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Hampanda K, Grubbs H, Castillo-Mancilla J, Anderson PL, Thorne J, Helova A, Turan JM, Onono M, Abuogi LL. Antiretroviral therapy adherence among peripartum women with HIV in Kenya: an explanatory mixed methods study using dry blood spot measures and narrative interviews. AIDS Care 2024:1-12. [PMID: 39106970 DOI: 10.1080/09540121.2024.2383885] [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: 12/09/2023] [Accepted: 07/18/2024] [Indexed: 08/09/2024]
Abstract
ABSTRACTAdherence to antiretroviral therapy (ART) remains sub-optimal among pregnant and postpartum women with HIV (PPWH) in high HIV prevalence low resource settings with few effective behavioral interventions. A large body of qualitative literature has established general barriers and facilitators to ART adherence in PPWH at various levels (individual, interpersonal, structural). However, research exploring the underlying behavioral mechanisms of ART adherence in PPWH with objectively verified adherence biomarkers is extremely limited. We conducted 24 in-depth interviews with postpartum women in western Kenya who had linked ART drug concentrations obtained from three dried blood spot samples across the peripartum period. Among PPWH with a low drug concentration (n = 13) compared to those with continuously high drug concentrations (n = 11), distinct themes emerged related to HIV status disclosure, social support, interactions with the health system, and health beliefs. By combining ART biomarkers with patient reported challenges, there is the potential for real-time interventions to support sustained ART adherence among PPWH and improve maternal and infant health outcomes.
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Affiliation(s)
- K Hampanda
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO, USA
- Center for Global Health, University of Colorado, Aurora, CO, USA
| | - H Grubbs
- Department of Surgery, University of Oklahoma, Oklahoma City, OK, USA
| | - J Castillo-Mancilla
- Division of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - P L Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - J Thorne
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO, USA
- Center for Global Health, University of Colorado, Aurora, CO, USA
| | - A Helova
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Sparkman Center for Global Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J M Turan
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Sparkman Center for Global Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Public Health, School of Medicine, Koc University, Istanbul, Turkey
| | - M Onono
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - L L Abuogi
- Center for Global Health, University of Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado, Aurora, CO, USA
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De Torres RQ, Operario D. Characterizing the "HIV Care Adherence Journey" for Persons With HIV in the Philippines: Conceptual Foundation for Person-Centered Intervention. J Assoc Nurses AIDS Care 2024; 35:325-338. [PMID: 38563452 PMCID: PMC11209816 DOI: 10.1097/jnc.0000000000000461] [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] [Indexed: 04/04/2024]
Abstract
ABSTRACT Promoting adherence to HIV care among persons with HIV (PWH) is a key component to addressing the rising HIV epidemic in the Philippines. HIV care adherence is a complex process that may change throughout an individual's life course or "journey" living with HIV. This qualitative study aimed to explore the HIV care adherence journey of PWH. Maximum variation sampling was used to select 12 PWH and 3 health care providers for in-depth online interviews, which were analyzed using thematic analysis. The four themes that emerged to describe the HIV care adherence journey are integration, relation, navigation, and manifestation. Each theme corresponds to a unique set of activities and goals related to PWH's lived experiences as they initiate, practice, and maintain care adherence. This study provides a preliminary framework to characterize the HIV care adherence journey as a dynamic, complex, and multifaceted phenomenon, which can help to inform holistic interventions to support PWH.
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Affiliation(s)
- Ryan Q. De Torres
- College of Nursing, University of the Philippines Manila, Philippines and a Volunteer HIV Educator and Counselor, The LoveYourself Inc., Philippines
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Nice J, Saltzman L, Thurman TR, Zani B. Latent class analysis of ART barriers among adolescents and young adults living with HIV in South Africa. AIDS Care 2024; 36:45-53. [PMID: 38422434 DOI: 10.1080/09540121.2024.2307389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/10/2024] [Indexed: 03/02/2024]
Abstract
This study examined adherence to antiretroviral therapy (ART) among adolescents and young adults living with HIV in South Africa. Using survey data from 857 youth on ART, the study employed latent class analysis to identify subgroups based on self-reported reasons for missed ART doses. Three distinct classes emerged: the largest class (85%) occasionally forgot to take their medication or missed a dose because others were around, the second class (9%) missed doses only due to feeling sick, and the third class (6%) faced multiple barriers such as forgetting, feeling sick, worrying about side effects, or doubting the effectiveness of ART. Youth who reported multiple barriers to adherence had significantly lower adjusted odds (AOR = 0.35, 95% CI = 0.16-0.78) of reporting 90% past month adherence compared to those who occasionally forgot their medication. Additionally, contextual factors such as food security, being treated well at the clinic, and being accompanied to the clinic were associated with higher odds of adherence. The findings highlight the importance of considering co-occurring barriers to adherence and tailoring interventions accordingly. Addressing contextual factors, such as ensuring food security and providing supportive clinic environments, is also crucial for promoting optimal adherence among adolescents and young adults living with HIV.
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Affiliation(s)
- Johanna Nice
- Highly Vulnerable Children Research Center, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- International Health and Sustainable Development department, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Leia Saltzman
- Tulane University School of Social Work, New Orleans, LA, USA
| | - Tonya R Thurman
- Highly Vulnerable Children Research Center, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- International Health and Sustainable Development department, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Tulane International LLC, Cape Town, South Africa
| | - Babalwa Zani
- Highly Vulnerable Children Research Center, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Tulane International LLC, Cape Town, South Africa
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Carillon S, Laborde-Balen G, Diop M, Diop K, Breton G, Ndiaye B, Taverne B. Implementing long-acting injectable antiretroviral treatments in Senegal: issues, challenges and conditions for introducing them. Qualitative study with healthcare providers and patients. AIDS Care 2024; 36:703-709. [PMID: 37708454 DOI: 10.1080/09540121.2023.2253506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 08/25/2023] [Indexed: 09/16/2023]
Abstract
Long-acting injectable antiretroviral therapy (LAI-ART) can offer people living with HIV (PLWH) a promising alternative to daily oral therapy. This article highlights the issues, challenges and conditions related to introducing LAI-ART into the social lives of PLWH and HIV-care practices in Senegal. Semi-structured interviews were conducted with 42 PLWH in two hospital care units in Dakar and with 13 healthcare providers and 6 peer educators. Interviews were transcribed, thematically coded and analysed using a cross-sectional approach. We found three key issues. First, simplifying living with HIV: PLWH respondents perceive LAI-ART as an opportunity to ease the burden associated with taking tablets. This enthusiasm may however be qualified by an ambivalent relationship with injections and is subject to certain conditions. Second, certain constraints linked to the medicalisation of care are to be anticipated, including the obligation to go to the hospital every two months for injections. These findings foreshadow the new management work for medical follow-up expected to fall on PLWH and caregivers. Third, the challenges of introducing LAI-ART in Senegal are to ensure adequate organisation of care and supply and sustainability of the program. These results clarify how to implement programs to introduce LAI-ART into real life in the West African context.
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Affiliation(s)
- Séverine Carillon
- Centre Régional de Formation et de recherche pour la prise en charge de Fann (CRCF), CHNU de Fann, Dakar, Sénégal
| | | | - Maïmouna Diop
- Centre Régional de Formation et de recherche pour la prise en charge de Fann (CRCF), CHNU de Fann, Dakar, Sénégal
| | - Karim Diop
- Division la Lutte contre le sida / Ministère de la santé, Dakar, Sénégal
| | | | - Bara Ndiaye
- Faculté de médecine, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Bernard Taverne
- TransVIHMI (Université de Montpellier, INSERM, IRD), Montpellier, France
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Killian C, West RL, Orrell C, Gifford A, Haberer JE, Halim N, Jennings L, Berkowitz N, Fourie S, Sabin L. Negative clinic experiences as a barrier to care for people with HIV and their impact on patient preferences for intervention support: a qualitative study in Cape Town, South Africa. AIDS Care 2024:1-10. [PMID: 38676915 DOI: 10.1080/09540121.2024.2346255] [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: 05/01/2023] [Accepted: 04/17/2024] [Indexed: 04/29/2024]
Abstract
We conducted qualitative research among people with HIV (PWH) and care providers in Cape Town, South Africa to understand the impact of negative clinic experiences on adherence and support preferences. In-depth interviews were conducted with 41 patients with an unsuppressed viral load or a treatment gap, and focus group discussions with physicians, nurses, counselors, and community health workers. Questions addressed treatment history and adherence barriers, then participants evaluated evidence-based adherence interventions for potential scale up. Inductive analysis examined care experiences and corresponding preference for intervention options. More than half of PWH described negative experiences during clinic visits, including mistreatment by staff and clinic administration issues, and these statements were corroborated by providers. Those with negative experiences in care stated that fear of mistreatment led to nonadherence. Most patients with negative experiences preferred peer support groups or check-in texts to clinic-based interventions. We found that PWH's negative clinic experiences were a primary reason behind nonadherence and influenced preferences for support mechanisms. These findings emphasize the importance of HIV treatment adherence interventions at multiple levels both in and outside of the clinic, and providing more comprehensive training to providers to better serve PWH in adherence counseling, especially those who are most vulnerable..
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Affiliation(s)
- Clare Killian
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Rebecca L West
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and the Department of Medicine, University of Cape Town, South Africa
| | - Allen Gifford
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Department of Law, Policy, and Management, BU School of Public Health, Boston, MA, USA
| | - Jessica E Haberer
- Center of Global Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Nafisa Halim
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Lauren Jennings
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and the Department of Medicine, University of Cape Town, South Africa
| | | | - Stephanie Fourie
- Western Cape Government, Department of Health, Cape Town, South Africa
| | - Lora Sabin
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Kolié D, Guillard E, Sow A, Manet H, Camara BS, Bigirimana T, Harouna M, Delamou A. Exploring experiences of HIV care to optimize patient-centred care in Conakry, Guinea: a qualitative study. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1134404. [PMID: 38655091 PMCID: PMC11035823 DOI: 10.3389/frph.2024.1134404] [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: 01/14/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Studies on the organisation of care and the power dynamic between providers and patients with HIV in sub-Saharan Africa are rare. This study aims to describe the patient-provider relationship and explore the challenges to optimal and patient-centred care for HIV patients. Methods This was a qualitative exploratory descriptive study using in-depth individual interviews and focus group discussions. In total, 17 individual interviews and 5 focus group discussions were conducted. This was conducted in four urban health facilities in Conakry, the capital of Guinea. Three group of participants were included in this study namely patients with HIV; health providers including facilities and services managers; and psychosocial counsellors. Psychosocial counsellors provide emotional and psychosocial support to HIV patients. Their role in the organization care in Guinea is new and they contribute to strengthening adherence of patients with HIV to ARV treatment. Results Patients with HIV, health providers, and psychosocial counsellors have a positive perception of the patient-provider relationship. This relationship was characterized essentially by maintaining confidentiality of HIV status disclosure, caring attitudes towards patients (being available, adjusting locations for accessing ART, based on patients' preferences), and participating in HIV patient's social life. However, scolding and miscommunication about the interpretation of viral load tests were reported. The shortage of human resources, low salaries of health staff, poor infrastructure, and the financial burden borne by patients with HIV impede the implementation of optimal patient-centred care. Conclusion Integrating psychosocial counsellors in HIV care organization, improving access to ARV, infrastructure, increasing human resources, and removing the financial burden for HIV patients are needed to optimal patient-centred care in Guinea.
