 to 0.74)) was also associated with reduced child mortality. CONCLUSIONS This study shows an important decline in under-2 child mortality among children born to both mothers with and without HIV in Rwanda over a 10-year span.
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Affiliation(s)
- Eric Remera
- Institute of HIV, Disease Prevention and Control, Rwanda Biomedical Center, Gasabo, City of Kigali, Rwanda
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Basel Institute for Clinical Epidemiology and Biostatistics Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Global Health Equity, Kigali, Rwanda
| | - Frédérique Chammartin
- University of Basel, Basel, Switzerland
- Basel Institute for Clinical Epidemiology and Biostatistics Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Sabin Nsanzimana
- Institute of HIV, Disease Prevention and Control, Rwanda Biomedical Center, Gasabo, City of Kigali, Rwanda
- University of Global Health Equity, Kigali, Rwanda
| | - Jamie Ian Forrest
- The University of British Columbia School of Population and Public Health, Vancouver, British Columbia, Canada
| | | | - Placidie Mugwaneza
- Institute of HIV, Disease Prevention and Control, Rwanda Biomedical Center, Gasabo, City of Kigali, Rwanda
| | | | - Muhammed Semakula
- Institute of HIV, Disease Prevention and Control, Rwanda Biomedical Center, Gasabo, City of Kigali, Rwanda
- Center for Excellence in Data Science, University of Rwanda - Kigali Campus, Kigali, Rwanda
- Centre for Statistics, Hasselt University Faculty of Business Economics, Hasselt, Limburg, Belgium
| | - Jeanine U Condo
- National University of Rwanda School of Public Health, Kigali, Rwanda
- Tulane University, New Orleans, Louisiana, USA
| | - Nathan Ford
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - David J Riedel
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Marie Paul Nisingizwe
- The University of British Columbia School of Population and Public Health, Vancouver, British Columbia, Canada
| | | | - Edward J Mills
- Cytel, Vancouver, British Columbia, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Heiner Bucher
- University of Basel, Basel, Switzerland
- Basel Institute for Clinical Epidemiology and Biostatistics Department of Clinical Research, University Hospital Basel, Basel, Switzerland
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Remera E, Mugwaneza P, Chammartin F, Mulindabigwi A, Musengimana G, Forrest JI, Mwanyumba F, Kondwani N, Condo JU, Riedel DJ, Mills EJ, Nsanzimana S, Bucher HC. Towards elimination of mother-to-child transmission of HIV in Rwanda: a nested case-control study of risk factors for transmission. BMC Pregnancy Childbirth 2021; 21:339. [PMID: 33910502 PMCID: PMC8082927 DOI: 10.1186/s12884-021-03806-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mother-to-child HIV transmission (MTCT) has substantially declined since the scale-up of prevention programs around the world, including Rwanda. To achieve full elimination of MTCT, it is important to understand the risk factors associated with residual HIV transmission, defined as MTCT at the population-level that still occurs despite universal access to PMTCT. METHODS We performed a case control study of children born from mothers with HIV with known vital status at 18 months from birth, who were followed in three national cohorts between October and December 2013, 2014, and 2015 in Rwanda. Children with HIV were matched in a ratio of 1:2 with HIV-uninfected children and a conditional logistic regression model was used to investigate risk factors for MTCT. RESULTS In total, 84 children with HIV were identified and matched with 164 non-infected children. The median age of mothers from both groups was 29 years (interquartile range (IQR): 24-33). Of these mothers, 126 (51.4 %) initiated antiretroviral therapy (ART) before their pregnancy on record. In a multivariable regression analysis, initiation of ART in the third trimester (Adjusted Odds Ratio [aOR]: 9.25; 95 % Confidence Interval [95 % CI]: 2.12-40.38) and during labour or post-partum (aOR: 8.87; 95 % CI: 1.92-40.88), compared to initiation of ART before pregnancy, increased the risk of MTCT. Similarly, offspring of single mothers (aOR: 7.15; 95 % CI: 1.15-44.21), and absence of postpartum neonatal ART prophylaxis (aOR: 7.26; 95 % CI: 1.66-31.59) were factors significantly associated with MTCT. CONCLUSIONS Late ART initiation for PMTCT and lack of postpartum infant prophylaxis are still the most important risk factors to explain MTCT in the era of universal access. Improved early attendance at antenatal care, early ART initiation, and enhancing the continuum of care especially for single mothers is crucial for MTCT elimination in Rwanda.
