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Claassen CW, Kafunda I, Mwango L, Shiyanda S, Stoebenau K, Gekanju-Toeque M, Lindsay B, Adebayo O, Sinjani M, Kaayunga C, Wa Banza PK, Mweebo K, Kancheya N, Musokotwane K, Mwila A, Monze N, Nichols BE, Blanco N, Lavoie MCC, Watson DC, Hachaambwa L, Sheneberger R. Achieving HIV Epidemic Control and Improving Maternal Healthcare Services with Community-Based HIV Service Delivery in Zambia: Mixed-Methods Assessment of the SMACHT Project. AIDS Behav 2023; 27:3571-3583. [PMID: 37204561 PMCID: PMC11252556 DOI: 10.1007/s10461-023-04071-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Abstract
Novel community-based approaches are needed to achieve and sustain HIV epidemic control in Zambia. Under the Stop Mother and Child HIV Transmission (SMACHT) project, the Community HIV Epidemic Control (CHEC) differentiated service delivery model used community health workers to support HIV testing, ART linkage, viral suppression, and prevention of mother-to-child transmission (MTCT). A multi-methods assessment included programmatic data analysis from April 2015 to September 2020, and qualitative interviews from February to March 2020. CHEC provided HIV testing services to 1,379,387 clients; 46,138 were newly identified as HIV-positive (3.3% yield), with 41,366 (90%) linked to ART. By 2020, 91% (60,694/66,841) of clients on ART were virally suppressed. Qualitatively, healthcare workers and clients benefitted from CHEC, with provision of confidential services, health facility decongestion, and increased HIV care uptake and retention. Community-based models can increase uptake of HIV testing and linkage to care, and help achieve epidemic control and elimination of MTCT.
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Affiliation(s)
- Cassidy W Claassen
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA.
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia.
- MGIC-Zambia, Plot 31C. Bishops Road. Kabulonga, P/B E017, Post-Net Box 319 Crossroads, Lusaka, Zambia.
| | - Ina Kafunda
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | | | - Steven Shiyanda
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | | | - Mona Gekanju-Toeque
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Brianna Lindsay
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | | | - Msangwa Sinjani
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | | | | | - Keith Mweebo
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Nzali Kancheya
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | - Annie Mwila
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Newman Monze
- Southern Provincial Health Office, Ministry of Health, Choma, Zambia
| | | | - Natalia Blanco
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marie-Claude C Lavoie
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | - Robb Sheneberger
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
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Khumalo GE, Ntuli S, Lutge E, Mashamba-Thompson TP. Geo-analysis: the distribution of community health workers in relation to the HIV prevalence in KwaZulu-Natal province, South Africa. BMC Health Serv Res 2022; 22:326. [PMID: 35277152 PMCID: PMC8915516 DOI: 10.1186/s12913-022-07707-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/28/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The South African Ward Based Primary Health Care Outreach Team (WBPHCOT) policy framework states that the distribution of community health workers (CHWs) should be proportional to levels of poverty and disease within the population. We aimed to describe the spatial distribution of CHWs in relation to the prevalence of the Human Immunodeficiency Virus (HIV) which has itself been associated with poverty in previous studies. METHODS This was a descriptive, cross-sectional study in which secondary data was used for geospatial analysis. Based on the extrapolation from the norm of one WBPHCOT per 6000 individuals, we utilized geographic information system (GIS) methods to visualize the distribution of CHWs in relation to the prevalence of HIV in KwaZulu-Natal (KZN). Dot density mapping was used to visualize the random distribution of CHWs in relation to HIV prevalence and population in the districts. The districts' HIV prevalence, number of PLWH, ratio of CHW: people living with HIV (PLWH), ratio of CHW: population and poverty scores were mapped using choropleth mapping. MapInfo Pro 17.0 was used to map geospatial presentation of the data. RESULTS Overall, KZN province showed under allocation of CHWs with a CHW: people ratio of 1: 1156 compared to the estimated norm of 1: 600-1000. At district level, only two of 11 districts met the suggested norm of CHW: PLWH (1: 109-181). This indicates shortages and misallocation of CHWs in the nine remaining districts. Furthermore, our findings showed extensive geospatial heterogeneity with no clear pattern in the distribution of CHWs. There was no relationship between CHW distribution and HIV prevalence or poverty scores in the districts. CONCLUSION This study shows inequality in the distribution of CHWs which may be associated with inequalities in the provision of HIV related services. It is critical to strengthen the response to the HIV epidemic through the appropriate distribution of CHWs especially in those districts with high levels of HIV prevalence and poverty.