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Affiliation(s)
- Delphin Kolié
- Ministry of Health and Public Hygiene, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
- African Centre of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | | | | | - Hawa Manet
- Ministry of Health and Public Hygiene, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
- African Centre of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Bienvenu Salim Camara
- Ministry of Health and Public Hygiene, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
- African Centre of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | | | | | - Alexandre Delamou
- Ministry of Health and Public Hygiene, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
- African Centre of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
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Hines AC, Rose AL, Regenauer KS, Brown I, Johnson K, Bonumwezi J, Ndamase S, Ciya N, Magidson JF, Myers B. " Early in the morning, there's tolerance and later in the day it disappears" - The intersection of resource scarcity, stress and stigma in mental health and substance use care in South Africa. Glob Ment Health (Camb) 2024; 11:e45. [PMID: 38690575 PMCID: PMC11058524 DOI: 10.1017/gmh.2024.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/29/2024] [Accepted: 03/21/2024] [Indexed: 05/02/2024] Open
Abstract
Stress is a challenge among non-specialist health workers worldwide, particularly in low-resource settings. Understanding and targeting stress is critical for supporting non-specialists and their patients, as stress negatively affects patient care. Further, stigma toward mental health and substance use conditions also impacts patient care. However, there is little information on the intersection of these factors. This sub-analysis aims to explore how substance use and mental health stigma intersect with provider stress and resource constraints to influence the care of people with HIV/TB. We conducted semi-structured interviews (N=30) with patients (n=15) and providers (n=15, non-specialist health workers) within a low-resource community in Cape Town, South Africa. Data were analyzed using thematic analysis. Three key themes were identified: (1) resource constraints negatively affect patient care and contribute to non-specialist stress; (2) in the context of stress, non-specialists are hesitant to work with patients with mental health or substance use concerns, who they view as more demanding and (3) stress contributes to provider stigma, which negatively impacts patient care. Findings highlight the need for multilevel interventions targeting both provider stress and stigma toward people with mental health and substance use concerns, especially within the context of non-specialist-delivered mental health services in low-resource settings.
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Affiliation(s)
- Abigail C. Hines
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Alexandra L. Rose
- Department of Psychology, University of Maryland, College Park, MD, USA
| | | | - Imani Brown
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Kim Johnson
- Mental Health, Alcohol, Substance Use, Tobacco Research Unit, South African Medical Research Council, Parow, South Africa
| | - Jessica Bonumwezi
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Sibabalwe Ndamase
- Mental Health, Alcohol, Substance Use, Tobacco Research Unit, South African Medical Research Council, Parow, South Africa
| | - Nonceba Ciya
- Mental Health, Alcohol, Substance Use, Tobacco Research Unit, South African Medical Research Council, Parow, South Africa
| | - Jessica F. Magidson
- Department of Psychology, University of Maryland, College Park, MD, USA
- Center for Substance Use, Addiction & Health Research (CESAR), University of Maryland, College Park, MD, USA
| | - Bronwyn Myers
- Mental Health, Alcohol, Substance Use, Tobacco Research Unit, South African Medical Research Council, Parow, South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Ganta AG, Wabeto E, Minuta WM, Wegi C, Berheto T, Samuel S, Assele DD. Predictors of loss to follow up among adults on antiretroviral therapy before and after the start of treat-all strategy in public health facilities of Hawassa city, Ethiopia: A Competing risk regression. PLoS One 2024; 19:e0299505. [PMID: 38483944 PMCID: PMC10939213 DOI: 10.1371/journal.pone.0299505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/09/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Treat-all strategies improved patient outcomes, despite higher rates of loss to follow-up compared to the pre-treat era. Patients in Ethiopia experienced a higher rate of LTFU during the treat-all strategy period; however, studies did not identify contributing factors in comparison with previous strategies. This study aimed to assess the incidence and predictors of loss to follow-up before and after the start of the treat-all strategy among adults on anti-retroviral therapy in public health facilities in Hawassa City, Ethiopia. METHODS An institution-based retrospective follow-up study was conducted among 1190 randomly selected adults on antiretroviral therapy in public health facilities in Hawassa City. Using the Open Data Kit (ODK), data were collected from medical records and exported to Stata version 16 and R 4.2.1 for analysis. A Grays test and cumulative incidence curve were used to compare the cumulative incidence function of loss to follow-up. Bivariable and multivariable competing risk regression were fitted to identify predictors of LTFU and variables with a p-value <0.05 were considered significant. RESULTS The cumulative incidence of lost-to-follow-up was 4.92(3.84,6.3) and 8.67(7.26,10.3) per 100 person-years (PY) in pre-treat all and treat all cohorts, respectively. The cumulative incidence of mortality was 5.86(4.67,7.35) and 3(2.26,4.12) per 100 PY in pre-treat and treat all cohorts, respectively. Fair/poor adherence (aSHR:5.17; (95% CI 1.97, 13.51), underweight (aSHR:2.13; 95% CI: 1.15-3.93) and WHO stage III/IV (aSHR:2.69; 95% CI: 1.27, 5.71) were predictors of loss up in pre-treat all, whereas fair/poor adherence (aSHR = 2.07; 95% CI: 1.18, 3.68), underweight (aSHR:1.71; 95% CI: 1.13, 2.56), and CD4 cell >350 cell/m3 (aSHR: 1.67; 95% CI: 1.05, 2.65) predicts of loss up in treat all cohorts. CONCLUSION This study demonstrated that the incidence of loss to follow-up was considerably higher in the treat-all period as compared to the pre-treat-all era. Poor medication compliance, underweight, and a CD4 level >350 cells/m3 contributed to the higher rate of LTFU in the treat-all strategy. Targeted interventions, such as nutritional support and strengthening medication adherence counseling, should be implemented to maintain treatment retention and reduce antiretroviral therapy dropout rates.
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Affiliation(s)
- Abera Gezume Ganta
- Department of Public Health, College of Health Science and Medicine, Jinka University, Jinka, Ethiopia
| | - Ermias Wabeto
- Department of Public Health, College of Health Science and Medicine, Jinka University, Jinka, Ethiopia
| | - Worku Mimani Minuta
- Department of Public Health, College of Health Science and Medicine, Jinka University, Jinka, Ethiopia
| | - Chala Wegi
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tezera Berheto
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Serawit Samuel
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Desalegn Dawit Assele
- Department of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Twimukye A, Alhassan Y, Ringwald B, Malaba T, Myer L, Waitt C, Lamorde M, Reynolds H, Khoo S, Taegtmeyer M. Support, not blame: safe partner disclosure among women diagnosed with HIV late in pregnancy in South Africa and Uganda. AIDS Res Ther 2024; 21:14. [PMID: 38481233 PMCID: PMC10938717 DOI: 10.1186/s12981-024-00600-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND HIV partner disclosure rates remain low among pregnant women living with HIV in many African countries despite potential benefits for women and their families. Partner disclosure can trigger negative responses like blame, violence, and separation. Women diagnosed with HIV late in pregnancy have limited time to prepare for partner disclosure. We sought to understand challenges around partner disclosure and non-disclosure faced by women diagnosed with HIV late in pregnancy in South Africa and Uganda and to explore pathways to safe partner disclosure. METHODS We conducted in-depth interviews and focus group discussions with pregnant women and lactating mothers living with HIV (n = 109), disaggregated by antenatal care (ANC) initiation before and after 20 weeks of gestation, male partners (n = 87), and health workers (n = 53). All participants were recruited from DolPHIN2 trial sites in Kampala (Uganda) and Gugulethu (South Africa). Topic guides explored barriers to partner disclosure, effects of non-disclosure, strategies for safe disclosure. Using the framework analysis approach, we coded and summarised data based on a socio-ecological model, topic guides, and emerging issues from the data. Data was analysed in NVivo software. RESULTS Our findings illustrate pregnant women who initiate ANC late experience many difficulties which are compounded by the late HIV diagnosis. Various individual, interpersonal, community, and health system factors complicate partner disclosure among these women. They postpone or decide against partner disclosure mainly for own and baby's safety. Women experience stress and poor mental health because of non-disclosure while demonstrating agency and resilience. We found many similarities and some differences around preferred approaches to safe partner disclosure among female and male participants across countries. Women and male partners preferred healthcare workers to assist with disclosure by identifying the 'right' time to disclose, mentoring women to enhance their confidence and communication skills, and providing professional mediation for partner disclosure and couple testing. Increasing the number of counsellors and training them on safe partner disclosure was deemed necessary for strengthening local health services to improve safe partner disclosure. CONCLUSION HIV diagnosis late in pregnancy amplifies existing difficulties among pregnant women. Late ANC initiation is an indicator for the likelihood that a pregnant woman is highly vulnerable and needs safeguarding. Respective health programmes should be prepared to offer women initiating ANC late in pregnancy additional support and referral to complementary programmes to achieve safe partner disclosure and good health.