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Affiliation(s)
- Eric Remera
- Institute of HIV Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda. .,Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Placidie Mugwaneza
- Institute of HIV Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Frédérique Chammartin
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Augustin Mulindabigwi
- Institute of HIV Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Gentille Musengimana
- Institute of HIV Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Jamie I Forrest
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Fabian Mwanyumba
- United Nations International Children's Emergency Fund, Kampala, Uganda
| | - Ng'oma Kondwani
- United Nations International Children's Emergency Fund, Kigali, Rwanda
| | - Jeanine U Condo
- School of Public Health, College of Medicine & Health Sciences, University of Rwanda, Kigali, Rwanda.,Tulane University, New Orleans, USA
| | - David J Riedel
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Edward J Mills
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Sabin Nsanzimana
- Institute of HIV Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Tarigan YN, Woodman RJ, Miller ER, Wisaksana R, Ward PR. Impact of strategic use of antiretroviral therapy intervention to the HIV continuum of care in 13 cities in Indonesia: an interrupted time series analysis. AIDS Res Ther 2021; 18:22. [PMID: 33902631 PMCID: PMC8074419 DOI: 10.1186/s12981-021-00340-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/08/2021] [Indexed: 12/01/2022] Open
Abstract
Background In 2013 the Indonesian government introduced the strategic use of antiretroviral therapy (SUFA) initiative of expanding access to HIV test and treatment, to help achieve the UNAIDS 90–90–90 targets. However, there has been no comprehensive evaluation of the impact of this intervention in Indonesia. We conducted an interrupted time series (ITS) analysis across 6-years to assess its immediate and medium-term impact. Methods Monthly aggregated HIV data from all HIV care clinics for persons aged ≥ 15 years were collected from 13 pilot cities. The data period encompassed 3-years prior to SUFA (26 Dec 2010–25 Dec 2013) and 3-years post-SUFA (26 Dec 2013–25 Dec 2016). The ITS was performed using a multilevel negative binomial regression model to assess the immediate and trend changes in each stage of the HIV continuum of care. Results In the pre-SUFA period, the overall coverage in the respective risk populations for HIV tests, cases, enrolments, eligible cases and ARV initiation were 1.0%, 8.6%, 98.9%, 76.9% and 75.8% respectively. In the post-SUFA period coverage was 3%, 3.8%, 98.6%, 90.3% and 81.2% respectively—with a significant increase in the median number of HIV tests, HIV cases, those eligible for ARV treatment and treatment initiation (p < 0.05 for each). The ITS analysis demonstrated immediate increases in HIV tests (IRR = 1.41, 95% CI 1.25, 1.59; p < 0.001) and an immediate decrease in detected HIV cases per person tested (IRR = 0.77, 95% CI 0.69–0.86; p < 0.001) in the month following commencement of SUFA. There was also a 3% decline in the monthly trend for HIV tests performed (IRR = 0.97; 95% CI 0.97–0.98, p < 0.001), a 1% increase for detected cases (IRR = 1.01, 95% CI 1.0–1.02, p < 0.001), and a 1% decline for treatment initiation (IRR = 0.99,95% CI 0.99–1.0 p < 0.05). Conclusions SUFA was associated with an immediate and sustained increase in the absolute number of HIV tests performed, detected HIV cases, and close to complete coverage of detected cases that were enrolled to care and defined as eligible for treatment. However, treatment initiation remained sub-optimal. The findings of this study provide valuable information on the real-world effect of accelerating ARV utilizing Treatment as Prevention for the full HIV continuum of care in limited resource countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12981-021-00340-4.
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Kisigo GA, Ngocho JS, Knettel BA, Oshosen M, Mmbaga BT, Watt MH. "At home, no one knows": A qualitative study of retention challenges among women living with HIV in Tanzania. PLoS One 2020; 15:e0238232. [PMID: 32853233 PMCID: PMC7451655 DOI: 10.1371/journal.pone.0238232] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 08/12/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Despite the broad success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs, HIV care engagement during the pregnancy and postpartum periods is suboptimal. This study explored the perspectives of women who experienced challenges engaging in PMTCT care, in order to better understand factors that contribute to poor retention and to identify opportunities to improve PMTCT services. METHODS We conducted in-depth interviews with 12 postpartum women to discuss their experiences with PMTCT care. We used data from a larger longitudinal cohort study conducted in five PMTCT clinics in Moshi, Tanzania to identify women with indicators of poor care engagement (i.e., medication non-adherence, inconsistent clinic attendance, or high viral load). Women who met one of these criteria were contacted by telephone and invited to complete an interview. Data were analyzed using applied thematic analysis. RESULTS We observed a common pathway that fear of stigma contributed to a lack of HIV disclosure and reduced social support for seeking HIV care. Women commonly distrusted the results of their initial HIV test and reported medication side effects after care initiation. Women also reported barriers in the health system, including difficult-to-navigate clinic transfer policies and a lack of privacy and confidentiality in service provision. When asked how care might be improved, women felt that improved counseling and follow-up, affirming patient-provider interactions, and peer treatment supporters would have a positive effect on care engagement. CONCLUSION In order to improve the impact of PMTCT programs, there is a need to implement active tracking and follow-up of patients, targeting individuals with evidence of poor care engagement. Tailored supportive intervention approaches may help patients to cope with both the perceived and actual impacts of HIV stigma, including navigating disclosures to loved ones and accessing social support. Fostering HIV acceptance is likely to facilitate commitment to long-term treatment.