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Affiliation(s)
- G E Khumalo
- University of KwaZulu-Natal, Discipline of Public Health Medicine, School of Nursing & Public Health, Howard College Campus, Durban, South Africa.
- Health Research & Knowledge Management Unit; KwaZulu-Natal Department of Health, 330 Langalibalele Street, Pietermaritzburg, South Africa.
| | - S Ntuli
- Geographical Information System Unit, African Health Research Institute, Somkhele, Mtubatuba, South Africa
| | - E Lutge
- University of KwaZulu-Natal, Discipline of Public Health Medicine, School of Nursing & Public Health, Howard College Campus, Durban, South Africa
- Health Research & Knowledge Management Unit; KwaZulu-Natal Department of Health, 330 Langalibalele Street, Pietermaritzburg, South Africa
| | - T P Mashamba-Thompson
- University of KwaZulu-Natal, Discipline of Public Health Medicine, School of Nursing & Public Health, Howard College Campus, Durban, South Africa
- Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Bophelo Rd, Prinshof 349-Jr, Pretoria, 0084a, South Africa
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Does Venue of HIV Testing and Results Disclosure in the Context of a Research Study Affect Adolescent Health and Behavior? Results from a Study in Western Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063249. [PMID: 35328936 PMCID: PMC8953200 DOI: 10.3390/ijerph19063249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023]
Abstract
Ethical concerns about risks to minor adolescents participating in HIV prevention research is a barrier to their inclusion. One concern is whether HIV testing and results disclosure venue affects the health and behavior of adolescent participants. We assessed for differential effects on quality of life (QOL), depressive symptoms, and sexual behavior due to (1) testing venue (home or health facility) and (2) test result (HIV-positive, HIV-negative, indeterminate). We collected data at three timepoints (baseline, 2-month follow-up, 12-month follow-up) from 113 Kenyan adolescents aged 15-19 (51% female). We analyzed the data using linear mixed effects models for the QOL and depressive symptoms outcomes and a logistic model for the sexual behavior outcome. Results showed a small mental health benefit for adolescents tested for HIV at a health facility compared with home. There was little evidence that testing venue influenced sexual behavior or that test results moderated the effects of HIV testing across all outcomes. The decision to conduct HIV testing at home or a health facility may not be very consequential for adolescents' health and behavior. Findings underscore the need to critically examine assumptions about adolescent vulnerability to better promote responsible conduct of HIV prevention research with youth in sub-Saharan Africa.
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Govere SM, Galagan S, Tlou B, Mashamba-Thompson T, Bassett IV, Drain PK. Effect of perceived HIV risk on initiation of antiretroviral therapy during the universal test and treat era in South Africa. BMC Infect Dis 2021; 21:976. [PMID: 34544376 PMCID: PMC8451135 DOI: 10.1186/s12879-021-06689-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 08/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Africa has not achieved the 90-90-90 goals, in part due to low rates of antiretroviral therapy (ART) initiation among those aware of their HIV status. Perceived risk of HIV at the time of testing may affect likelihood of rapid ART initiation. The purpose of this study was to evaluate factors associated with perceived risk of HIV and the relationship between perceived HIV risk and rapid ART initiation during the universal test and treat era which was adapted in October 2016. METHODS We conducted a prospective study of adults undergoing HIV testing from October 2016-February 2019 at Ithembalabantu Clinic in Durban. Eligible participants reported not previously being diagnosed with HIV. Before HIV testing, participants were asked to assess their perceived HIV risk on a four-level scale. We categorized "definitely not" and "probably not going to acquire HIV" as a low perceived risk, and "probably will" and "definitely will become HIV-infected" as a high perceived risk of HIV infection. Participants were followed for up to 14 months following HIV testing to assess ART initiation. RESULTS Among 1519 people newly diagnosed with HIV, 55% were female and mean age was 33 years. Among those, 1382 (90.9%) had a high HIV risk perception and 137 (9.1%) reported low HIV risk perception. In the low risk group individuals were more likely to be female (58% vs 55%), unemployed (62% vs 59%), have a partner with unknown HIV status (61% vs 55%) compared to the high risk group. 83.2% of those with low HIV risk perception reported previously HIV testing compared 91.5% of those with high HIV risk perception. In the multivariate model, males were associated with a higher chances of initiating ART compared to females (adjusted hazard ratio (aHR): 1.187, CI 1.187 (1.060-1.329) and being unemployed (aHR 0.767 CI (0.650-0.905). Those with a low HIV risk perception were less likely to initiate ART 125 (91%) vs 1310 (95%) p = 0.022), and took longer to initiate on ART after HIV diagnosis (11 days' vs 4 days, p = 0.042). CONCLUSION Factors associated with high HIV risk perception included being unemployed, single, and having a partner of unknown HIV status. People living with HIV (PLHIV) in South Africa who had a low self-perceived risk to HIV infection were less likely to initiate ART. Assessing self-perceived risk of HIV infection may help direct counselling and improve ART initiation to achieve universal 90-90-90 goal.