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Affiliation(s)
- Adelline Twimukye
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Yussif Alhassan
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Beate Ringwald
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Thokozile Malaba
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Catriona Waitt
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Mohammed Lamorde
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Helen Reynolds
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Saye Khoo
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Tropical Infectious Disease Unit, Liverpool University Hospital Foundation Trust, Liverpool, UK
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
- Tropical Infectious Disease Unit, Liverpool University Hospital Foundation Trust, Liverpool, UK
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10
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Burke RM, Rickman HM, Pinto C, Ehrenkranz P, Choko A, Ford N. Reasons for disengagement from antiretroviral care in the era of "Treat All" in low- or middle-income countries: a systematic review. J Int AIDS Soc 2024; 27:e26230. [PMID: 38494657 PMCID: PMC10945039 DOI: 10.1002/jia2.26230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/23/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION Disengagement from antiretroviral therapy (ART) care is an important reason why people living with HIV do not achieve viral load suppression become unwell. METHODS We searched two databases and conference abstracts from January 2015 to December 2022 for studies which reported reasons for disengagement from ART care. We included quantitative (mainly surveys) and qualitative (in-depth interviews or focus groups) studies conducted after "treat all" or "Option B+" policy adoption. We used an inductive approach to categorize reasons: we report how often reasons were reported in studies and developed a conceptual framework for reasons. RESULTS We identified 21 studies which reported reasons for disengaging from ART care in the "Treat All" era, mostly in African countries: six studies in the general population of persons living with HIV, nine in pregnant or postpartum women and six in selected populations (one each in people who use drugs, isolated indigenous communities, men, women, adolescents and men who have sex with men). Reasons reported were: side effects or other antiretroviral tablet issues (15 studies); lack of perceived benefit of ART (13 studies); psychological, mental health or drug use (13 studies); concerns about stigma or confidentiality (14 studies); lack of social or family support (12 studies); socio-economic reasons (16 studies); health facility-related reasons (11 studies); and acute proximal events such as unexpected mobility (12 studies). The most common reasons for disengagement were unexpected events, socio-economic reasons, ART side effects or lack of perceived benefit of ART. Conceptually, studies described underlying vulnerability factors (individual, interpersonal, structural and healthcare) but that often unexpected proximal events (e.g. unanticipated mobility) acted as the trigger for disengagement to occur. DISCUSSION People disengage from ART care for individual, interpersonal, structural and healthcare reasons, and these reasons overlap and interact with each other. While HIV programmes cannot predict and address all events that may lead to disengagement, an approach that recognizes that such shocks will happen could help. CONCLUSIONS Health services should focus on ways to encourage clients to engage with care by making ART services welcoming, person-centred and more flexible alongside offering adherence interventions, such as counselling and peer support.
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Affiliation(s)
- Rachael M. Burke
- Clinical Research DepartmentLondon School of Hygiene and Tropical MedicineLondonUK
- Malawi Liverpool Wellcome Clinical Research ProgrammeQueen Elizabeth Central HospitalBlantyreMalawi
| | - Hannah M. Rickman
- Clinical Research DepartmentLondon School of Hygiene and Tropical MedicineLondonUK
- Malawi Liverpool Wellcome Clinical Research ProgrammeQueen Elizabeth Central HospitalBlantyreMalawi
| | - Clarice Pinto
- Global HIV, Hepatitis and STIs ProgrammeWorld Health OrganisationGenevaSwitzerland
| | - Peter Ehrenkranz
- Global Health, Bill & Melinda Gates FoundationSeattleWashingtonUSA
| | - Augustine Choko
- Malawi Liverpool Wellcome Clinical Research ProgrammeQueen Elizabeth Central HospitalBlantyreMalawi
- International Public Health DepartmentLiverpool School of Tropical MedicineLiverpoolUK
| | - Nathan Ford
- Global HIV, Hepatitis and STIs ProgrammeWorld Health OrganisationGenevaSwitzerland
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public Health and Family MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
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11
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Maskew M, Benade M, Huber A, Pascoe S, Sande L, Malala L, Manganye M, Rosen S. Patterns of engagement in care during clients' first 12 months after HIV treatment initiation in South Africa: A retrospective cohort analysis using routinely collected data. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002956. [PMID: 38416789 PMCID: PMC10901315 DOI: 10.1371/journal.pgph.0002956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/02/2024] [Indexed: 03/01/2024]
Abstract
Retention on antiretroviral therapy (ART) during the early treatment period is one of the most serious challenges facing HIV programs, but the timing and patterns of early disengagement from care remain poorly understood. We describe patterns of engagement in HIV care during the first year after treatment initiation. We analysed retrospective datasets of routinely collected electronic medical register (EMR) data for ≥18-year-old clients who initiated ART at public sector clinics in South Africa after 01/01/2018 and had ≥14 months of potential follow-up. Using scheduled visit dates, we characterized engagement in care as continuous (no treatment interruption), cyclical (at least one visit >28 days late with a return visit observed) or disengaged (visit not attended and no evidence of return). We report 6- and 12-month patterns of retention in care and viral suppression. Among 35,830 participants (65% female, median age 33), in months 0-6, 59% were continuously in care, 14% had engaged cyclically, 11% had transferred to another facility, 1% had died, and 16% had disengaged from care at the initiating facility. Among disengagers in the first 6 months, 58% did not return after their initiation visit. By 12 months after initiation, the overall proportion disengaged was 23%, 45% were classified as continuously engaged in months 7-12, and only 38% of the cohort had maintained continuous engagement at both the 6- and 12-month endpoints. Participants who were cyclically engaged in months 0-6 were nearly twice as likely to disengage in months 7-12 as were continuous engagers in months 0-6 (relative risk 1.76, 95% CI:1.61-1.91) and were more likely to have an unsuppressed viral load by 12 months on ART (RR = 1.28; 95% CI1.13-1.44). The needs of continuous and cyclical engagers and those disengaging at different timepoints may vary and require different interventions or models of care.
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Affiliation(s)
- Mhairi Maskew
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mariet Benade
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Medical Microbiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Amy Huber
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sophie Pascoe
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda Sande
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lufuno Malala
- HIV & AIDS Treatment, Care and Support Directorate, HIV & AIDS and STI Cluster, National Department of Health, Pretoria, South Africa
| | - Musa Manganye
- HIV & AIDS Treatment, Care and Support Directorate, HIV & AIDS and STI Cluster, National Department of Health, Pretoria, South Africa
| | - Sydney Rosen
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
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12
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Denardo D, Cort DA. Temporal changes in HIV-related stigma and sexual behaviours: An examination of 22 African countries. Glob Public Health 2024; 19:2405019. [PMID: 39324704 DOI: 10.1080/17441692.2024.2405019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 09/10/2024] [Indexed: 09/27/2024]
Abstract
ABSTRACTDespite non-trivial success against the HIV epidemic, health experts in Sub-Saharan Africa (SSA) remain concerned about new infections, stigma attitudes, and increasing rates of higher-risk sexual behaviours (HRSBs). Although this concern has produced voluminous scholarship on the behavioural consequences of belonging to stigmatised populations, scholars have only recently examined the behavioural consequences of holding stigmatising attitudes. Existing work generally finds a positive relationship between stigmatising beliefs and the practice of HRSBs. Yet, it is unknown whether this relationship has changed for countries over the past two decades. We fill this gap using Demographic and Health Survey data from 22 SSA countries. We first find that in most countries, the practice of HRSBs has increased, while stigma beliefs have become more tolerant. Second, the relationship between stigma beliefs and HRSBs changed in only six countries: Nigeria, Kenya, Mozambique, Sierra Leone, Ethiopia, and Lesotho. It changed from non-existent or negative to positive in Nigeria, Kenya, Mozambique, and Ethiopia, but non-existent to negative in Sierra Leone. In Lesotho, the positive association weakened over time. These findings highlight the importance of social and epidemic contexts when considering how stigma impacts sexual behaviours and HIV rates in SSA.
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Affiliation(s)
- Danielle Denardo
- Social and Behavioral Sciences, Soka University of America, Aliso Viejo, CA, USA
| | - David A Cort
- Department of Sociology, University of Massachusetts, Boston, MA, USA
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13
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Nicol E, Jama NA, Mehlomakulu V, Hlongwa M, Pass D, Basera W, Bradshaw D. Enhancing linkage to HIV care in the "Universal Test and Treat" era: Barriers and enablers to HIV care among adults in a high HIV burdened district in KwaZulu-Natal, South Africa. BMC Public Health 2023; 23:1756. [PMID: 37689667 PMCID: PMC10492313 DOI: 10.1186/s12889-023-16576-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/21/2023] [Indexed: 09/11/2023] Open
Abstract
Ending AIDS by 2030 would depend on how successful health systems are in linking people living with HIV (PLHIV) into care. The World Health Organization recommended the 'Universal Test and Treat' (UTT) strategy - initiating all individuals testing positive on antiretroviral therapy (ART) irrespective of their CD4 count and clinical staging. This study aimed to explore the enablers and barriers to linkage to HIV care among adults with a new HIV diagnosis in a high-HIV prevalent rural district in South Africa. A qualitative study was undertaken to explore patients' perceptions of enablers and barriers of linkage-to-care, using a life-story narration and dialogue approach. In-depth interviews were conducted with 38 HIV-positive participants sampled from a cohort of 1194 HIV-positive patients recruited from December 2017 to June 2018. Participants were selected based on whether they had been linked to care or not within 3 months of positive HIV diagnosis. Interviews were thematically analysed using a general inductive approach. Of the 38 participants, 22 (58%) linked to care within three months of HIV-positive diagnosis. Factors that facilitated or inhibited linkage-to-care were found at individual, family, community, as well as health systems levels. Enablers included a positive HIV testing experience, and assistance from the fieldwork team. Support from family, and friends, as well as prior community-based education about HIV and ART were also noted. Individual factors such as acceptance of HIV status, previous exposure to PLHIV, and fear of HIV progressing, were identified. Barriers to linkage included, denial of HIV status, dislike of taking pills, and preference for alternative medicine. Negative experiences with counselling and health systems inefficiency were also noted as barriers. Perceived stigma and socio-economic factors, such as lack of food or money to visit the clinic were other barriers. Community-based and health system-level interventions would need to focus on clinic readiness in providing patients with necessary and effective health services such as proper and adequate counselling. This could increase the number of patients who link to care. Finally, interventions to improve linkage-to-care should consider a holistic approach, including training healthcare providers, community outreach and the provision of psychological, social, and financial support.
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Affiliation(s)
- Edward Nicol
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, TygerbergCape Town, 7505, South Africa.