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Affiliation(s)
- Godfrey A. Kisigo
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - James S. Ngocho
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Brandon A. Knettel
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Martha Oshosen
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- The University of Cape Town, Cape Town, South Africa
| | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Melissa H. Watt
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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Nguyen RN, Ton QC, Tran QH, Nguyen TKL. <p>Mother-to-Child Transmission of HIV and Its Predictors Among HIV-Exposed Infants at an Outpatient Clinic for HIV/AIDS in Vietnam</p>. HIV AIDS (Auckl) 2020; 12:253-261. [PMID: 32765117 PMCID: PMC7371555 DOI: 10.2147/hiv.s259592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/28/2020] [Indexed: 11/26/2022] Open
Abstract
Background Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is decreasing worldwide; however, achieving the MTCT elimination target of 2% by 2020 and 0% by 2030 is challenging in resource-limited countries. The purpose of this study is to determine the evolution of the HIV transmission rate in infants from 2007 to 2018 and to identify the risk factors of HIV transmission among HIV-exposed infants in Vietnam. Patients and Methods A prospective cohort study of 608 HIV-exposed infants was conducted at the Pediatric Outpatient Clinic (pOPC) of the Women and Children Hospital of An Giang, Vietnam between September 2007 and December 2019. A follow-up registration book was used to collect data, which were entered into Microsoft Excel and analyzed by SPSS version 22.0. Both bivariate and multivariate analyses were carried out to identify associations. Results A total of 608 HIV-exposed infant were enrolled in the study, of which 472 were included in the final analysis. The median age of infants at enrollment to follow-up was 6.3 weeks (interquartile range [IQR]=6.0–6.9 weeks). A total of 42 infants out of 472 were infected with HIV, giving an overall MTCT rate of 8.9% (95% confidence interval (CI)=6.4–12.0). The transmission rate decreased from 27.9% in 2007 to 0% in 2018. Absence of maternal ARV (antiretrovirals) intervention before or during pregnancy (AOR=40.6, 95% CI=5.5–308) and absence of ARV prophylaxis for HIV-exposed infants (AOR=3.4, 95% CI=1.1–10.3) were significantly and independently associated with MTCT of HIV in this study. Conclusion There is a significant progress on the reduction of MTCT rate in An Giang, Vietnam. Absence of ART interventions for mothers and infants are significant factors associated with HIV transmission. Providing free ARV and increasing the coverage of ARV intervention for pregnant women are keys for reducing the MTCT rate in the future.
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Affiliation(s)
- Rang Ngoc Nguyen
- Department of Pediatrics, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
- Women and Children Hospital of an Giang, An Giang, Vietnam
- Correspondence: Rang Ngoc Nguyen Tel +84 913106404 Email
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Kisigo GA, Manavalan P, Cichowitz C, Knettel BA, Mmbaga BT, Watt MH. Experiences of Fetal or Infant Loss among Tanzanian Women in HIV Care. JOURNAL OF LOSS & TRAUMA 2019; 24:625-635. [PMID: 34305478 PMCID: PMC8299521 DOI: 10.1080/15325024.2019.1600850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/24/2019] [Indexed: 10/26/2022]
Abstract
This study examined the impact of fetal or infant loss on HIV care engagement. We conducted semi-structured interviews with 15 HIV-infected women who experienced fetal or infant loss while enrolled in prevention of mother-to-child transmission (PMTCT) services in Tanzania. Women attributed the loss to delays in receiving healthcare. Provider communication about the cause of the loss was poor, and women reported substantial distress related to the loss. One-fifth reported gaps in HIV care or disengagement from care following their loss. Loss of a fetus or infant is not uncommon in HIV endemic settings, and should be integrated into PMTCT guidelines.
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Affiliation(s)
- Godfrey A Kisigo
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Cody Cichowitz
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi Tanzania
| | - Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, NC, USA
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