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Affiliation(s)
- Sabina M Govere
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa. .,AIDS Healthcare Foundation, 162 ZweMadlala Road, Section W, Umlazi, Durban, 4041, South Africa.
| | - Sean Galagan
- School of Medicine, University of Washington, Seattle, USA
| | - Boikhutso Tlou
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Ingrid V Bassett
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA.,Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, USA.,Center for AIDS Research, CFAR, Harvard University, Boston, USA.,Harvard Medical School, Boston, USA
| | - Paul K Drain
- School of Medicine, University of Washington, Seattle, USA.,Department of Global Health, University of Washington, Seattle, USA
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Medina-Marino A, de Vos L, Bezuidenhout D, Denkinger CM, Schumacher SG, Shin SS, Stevens W, Theron G, van der Walt M, Daniels J. "I got tested at home, the help came to me": acceptability and feasibility of home-based TB testing of household contacts using portable molecular diagnostics in South Africa. Trop Med Int Health 2021; 26:343-354. [PMID: 33289194 DOI: 10.1111/tmi.13533] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The effectiveness of household contact investigations is limited by low referral uptake for clinic-based TB testing by symptomatic household contacts. We qualitatively investigated the acceptability and perceived benefits of home-based TB testing using a portable GeneXpert-I instrument (GX-I) in an urban South African township. METHODS In-depth interviews were conducted with household contacts tested and those that observed testing. Semi-structured interviews explored household contact's understanding of TB, perceptions of the GX-I device and testing procedures, confidentiality, willingness to refer others, and views on home- vs. clinic-based testing. Focus group discussions with home-based TB testing implementing staff assessed operational considerations for scale-up. Data were analysed using a constant comparison approach to qualitatively evaluate the acceptability and feasibility of home-based TB testing. RESULTS Thirty in-depth interviews and two focus group discussions were conducted. Observing one's own sputum being tested resulted in an emergent trust in home-based TB testing, the GX-I device and one's test results. Home-based TB testing was considered convenient, helped to overcome apathy towards testing and mitigated barriers to clinic-based testing. Perceptions that home-based TB testing contributes to improved household and community health resulted in an emergent theme of alleviation of health insecurities. Operational concerns regarding inadvertent disclosure of one's diagnosis to household members and time spent in people's homes were identified. CONCLUSIONS Home-based TB testing was acceptable and feasible. Individuals expressed belief in the machine by being able to witness the testing process. Though most themes mirrored qualitative studies of home-based HIV testing, the alleviation of health insecurities theme is unique to home-based TB testing. Future research must evaluate the impact of home-based TB testing on case finding yield, time-to-treatment initiation and household outcomes.
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Affiliation(s)
- Andrew Medina-Marino
- Research Unit, Foundation for Professional Development, East London, South Africa.,Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lindsey de Vos
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Dana Bezuidenhout
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Claudia M Denkinger
- Foundation for Innovative New Diagnostics, Geneva, Switzerland.,Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Sanghyuk S Shin
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, USA
| | - Wendy Stevens
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
| | - Grant Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa
| | | | - Joseph Daniels
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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