- Division of Health Systems and Public Health, Stellenbosch University, Cape Town, South Africa.
| | - Ngcwalisa Amanda Jama
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, TygerbergCape Town, 7505, South Africa
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Vuyelwa Mehlomakulu
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, TygerbergCape Town, 7505, South Africa
| | - Mbuzeleni Hlongwa
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, TygerbergCape Town, 7505, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Public Health, Societies and Belonging, Human Sciences Research Council, Pretoria, South Africa
| | - Desiree Pass
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, TygerbergCape Town, 7505, South Africa
| | - Wisdom Basera
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, TygerbergCape Town, 7505, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, TygerbergCape Town, 7505, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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14
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Shringarpure K, Gurumurthy M, Sagili KD, Taylor M, Garner P, Tonsing J, Rao R, Sachdeva KS. Patient adherence to tuberculosis treatment in the Indian subcontinent: systematic review and meta-synthesis of qualitative research. BMJ Open 2023; 13:e063926. [PMID: 37142319 PMCID: PMC10163483 DOI: 10.1136/bmjopen-2022-063926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVES How well patients adhere to their tuberculosis (TB) treatment influences their recovery and development of drug resistance, but influences on adherence are multiple and often competing. We synthesised qualitative studies from our setting in the Indian subcontinent to understand the dimensions and dynamics involved to help inform service provision. DESIGN Qualitative synthesis comprising inductive coding, thematic analysis and forming a conceptual framework. DATA SOURCES Medline (OVID), Embase (OVID), CINAHL (EBSCOHost), PsycINFO (EBSCOHost), Web of Science Core Collection, Cochrane Library and Epistemonikos were databases searched on 26 March 2020 for studies published since 1 January 2000. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included reports in English from the Indian subcontinent that used qualitative or mixed-methodology designs and reported findings around adherence to TB treatment. Full texts meeting eligibility were sampled based on 'thickness' (the richness of the qualitative data reported). DATA EXTRACTION AND SYNTHESIS Two reviewers used standardised methods to screen abstracts and code. Included studies were assessed for reliability and quality using a standard tool. Qualitative synthesis was performed by inductive coding, thematic analysis and developing conceptual framework. RESULTS Of 1729 abstracts screened from initial search, 59 were shortlisted for full-text review. Twenty-four studies that qualified as 'thick' were included in the synthesis. Studies were set in India (12), Pakistan (6), Nepal (3), Bangladesh (1) or in two or more of these countries (2). Of the 24 studies, all but one included people who were taking TB treatment (1 study included only healthcare providers), and 17 included healthcare workers, community members or both.We identified three themes: (1) personal influences on the people with TB include interconnections between their social role in the family unit, their own priorities in day-to-day living and their experience to date with the disease; (2) adherence is profoundly influenced by how individual healthcare providers interact with patients on treatment and address their needs; (3) adherence is influenced across communities by structural, social, economic and cultural factors related to treatment. CONCLUSION Staff in TB programmes require an understanding of the various competing influences on individuals undergoing treatment. Programmes need to have more flexible and people-centred approaches to service provision in order to achieve adherence, and thus improve treatment outcomes. PROSPERO REGISTRATION NUMBER CRD42020171409.
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Affiliation(s)
- Kalpita Shringarpure
- Department of Community Medicine, Medical College Baroda, Baroda, Gujarat, India
| | - Meera Gurumurthy
- Research Division, Vital Strategies, Singapore
- TB Department, International Union Against Tuberculosis and Lung Disease (The Union), South East Asia Office, New Delhi, India
| | - Karuna D Sagili
- TB Department, International Union Against Tuberculosis and Lung Disease (The Union), South East Asia Office, New Delhi, India
| | - Melissa Taylor
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Paul Garner
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jamie Tonsing
- TB Department, International Union Against Tuberculosis and Lung Disease (The Union), South East Asia Office, New Delhi, India
- The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Geneva, Switzerland
| | - Raghuram Rao
- National Tuberculosis Elimination Programme (NTEP), Central TB Division, India Ministry of Health and Family Welfare, New Delhi, India
| | - Kuldeep Singh Sachdeva
- TB Department, International Union Against Tuberculosis and Lung Disease (The Union), South East Asia Office, New Delhi, India
- National Tuberculosis Elimination Programme (NTEP), Central TB Division, India Ministry of Health and Family Welfare, New Delhi, India
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15
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David IJ, Schatz E, Angotti N, Myroniuk TW, Mojola SA. "I'm Getting Life from the Treatment": Perceptions of Life and Death Among Middle-Aged and Older Medication-Adherent Persons Living with HIV in Rural South Africa. J Aging Soc Policy 2023:1-23. [PMID: 36973857 DOI: 10.1080/08959420.2023.2195348] [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: 08/24/2021] [Accepted: 08/15/2022] [Indexed: 03/29/2023]
Abstract
The widespread availability of health information and treatment for HIV in Southern Africa does not reach all populations. Few programs and materials are developed with middle-aged and older rural individuals living with HIV as the target audience, despite this being a growing population. This vacuum inevitably exacerbates the disjuncture between clinical and experiential knowledge. This study uses in-depth interviews from 2018 with middle-aged and older rural South Africans who self-report medication adherence to ART in order to explore experiences of living with HIV and beliefs about anti-retroviral treatment (ART). Participants revealed a general sense of vulnerability as a major motivation for HIV medication adherence. A majority of the participants believed that death was imminent if they defaulted on ART at any point in time. Although the availability of ART brought hope to many, HIV was still perceived as a death sentence, particularly if ART adherence was imperfect. The study findings suggest a need to examine the psychosocial component of community programs for middle-aged and older people living with HIV. For this growing population that experienced the full course of the epidemic, more research is needed on the burden of psychological and mental health issues emerging from the need for long-term HIV medication adherence.
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Affiliation(s)
- Ifeolu J David
- Department of public health, University of Missouri, Columbia, MO, USA
| | - Enid Schatz
- Department of public health, University of Missouri, Columbia, MO, USA
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Angotti
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of sociology, American University, Washington DC, USA
| | - Tyler W Myroniuk
- Department of public health, University of Missouri, Columbia, MO, USA
| | - Sanyu A Mojola
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of sociology, Princeton University, Princeton, NJ, USA
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16
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Nhemachena T, Späth C, Arendse KD, Lebelo K, Zokufa N, Cassidy T, Whitehouse K, Keene CM, Swartz A. Between empathy and anger: healthcare workers' perspectives on patient disengagement from antiretroviral treatment in Khayelitsha, South Africa - a qualitative study. BMC PRIMARY CARE 2023; 24:34. [PMID: 36698083 PMCID: PMC9878968 DOI: 10.1186/s12875-022-01957-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 12/23/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND & OBJECTIVES The benefits of long-term adherence to antiretroviral therapy (ART) are countered by interruptions in care or disengagement from care. Healthcare workers (HCWs) play an important role in patient engagement and negative or authoritarian attitudes can drive patients to disengage. However, little is known about HCWs' perspectives on disengagement. We explored HCWs' perspectives on ART disengagement in Khayelitsha, a peri-urban area in South Africa with a high HIV burden. METHOD Semi-structured interviews were conducted with 30 HCWs in a primary care HIV clinic to explore their perspectives of patients who disengage from ART. HCWs interviewed included clinical (doctors and nurses) and support staff (counsellors, social workers, data clerks, security guards, and occupational therapists). The interview guide asked HCWs about their experience working with patients who interrupt treatment and return to care. Transcripts were audio-recorded, transcribed, and analysed using an inductive thematic analysis approach. RESULTS Most participants were knowledgeable about the complexities of disengagement and barriers to sustaining engagement with ART, raising their concerns that disengagement poses a significant public health problem. Participants expressed empathy for patients who interrupted treatment, particularly when the challenges that led to their disengagement were considered reasonable by the HCWs. However, many also expressed feelings of anger and frustration towards these patients, partly because they reported an increase in workload as a result. Some staff, mainly those taking chronic medication themselves, perceived patients who disengage from ART as not taking adequate responsibility for their own health. CONCLUSION Lifelong engagement with HIV care is influenced by many factors including disclosure, family support, and HCW interactions. Findings from this study show that HCWs had contradictory feelings towards disengaged patients, experiencing both empathy and anger. Understanding this could contribute to the development of more nuanced interventions to support staff and encourage true person-centred care, to improve patient outcomes.
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Affiliation(s)
- Tsephiso Nhemachena
- grid.7836.a0000 0004 1937 1151School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Carmen Späth
- grid.7836.a0000 0004 1937 1151School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kirsten D. Arendse
- grid.452731.60000 0004 4687 7174Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa
| | - Keitumetse Lebelo
- grid.452731.60000 0004 4687 7174Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa
| | - Nompumelelo Zokufa
- grid.452731.60000 0004 4687 7174Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa
| | - Tali Cassidy
- grid.7836.a0000 0004 1937 1151School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa ,grid.452731.60000 0004 4687 7174Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa
| | - Katherine Whitehouse
- grid.452731.60000 0004 4687 7174Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa
| | - Claire M. Keene
- grid.452731.60000 0004 4687 7174Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa ,grid.4991.50000 0004 1936 8948Health Systems Collaborative, Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Alison Swartz
- grid.7836.a0000 0004 1937 1151School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa ,grid.8356.80000 0001 0942 6946Department of Psychosocial and Psychoanalytic Studies, University of Essex, Essex, England
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17
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Akpan U, Kakanfo K, Ekele OD, Ukpong K, Toyo O, Nwaokoro P, James E, Pandey S, Olatubosun K, Bateganya M. Predictors of treatment interruption among patients on antiretroviral therapy in Akwa Ibom, Nigeria: outcomes after 12 months. AIDS Care 2023; 35:114-122. [PMID: 35765160 DOI: 10.1080/09540121.2022.2093826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Understanding the characteristics of people living with HIV who interrupt antiretroviral therapy (ART) is critical for designing client-centered services to ensure optimal outcomes. We assessed predictors of treatment interruption in 22 HIV clinics in Nigeria. We reviewed records of HIV-positive patients aged ≥15 years who started ART 1 January and 31 March 2019. We determined treatment status over 12 months as either active, or interrupted treatment (defined as interruption in treatment up to 28 days or longer). Potential predictors were assessed using Cox hazard regression models. Overall, 1185 patients were enrolled on ART, 829 (70%) were female, and median age was 32 years. Retention at 1, 3, 6, 9, and 12 months was 85%, 80%, 76%, 72%, and 68%, respectively. Predictors of treatment interruption were post-secondary education (p = 0.04), diagnosis through voluntary counseling and testing (p < 0.001), receiving care at low-volume facilities (p < 0.001), lack of access to a peer counselor (p < 0.001), and residing outside the clinic catchment area (p = 0.03). Treatment interruption was common but can be improved by focusing on lower volume health facilities, providing peer support especially to those with higher education, and client-centered HIV services for those who live further from clinics..
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Affiliation(s)
- Uduak Akpan
- Achieving Health Nigeria Initiative, Akwa Ibom, Nigeria
| | | | - Oche D Ekele
- Achieving Health Nigeria Initiative, Akwa Ibom, Nigeria
| | - Kufre Ukpong
- Achieving Health Nigeria Initiative, Akwa Ibom, Nigeria
| | - Otoyo Toyo
- Achieving Health Nigeria Initiative, Akwa Ibom, Nigeria
| | | | - Ezekiel James
- United States Agency for International Development, Abuja, Nigeria
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18
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Attrition from Care Among Men Initiating ART in Male-Only Clinics Compared with Men in General Primary Healthcare Clinics in Khayelitsha, South Africa: A Matched Propensity Score Analysis. AIDS Behav 2023; 27:358-369. [PMID: 35908271 PMCID: PMC9852215 DOI: 10.1007/s10461-022-03772-9] [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] [Accepted: 06/25/2022] [Indexed: 01/24/2023]
Abstract
Men have higher rates of attrition from antiretroviral therapy (ART) programs than women. In Khayelitsha, a high HIV prevalence area in South Africa, two public sector primary healthcare clinics offer services, including HIV testing and treatment, exclusively to men. We compared attrition from ART care among men initiating ART at these clinics with male attrition in six general primary healthcare clinics in Khayelitsha. We described baseline characteristics of patients initiating ART at the male and general clinics from 1 January 2014 to 31 March 2018. We used exposure propensity scores (generated based on baseline health and age) to match male clinic patients 1:1 to males at other clinics. The association between attrition (death or loss to follow-up, defined as no visits for nine months) and clinic type was estimated using Cox proportional hazards regression. Follow-up time began at ART initiation and ended at attrition, clinic transfer, or dataset closure. Before matching, patients from male clinics (n = 784) were younger than males from general clinics (n = 2726), median age: 31.2 vs 35.5 years. Those initiating at male clinics had higher median CD4 counts at ART initiation [Male Clinic 1: 329 (IQR 210-431), Male Clinic 2: 364 (IQR 260-536), general clinics 258 (IQR 145-398), cells/mm3]. In the matched analysis (1451 person-years, 1568 patients) patients initiating ART at male clinics had lower attrition (HR 0.71; 95% CI 0.60-0.85). In separate analyses for each of the two male clinics, only the more established male clinic showed a protective effect. Male-only clinics reached younger, healthier men, and had lower ART attrition than general services. These findings support clinic-specific adaptations to create more male-friendly environments.
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19
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Ulvund I, Dadi GB, Gutteberg A. 'I am struggling to survive' - limited living conditions increase the burden of HIV: A qualitative study. Glob Public Health 2023; 18:2280049. [PMID: 37967520 DOI: 10.1080/17441692.2023.2280049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/01/2023] [Indexed: 11/17/2023]
Abstract
The human immunodeficiency virus (HIV) continues to have life-limiting health consequences for many individuals and remains a significant threat to global public health. This qualitative study explores the experiences of people living with HIV in Sidama, Ethiopia. Interviews with 19 adults recruited from an HIV outpatient clinic were conducted using a semi-structured interview guide. The analysis method used was systematic text condensation. The results reveal that an HIV diagnosis triggered strong emotions. Economic concerns, stigma, and discrimination also increased the burden of a diagnosis, which could lead to a loss of income or housing. Consequently, informants' ability to maintain a regular life and receive social and psychological support was reduced. Religious faith provided strength to informants, though they stated that some religious leaders do not support antiretroviral therapy. Understanding the everyday challenges of people living with HIV is crucial for health professionals and health programme developers working to promote health and enable people to follow their recommended course of treatment. Person-centred care is recommended. In particular, the poorest should receive attention. It is also crucial to reduce stigma and discriminatory attitudes towards people living with HIV and to motivate faith leaders to prevent HIV stigma and support antiretroviral therapy.
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Affiliation(s)
- Ingeborg Ulvund
- Faculty of Health Sciences and Social Care, Molde University College, Specialized University in Logistics, Molde, Norway
| | - Gezahegn Bekele Dadi
- School of Nursing, Hawassa University-College of Medicine & Health Science, Hawassa, Ethiopia
| | - Anne Gutteberg
- Faculty of Health Sciences and Social Care, Molde University College, Specialized University in Logistics, Molde, Norway
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20
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Ndoro T, Ndlovu N, Nyasulu P. Factors associated with ART adherence among HIV-positive adherence club members in Ekurhuleni Metropolitan Municipality, South Africa: A cross-sectional study. PLoS One 2022; 17:e0277039. [PMID: 36318541 PMCID: PMC9624407 DOI: 10.1371/journal.pone.0277039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND HIV is a leading cause of morbidity and mortality in South Africa that can be managed using antiretroviral therapy (ART). Adherence clubs are interventions that have been introduced to decentralize ART to improve ART adherence and provide social support for club members. However, ART adherence can be suboptimal even among adherence club members. AIM This study aimed to determine the factors affecting ART adherence among people living with HIV/AIDS (PLWHA) attending adherence clubs in Ekurhuleni Metropolitan Municipality. METHODS A cross-sectional study was conducted. Ordinal logistic regression was used in univariable and multivariable analyses to determine factors significantly associated with adherence scores. Factors included in the final model were age, comorbidity, ART regimen and club membership duration. RESULTS The records of 730 participants were analysed. After adjusting for age, participants with comorbidities were half as likely to report high ART adherence scores compared to participants without comorbidities (AOR = 0.5, 95% CI: 0.3-0.8, p = 0.005). The adjusted odds of reporting high levels of adherence among participants on cART were 1.8 times those on a single tablet regimen (AOR = 1.8, 95% CI: 1.0-3.2; p = 0.033). There was a 20% reduction in the adjusted odds of reporting high ART adherence for each additional year of adherence club membership (AOR = 0.8, 95% CI: 0.8-0.9, p<0.001). CONCLUSION Increasing years spent as adherence club members, single tablet ART regimens and the presence of comorbidities were all significantly associated with low ART adherence among study participants. Regular assessment of the quality of counselling sessions for ART adherence club members and questionnaires for early screening of treatment fatigue have been suggested as tools for improved adherence in ART adherence club settings.
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Affiliation(s)
- Tariro Ndoro
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ntombizodwa Ndlovu
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Nyasulu
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Abstract
BACKGROUND Malaria remains an important public health problem. Research in 1900 suggested house modifications may reduce malaria transmission. A previous version of this review concluded that house screening may be effective in reducing malaria. This update includes data from five new studies. OBJECTIVES To assess the effects of house modifications that aim to reduce exposure to mosquitoes on malaria disease and transmission. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register; Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE (PubMed); Embase (OVID); Centre for Agriculture and Bioscience International (CAB) Abstracts (Web of Science); and the Latin American and Caribbean Health Science Information database (LILACS) up to 25 May 2022. We also searched the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, and the ISRCTN registry to identify ongoing trials up to 25 May 2022. SELECTION CRITERIA Randomized controlled trials, including cluster-randomized controlled trials (cRCTs), cross-over studies, and stepped-wedge designs were eligible, as were quasi-experimental trials, including controlled before-and-after studies, controlled interrupted time series, and non-randomized cross-over studies. We sought studies investigating primary construction and house modifications to existing homes reporting epidemiological outcomes (malaria case incidence, malaria infection incidence or parasite prevalence). We extracted any entomological outcomes that were also reported in these studies. DATA COLLECTION AND ANALYSIS Two review authors independently selected eligible studies, extracted data, and assessed the risk of bias. We used risk ratios (RR) to compare the effect of the intervention with the control for dichotomous data. For continuous data, we presented the mean difference; and for count and rate data, we used rate ratios. We presented all results with 95% confidence intervals (CIs). We assessed the certainty of evidence using the GRADE approach. MAIN RESULTS One RCT and six cRCTs met our inclusion criteria, with an additional six ongoing RCTs. We did not identify any eligible non-randomized studies. All included trials were conducted in sub-Saharan Africa since 2009; two randomized by household and four at the block or village level. All trials assessed screening of windows, doors, eaves, ceilings, or any combination of these; this was either alone, or in combination with roof modification or eave tube installation (an insecticidal "lure and kill" device that reduces mosquito entry whilst maintaining some airflow). In one trial, the screening material was treated with 2% permethrin insecticide. In five trials, the researchers implemented the interventions. A community-based approach was adopted in the other trial. Overall, the implementation of house modifications probably reduced malaria parasite prevalence (RR 0.68, 95% CI 0.57 to 0.82; 5 trials, 5183 participants; moderate-certainty evidence), although an inconsistent effect was observed in a subpopulation of children in one study. House modifications reduced moderate to severe anaemia prevalence (RR 0.70, 95% CI 0.55 to 0.89; 3 trials, 3643 participants; high-certainty evidence). There was no consistent effect on clinical malaria incidence, with rate ratios ranging from 0.38 to 1.62 (3 trials, 3365 participants, 4126.6 person-years). House modifications may reduce indoor mosquito density (rate ratio 0.63, 95% CI 0.30 to 1.30; 4 trials, 9894 household-nights; low-certainty evidence), although two studies showed little effect on this parameter. AUTHORS' CONCLUSIONS House modifications - largely screening, sometimes combined with insecticide and lure and kill devices - were associated with a reduction in malaria parasite prevalence and a reduction in people with anaemia. Findings on malaria incidence were mixed. Modifications were also associated with lower indoor adult mosquito density, but this effect was not present in some studies.
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Affiliation(s)
- Tilly Fox
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Marty Chaplin
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mark Napier
- Council for Scientific and Industrial Research, Pretoria, South Africa
- Centre for Development Support, University of the Free State, Bloemfontein, South Africa
| | - Evelyn A Olanga
- Malaria Alert Centre of the College of Medicine, Blantyre, Malawi
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22
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Kohler P, Larsen A, Sila J, Wilson K, Abuna F, Lagat H, Owiti G, Owens T, Pintye J, Richardson B, John-Stewart G, Kinuthia J. Mystery Shopper Assessment of PrEP Service Delivery Quality for Adolescent Girls and Young Women in Kenya: A Cross-sectional Study. J Assoc Nurses AIDS Care 2022; 33:534-541. [PMID: 35878051 DOI: 10.1097/jnc.0000000000000350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ABSTRACT Pre-exposure prophylaxis (PrEP) uptake and adherence among adolescent girls and young women (AGYW) may be negatively influenced by poor interactions with health care providers. We assessed PrEP counseling using unannounced standardized patient actors (USPs) at routine care clinics in Kenya. Trained actors posed as AGYW seeking PrEP services following case scripts and completed a checklist of provider adherence to national guidelines and communication skills. Scores were converted into a percentage and compared using linear regression. The overall mean quality score was 52.1 and varied across case scripts: a married new initiator yielded higher scores than portrayals of adherence/stigma challenges, transactional sex, and a minor adolescent. Mean guideline scores (31.4) were lower than communication scores (72.8), although in 36.5% of encounters, USPs stated they would not seek help from that provider again. Unannounced standardized patients reported provider reluctance to offer PrEP to AGYW. Interventions to strengthen provider counseling skills are needed.
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Affiliation(s)
- Pamela Kohler
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor of Global Health and Child, Family, and Population Health Nursing at the University of Washington, Seattle, Washington, USA. Anna Larsen, MPH, is a PhD Candidate in the Department of Epidemiology at the University of Washington, Seattle, Washington, USA. Joseph Sila, BSc, is a Data Analyst with Kenyatta National Hospital, Kisumu, Kenya. Kate Wilson, PhD, was a Research Scientist with the Department of Global Health, University of Washington, Seattle, Washington, USA. Felix Abuna, BA, is a Project Director with Kenyatta National Hospital, Kisumu, Kenya. Harison Lagat, BSN, MPH, RN, is a Research Coordinator with Kenyatta National Hospital, Kisumu, Kenya, and PhD Student at the University of Washington School of Nursing, Seattle, Washington, USA. George Owiti, RN, is a Research Coordinator with Kenyatta National Hospital, Kisumu, Kenya. Tamara Owens, PhD, is the Director of the Clinical Skills and Simulation Center at Howard University, Washington, DC, USA. Jillian Pintye, PhD, MPH, RN, is Assistant Professor of Biobehavioral Nursing and Health Informatics at the University of Washington, Seattle, Washington, USA. Barbra Richardson, PhD, is a Statistician with the Department of Biostatistics at the University of Washington, Seattle, Washington, USA. Grace John-Stewart, MD, PhD, is a Professor of Global Health, Epidemiology, Pediatrics, and Allergy and Infectious Diseases at the University of Washington, Seattle, Washington, USA. John Kinuthia, MBChB, MPH, is Head of the Department of Research and Programs at Kenyatta National Hospital, Nairobi, Kenya
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23
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Saya U, Wagner Z, Mukasa B, Wabukala P, Lunkuse L, Linnemayr S. The role of material deprivations in determining ART adherence: Evidence from a conjoint analysis among HIV-positive adults in Uganda. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000374. [PMID: 36962701 PMCID: PMC10022174 DOI: 10.1371/journal.pgph.0000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 06/30/2022] [Indexed: 11/19/2022]
Abstract
Despite sustained global scale-up of antiretroviral therapy (ART), adherence to ART remains low. Less than half of those in HIV care in Uganda achieve 85% adherence to their ART medication required for clinically meaningful viral suppression, leaving them at higher risk of transmission. Key barriers to ART adherence include poverty-related structural barriers that are inter-connected and occur simultaneously, making it challenging to examine and disentangle them empirically and in turn design effective interventions. Many people living with HIV (PLWH) make tradeoffs between these various barriers (e.g., between expenses for food or transportation) and these can influence long-term health behavior such as adherence to ART. To be able to estimate the distinct influence of key structural barriers related to poverty, we administered a conjoint analysis (CA) to 320 HIV-positive adults currently taking ART at an urban clinic in Uganda between July 2019 and September 2020. We varied the levels of four poverty-related attributes (food security, sleep deprivation, monthly income, and physical pain) that occur simultaneously and asked respondents how they would adhere to their medication under different combinations of attribute levels. This allows us to disentangle the effect of each attribute from one another and to assess their relative importance. We used regression analysis to estimate the effects of each attribute level and found that food security impacts expected adherence the most (treatment effect = 1.3; 95% CI 1.11-1.49, p<0.001), followed by income (treatment effect = 0.99; 95% CI 0.88-1.10, p<0.001. Sleep and pain also impact adherence, although by a smaller magnitude. Sub-group analyses conducted via regression analysis examine heterogeneity in results and suggest that the effects of material deprivations on expected adherence are greater among those with high levels of existing food insecurity. Results from this CA indicate that external factors inherent in the lives of the poor and unrelated to direct ART access can be important barriers to ART adherence. This study applies a CA (typically administered in marketing applications) among PLWH to better understand individual-level perceptions relating to poverty that often occur simultaneously. Policy interventions should address food insecurity and income to improve adherence among HIV-positive adults.
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Affiliation(s)
- Uzaib Saya
- Pardee RAND Graduate School, Santa Monica, California, United States of America
- RAND Corporation, Santa Monica, California, United States of America
| | - Zachary Wagner
- Pardee RAND Graduate School, Santa Monica, California, United States of America
- RAND Corporation, Santa Monica, California, United States of America
| | - Barbara Mukasa
- Mildmay Uganda, Mildmay Hospital and Institute of Health Sciences, Kampala, Uganda
| | - Peter Wabukala
- Mildmay Uganda, Mildmay Hospital and Institute of Health Sciences, Kampala, Uganda
| | - Lillian Lunkuse
- Mildmay Uganda, Mildmay Hospital and Institute of Health Sciences, Kampala, Uganda
| | - Sebastian Linnemayr
- Pardee RAND Graduate School, Santa Monica, California, United States of America
- RAND Corporation, Santa Monica, California, United States of America
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24
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Loveday M, Furin J, Hlangu S, Naidoo T. "I am alive because of her": factors affecting adherence to combination antiretroviral therapy among people living with HIV in KwaZulu-Natal, South Africa. BMC Infect Dis 2022; 22:680. [PMID: 35941552 PMCID: PMC9361592 DOI: 10.1186/s12879-022-07667-x] [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: 06/01/2022] [Accepted: 07/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People living with HIV need to take lifelong, combination antiretroviral therapy (cART), but there have been only limited explorations of how factors affecting adherence can change over the course of an individual's lifetime. METHODS We carried out a qualitative study of men and women living with HIV in KwaZulu, Natal, South Africa who were prescribed cART and who had periods of higher and lower adherence. RESULTS 18 individuals participated in open-ended interviews. Using a dynamic theory of adherence, we identified factual, relational, and experiential factors that were associated with adherence and non-adherence to cART. Periods of non-adherence were commonly reported. Participants described relationships and experiences as being important influences on their ability to adhere to cART throughout their treatment journeys. CONCLUSIONS Periods of non-adherence to cART are common. While many cART counseling models are based on conveying facts to people prescribed cART, providing opportunities for supportive relationship where people can process their varied experiences is likely important to maintaining health for people living with HIV.
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Affiliation(s)
- Marian Loveday
- HIV Prevention Research Unit, South African Medical Research Council, Durban, KwaZulu-Natal, South Africa.,CAPRISA-MRC HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave., Boston, MA, 02115, USA.
| | - Sindisiwe Hlangu
- HIV Prevention Research Unit, South African Medical Research Council, Durban, KwaZulu-Natal, South Africa
| | - Tasneem Naidoo
- R. K. Khan Hospital HAST Unit, Department of Health, Durban, KwaZulu-Natal, South Africa
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25
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“Returning to Ordinary Citizenship”: A Qualitative Study of Chinese PWUD’s Self-Management Strategies and Disengagement Model of Identity. Behav Sci (Basel) 2022; 12:bs12080258. [PMID: 36004829 PMCID: PMC9404964 DOI: 10.3390/bs12080258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023] Open
Abstract
How PWUD (people who use drugs) live under drug governance is an important research question. This study adopts a qualitative research method to explore how PWUD in China self-manage after perceiving the dilemma of incomplete citizenship and the social pressure brought by drug control arrangements. Through analysis of 130 PWUD’s files and in-depth interviews with 10 interviewees (from the 24 preliminary interviews), this study found that PWUD developed action strategies of hidden mobility (spatial isolation), disconnection of past experiences (time isolation), instrumental actions, as well as narrative strategies of reframing themselves as ordinary citizens with attempts of reversing identity disadvantages. Further, PWUD’s self-management strategies manifest as a disengagement model in which the actors (PWUD, not rehabilitation agencies) do not intend to develop integrative positive identities through dispersed, practiced behavioral strategies, but attempt to return to pre-addiction, non-socially exclusionary citizenship experiences. The disengagement model and its negative effect on PWUD’s social integration help us reflect on the current implementation of rehabilitation projects and institutional settings of drug governance.
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26
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Smith R, Villanueva G, Probyn K, Sguassero Y, Ford N, Orrell C, Cohen K, Chaplin M, Leeflang MM, Hine P. Accuracy of measures for antiretroviral adherence in people living with HIV. Cochrane Database Syst Rev 2022; 7:CD013080. [PMID: 35871531 PMCID: PMC9309033 DOI: 10.1002/14651858.cd013080.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Good patient adherence to antiretroviral (ART) medication determines effective HIV viral suppression, and thus reduces the risk of progression and transmission of HIV. With accurate methods to monitor treatment adherence, we could use simple triage to target adherence support interventions that could help in the community or at health centres in resource-limited settings. OBJECTIVES To determine the accuracy of simple measures of ART adherence (including patient self-report, tablet counts, pharmacy records, electronic monitoring, or composite methods) for detecting non-suppressed viral load in people living with HIV and receiving ART treatment. SEARCH METHODS The Cochrane Infectious Diseases Group Information Specialists searched CENTRAL, MEDLINE, Embase, LILACS, CINAHL, African-Wide information, and Web of Science up to 22 April 2021. They also searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov for ongoing studies. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included studies of all designs that evaluated a simple measure of adherence (index test) such as self-report, tablet counts, pharmacy records or secondary database analysis, or both, electronic monitoring or composite measures of any of those tests, in people living with HIV and receiving ART treatment. We used a viral load assay with a limit of detection ranging from 10 copies/mL to 400 copies/mL as the reference standard. We created 2 × 2 tables to calculate sensitivity and specificity. DATA COLLECTION AND ANALYSIS We screened studies, extracted data, and assessed risk of bias using QUADAS-2 independently and in duplicate. We assessed the certainty of evidence using the GRADE method. The results of estimated sensitivity and specificity were presented using paired forest plots and tabulated summaries. We encountered a high level of variation among studies which precluded a meaningful meta-analysis or comparison of adherence measures. We explored heterogeneity using pre-defined subgroup analysis. MAIN RESULTS We included 51 studies involving children and adults with HIV, mostly living in low- and middle-income settings, conducted between 2003 and 2021. Several studies assessed more than one index test, and the most common measure of adherence to ART was self-report. - Self-report questionnaires (25 studies, 9211 participants; very low-certainty): sensitivity ranged from 10% to 85% and specificity ranged from 10% to 99%. - Self-report using a visual analogue scale (VAS) (11 studies, 4235 participants; very low-certainty): sensitivity ranged from 0% to 58% and specificity ranged from 55% to 100%. - Tablet counts (12 studies, 3466 participants; very low-certainty): sensitivity ranged from 0% to 100% and specificity ranged from 5% to 99%. - Electronic monitoring devices (3 studies, 186 participants; very low-certainty): sensitivity ranged from 60% to 88% and the specificity ranged from 27% to 67%. - Pharmacy records or secondary databases (6 studies, 2254 participants; very low-certainty): sensitivity ranged from 17% to 88% and the specificity ranged from 9% to 95%. - Composite measures (9 studies, 1513 participants; very low-certainty): sensitivity ranged from 10% to 100% and specificity ranged from 49% to 100%. Across all included studies, the ability of adherence measures to detect viral non-suppression showed a large variation in both sensitivity and specificity that could not be explained by subgroup analysis. We assessed the overall certainty of the evidence as very low due to risk of bias, indirectness, inconsistency, and imprecision. The risk of bias and the applicability concerns for patient selection, index test, and reference standard domains were generally low or unclear due to unclear reporting. The main methodological issues identified were related to flow and timing due to high numbers of missing data. For all index tests, we assessed the certainty of the evidence as very low due to limitations in the design and conduct of the studies, applicability concerns and inconsistency of results. AUTHORS' CONCLUSIONS We encountered high variability for all index tests, and the overall certainty of evidence in all areas was very low. No measure consistently offered either a sufficiently high sensitivity or specificity to detect viral non-suppression. These concerns limit their value in triaging patients for viral load monitoring or enhanced adherence support interventions.
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Affiliation(s)
- Rhodine Smith
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | | | - Nathan Ford
- Department of HIV & Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | - Catherine Orrell
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Karen Cohen
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Marty Chaplin
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mariska Mg Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Paul Hine
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Beeman A, Bengtson AM, Swartz A, Colvin CJ, Lurie MN. Cyclical Engagement in HIV Care: A Qualitative Study of Clinic Transfers to Re-enter HIV Care in Cape Town, South Africa. AIDS Behav 2022; 26:2387-2396. [PMID: 35061116 PMCID: PMC9167245 DOI: 10.1007/s10461-022-03582-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 01/25/2023]
Abstract
Long-term patient engagement and retention in HIV care is an ongoing challenge in South Africa's strained health system. However, some patients thought to be "lost to follow-up" (LTFU) may have "transferred" clinics to receive care elsewhere. Through semi-structured interviews, we explored the relationship between clinic transfer and long-term patient engagement among 19 treatment-experienced people living with HIV (PLWH) who self-identified as having engaged in a clinic transfer at least once since starting antiretroviral therapy (ART) in Gugulethu, Cape Town. Our findings suggest that patient engagement is often fluid, as PLWH cycle in and out of care multiple times during their lifetime. The linear nature of the HIV care cascade model poorly describes the lived realities of PLWH on established treatment. Further research is needed to explore strategies for reducing unplanned clinic transfers and offer more supportive care to new and returning patients.
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Affiliation(s)
- Aly Beeman
- Brown University School of Public Health, Providence, RI, USA
| | - Angela M Bengtson
- Department of Epidemiology, Brown University School of Public Health, Box GS-121-2, Room 221, 121 South Main Street, Providence, RI, 02912, USA
| | - Alison Swartz
- Department of Epidemiology, Brown University School of Public Health, Box GS-121-2, Room 221, 121 South Main Street, Providence, RI, 02912, USA
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christopher J Colvin
- Department of Epidemiology, Brown University School of Public Health, Box GS-121-2, Room 221, 121 South Main Street, Providence, RI, 02912, USA
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Mark N Lurie
- Department of Epidemiology, Brown University School of Public Health, Box GS-121-2, Room 221, 121 South Main Street, Providence, RI, 02912, USA.
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
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Effects of psychosocial factors on nonadherence to ART in Ganta, Nimba county, Liberia. AIDS Res Ther 2022; 19:27. [PMID: 35752833 PMCID: PMC9233401 DOI: 10.1186/s12981-022-00455-2] [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: 11/30/2021] [Accepted: 06/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background It has been widely noted that lifetime adherence to antiretroviral therapy (ART) is necessary for HIV treatment outcome; however, retention on ART among people living with HIV (PLWH) remains a great challenge to achieve the Global AIDS Strategy: End inequalities, End AIDS. Nonadherence to ART is one of the HIV care problem in Liberia despite the availability of free ART. Psychosocial factors, i.e., perceived stigma and social support likely contributed to nonadherence to ART. We investigated associations among clinical factors, psychosocial factors, and nonadherence to ART. Methods A community-based cross-sectional study was conducted among 185 PLWH, age ≥ 18 years receiving ART in Ganta, Nimba county, Liberia at least 3 months. The structured questionnaire was used to collect data from April to May 2020. Associated factors of nonadherence to ART were identified using multivariable binary logistic regression, and the p-value < 0.05 was considered statistically significant. Results Of 185 respondents, 62.2% showed nonadherence to ART. Females reported higher nonadherence compared with males (64.4% vs. 56.6%). Multivariable binary logistic regression revealed strong experiences of stigma (PORadj = 2.392, p-value = 0.018), poor information support (PORadj = 2.102, p-value = 0.026) increased prevalence of ART nonadherence among Liberian PLWH. Conclusions The healthcare providers may apply interventions to reduce perceived stigma and to enhance continuous information provision in addition to support from health care providers and family members. An intensive monitoring of ART side effects is needed to be strengthened in particular among newly started ART patients.
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Mental Health Challenges and the Associated Factors in Women Living with HIV Who Have Children Living with HIV in Indonesia: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116879. [PMID: 35682460 PMCID: PMC9180562 DOI: 10.3390/ijerph19116879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022]
Abstract
Women living with HIV (WLHIV) are vulnerable to various mental health challenges. However, there is a paucity of studies globally and in the Indonesian context that have specifically explored mental health challenges among mothers living with HIV who also have children living with HIV (CLHIV). This qualitative study explored mental health challenges and the associated factors in mothers living with HIV who have CLHIV in Yogyakarta, Indonesia. In-depth interviews were employed to collect data from the participants (N = 23) who were recruited using the snowball sampling technique. A qualitative data analysis framework was used to guide the analysis of the findings. The findings showed that the mothers experienced a range of mental health issues due to their own, and their child’s diagnoses of stress, depression, anxiety, fear, sadness, and guilt. Lack of knowledge about HIV, fear of death, shame, not knowing whom to talk with and what to do after their own HIV diagnosis, and the HIV diagnosis of their children were factors that challenged their mental health. Difficulties in dealing with daily life or social activities of their CLHIV, dilemmas in addressing questions and complaints of their CLHIV about HIV treatment, and concerns about the health condition of their CLHIV and how their children cope with any potential negative social impacts also impacted the mothers’ mental health. Social factors such as unsympathetic expressions from friends towards them and their CLHIV and negatively worded religious-related advice from parents and relatives also contributed to their poor mental health. Our findings indicate the need for intervention programs that support mothers living with HIV and their CLHIV. Future large-scale studies involving mothers living with HIV who have CLHIV in Indonesia and other settings globally are needed to obtain a comprehensive understanding of mental health challenges and the associated factors they face.
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Saya U, MacCarthy S, Mukasa B, Wabukala P, Lunkuse L, Wagner Z, Linnemayr S. "The one who doesn't take ART medication has no wealth at all and no purpose on Earth" - a qualitative assessment of how HIV-positive adults in Uganda understand the health and wealth-related benefits of ART. BMC Public Health 2022; 22:1056. [PMID: 35619119 PMCID: PMC9137215 DOI: 10.1186/s12889-022-13461-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Increases in life expectancy from antiretroviral therapy (ART) may influence future health and wealth among people living with HIV (PLWH). What remains unknown is how PLWH in care perceive the benefits of ART adherence, particularly in terms of improving health and wealth in the short and long-term at the individual, household, and structural levels. Understanding future-oriented attitudes towards ART may help policymakers tailor care and treatment programs with both short and long-term-term health benefits in mind, to improve HIV-related outcomes for PLWH. METHODS In this qualitative study, we conducted semi-structured interviews among a subsample of 40 PLWH in care at a clinic in Uganda participating in a randomized clinical trial for treatment adherence in Uganda (clinicaltrials.gov: NCT03494777). Interviews were transcribed verbatim and translated from Luganda into English. Two co-authors independently reviewed transcripts, developed a detailed codebook, achieved 93% agreement on double-coded interviews, and analyzed data using inductive and deductive content analysis. Applying the social-ecological framework at the individual, household, and structural levels, we examined how PLWH perceived health and wealth-related benefits to ART. RESULTS Our findings revealed several benefits of ART expressed by PLWH, going beyond the short-term health benefits to also include long-term economic benefits. Such benefits largely focused on the ability of PLWH to live longer and be physically and mentally healthy, while also fulfilling responsibilities at the individual level pertaining to themselves (especially in terms of positive long-term habits and motivation to work harder), at the household level pertaining to others (such as improved relations with family and friends), and at the structural level pertaining to society (in terms of reduced stigma, increased comfort in disclosure, and higher levels of civic responsibility). CONCLUSIONS PLWH consider short and long-term health benefits of ART. Programming designed to shape ART uptake and increase adherence should emphasize the broader benefits of ART at various levels. Having such benefits directly integrated into the design of clinic-based HIV interventions can be useful especially for PLWH who face competing interests to increase medication adherence. These benefits can ultimately help providers and policymakers better understand PLWH's decision-making as it relates to improving ART-related outcomes.
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Affiliation(s)
- Uzaib Saya
- Pardee RAND Graduate School, Santa Monica, CA, 90401, USA.
- RAND Corporation, Santa Monica, CA, 90401, USA.
| | - Sarah MacCarthy
- Department of Health Behavior, University of Alabama at Birmingham School of Public Health, 227, Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL, 35233, USA
| | | | | | | | - Zachary Wagner
- Pardee RAND Graduate School, Santa Monica, CA, 90401, USA
- RAND Corporation, Santa Monica, CA, 90401, USA
| | - Sebastian Linnemayr
- Pardee RAND Graduate School, Santa Monica, CA, 90401, USA
- RAND Corporation, Santa Monica, CA, 90401, USA
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Katirayi L, Shoopala N, Mitruka K, Mengistu A, Woelk G, Baughman AL, Mutandi G, Hong SY, Hamunime N. Taking care to the patients: a qualitative evaluation of a community-based ART care program in northern Namibia. BMC Health Serv Res 2022; 22:498. [PMID: 35422033 PMCID: PMC9009034 DOI: 10.1186/s12913-022-07928-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Namibia is a large sparsely populated country with a high prevalence of HIV. People living with HIV who reside in remote areas often travel long distances through tough desert terrain to access HIV care and treatment. To address this barrier, community-based antiretroviral therapy (C-BART) sites were established in Okongo (2007–2008) and Eenhana districts (2016) of northern Namibia with the goal of bringing HIV and other health services closer patients’ homes. We conducted a qualitative evaluation of the acceptability and challenges of C-BART to guide program improvement. Methods For this qualitative descriptive study, research assistants collected data (August-December 2017) through in-depth interviews with 40 patients, seven health extension workers, and 11 policy/program managers, and through four focus group discussions with healthcare workers. Interviews were audio-recorded, translated, and coded using MAXQDA v.12. Data were analyzed using thematic analysis. Results The evaluation identified five themes: community ownership, acceptance of the C-BART sites, benefits of the C-BART program for the PLHIV community and their social networks, benefits of the C-BART program to the main health facility, and challenges with the C-BART program. The C-BART program was reported as life-changing by many patients who had previously struggled to afford four-wheel drive vehicles to access care. Patients and healthcare workers perceived that the community as a whole benefited from the C-BART sites not only due to the financial pressure lifted from friends and family members previously asked to help cover expensive transportation, but also due to the perception of diminished stigmatization of people living with HIV and improved health. The C-BART sites became a source of community and social support for those accessing the sites. Healthcare workers reported greater job satisfaction and decongestion of health facilities. The challenges that they reported included delays in authorization of vehicles for transportation to C-BART sites and lack of incentives to provide services in the community. Conclusion The C-BART program can serve as a model of care to expand access to HIV care and treatment and other health services to populations in remote settings, including rural and difficult-to-reach regions. The needs of healthcare workers should also be considered for the optimal delivery of such a model. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07928-0.
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Kiekens A, Dierckx de Casterlé B, Pellizzer G, Mosha IH, Mosha F, Rinke de Wit TF, Sangeda RZ, Surian A, Vandaele N, Vranken L, Killewo J, Jordan M, Vandamme AM. Exploring the mechanisms behind HIV drug resistance in sub-Saharan Africa: conceptual mapping of a complex adaptive system based on multi-disciplinary expert insights. BMC Public Health 2022; 22:455. [PMID: 35255842 PMCID: PMC8899794 DOI: 10.1186/s12889-022-12738-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND HIV drug resistance (HIVDR) continues to threaten the effectiveness of worldwide antiretroviral therapy (ART). Emergence and transmission of HIVDR are driven by several interconnected factors. Though much has been done to uncover factors influencing HIVDR, overall interconnectedness between these factors remains unclear and African policy makers encounter difficulties setting priorities combating HIVDR. By viewing HIVDR as a complex adaptive system, through the eyes of multi-disciplinary HIVDR experts, we aimed to make a first attempt to linking different influencing factors and gaining a deeper understanding of the complexity of the system. METHODS We designed a detailed systems map of factors influencing HIVDR based on semi-structured interviews with 15 international HIVDR experts from or with experience in sub-Saharan Africa, from different disciplinary backgrounds and affiliated with different types of institutions. The resulting detailed system map was conceptualized into three main HIVDR feedback loops and further strengthened with literature evidence. RESULTS Factors influencing HIVDR in sub-Saharan Africa and their interactions were sorted in five categories: biology, individual, social context, healthcare system and 'overarching'. We identified three causal loops cross-cutting these layers, which relate to three interconnected subsystems of mechanisms influencing HIVDR. The 'adherence motivation' subsystem concerns the interplay of factors influencing people living with HIV to alternate between adherence and non-adherence. The 'healthcare burden' subsystem is a reinforcing loop leading to an increase in HIVDR at local population level. The 'ART overreliance' subsystem is a balancing feedback loop leading to complacency among program managers when there is overreliance on ART with a perceived low risk to drug resistance. The three subsystems are interconnected at different levels. CONCLUSIONS Interconnectedness of the three subsystems underlines the need to act on the entire system of factors surrounding HIVDR in sub-Saharan Africa in order to target interventions and to prevent unwanted effects on other parts of the system. The three theories that emerged while studying HIVDR as a complex adaptive system form a starting point for further qualitative and quantitative investigation.
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Affiliation(s)
- Anneleen Kiekens
- Department of Microbiology, Immunology and Transplantation, Clinical and Epidemiological Virology, Institute for the Future, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.
| | | | | | - Idda H Mosha
- Department of Behavioural Sciences, Muhimbili University of Health and Allied Sciences, P.O Box 65015, Dar es Salaam, Tanzania
| | - Fausta Mosha
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania
| | - Tobias F Rinke de Wit
- Amsterdam Instiute for Global Health and Development (AIGHD), Amsterdam, the Netherlands
| | - Raphael Z Sangeda
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, P.O Box 65012, Dar es Salaam, Tanzania
| | - Alessio Surian
- FISPPA Department, Università Degli Studi Di Padova, 35139, Padova, Italy
| | - Nico Vandaele
- Faculty of Economics and Business, Access To Medicine Research Center, KU Leuven, Leuven, Belgium
| | - Liesbet Vranken
- Department of Earth and Environmental Sciences, Division of Bioeconomics, KU Leuven, Leuven, Belgium
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Michael Jordan
- Tufts University School of Medicine, Boston, USA
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, USA
- Tufts Center for Tufts Center for Integrated Management of Antimicrobial Resistance (CIMAR), Boston, USA
| | - Anne-Mieke Vandamme
- Department of Microbiology, Immunology and Transplantation, Clinical and Epidemiological Virology, Institute for the Future, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
- Center for Global Health and Tropical Medicine, Unidade de Microbiologia, Instituto de Higiene E Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
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Mirzazadeh A, Eshun-Wilson I, Thompson RR, Bonyani A, Kahn JG, Baral SD, Schwartz S, Rutherford G, Geng EH. Interventions to reengage people living with HIV who are lost to follow-up from HIV treatment programs: A systematic review and meta-analysis. PLoS Med 2022; 19:e1003940. [PMID: 35290369 PMCID: PMC8923443 DOI: 10.1371/journal.pmed.1003940] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 02/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Optimizing services to facilitate engagement and retention in care of people living with HIV (PLWH) on antiretroviral therapies (ARTs) is critical to decrease HIV-related morbidity and mortality and HIV transmission. We systematically reviewed the literature for the effectiveness of implementation strategies to reestablish and subsequently retain clinical contact, improve viral load suppression, and reduce mortality among patients who had been lost to follow-up (LTFU) from HIV services. METHODS AND FINDINGS We searched 7 databases (PubMed, Cochrane, ERIC, PsycINFO, EMBASE, Web of Science, and the WHO regional databases) and 3 conference abstract archives (CROI, IAC, and IAS) to find randomized trials and observational studies published through 13 April 2020. Eligible studies included those involving children and adults who were diagnosed with HIV, had initiated ART, and were subsequently lost to care and that reported at least one review outcome (return to care, retention, viral suppression, or mortality). Data were extracted by 2 reviewers, with discrepancies resolved by a third. We characterized reengagement strategies according to how, where, and by whom tracing was conducted. We explored effects, first, among all categorized as LTFU from the HIV program (reengagement program effect) and second among those found to be alive and out of care (reengagement contact outcome). We used random-effect models for meta-analysis and conducted subgroup analyses to explore heterogeneity. Searches yielded 4,244 titles, resulting in 37 included studies (6 randomized trials and 31 observational studies). In low- and middle-income countries (LMICs) (N = 16), tracing most frequently involved identification of LTFU from the electronic medical record (EMR) and paper records followed by a combination of telephone calls and field tracing (including home visits), by a team of outreach workers within 3 months of becoming LTFU (N = 7), with few incorporating additional strategies to support reengagement beyond contact (N = 2). In high-income countries (HICs) (N = 21 studies), LTFU were similarly identified through EMR systems, at times matched with other public health records (N = 4), followed by telephone calls and letters sent by mail or email and conducted by outreach specialist teams. Home visits were less common (N = 7) than in LMICs, and additional reengagement support was similarly infrequent (N = 5). Overall, reengagement programs were able to return 39% (95% CI: 31% to 47%) of all patients who were characterized as LTFU (n = 29). Reengagement contact resulted in 58% (95% CI: 51% to 65%) return among those found to be alive and out of care (N = 17). In 9 studies that had a control condition, the return was higher among those in the reengagement intervention group than the standard of care group (RR: 1.20 (95% CI: 1.08 to 1.32, P < 0.001). There were insufficient data to generate pooled estimates of retention, viral suppression, or mortality after the return. CONCLUSIONS While the types of interventions are markedly heterogeneity, reengagement interventions increase return to care. HIV programs should consider investing in systems to better characterize LTFU to identify those who are alive and out of care, and further research on the optimum time to initiate reengagement efforts after missed visits and how to best support sustained reengagement could improve efficiency and effectiveness.
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Affiliation(s)
- Ali Mirzazadeh
- Division of Infectious Disease and Global Epidemiology, Department of Epidemiology and Biostatistics, and Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, School of Medicine, Washington University at St Louis, St Louis, Missouri, United States of America
| | - Ryan R. Thompson
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America
| | | | - James G. Kahn
- University of California San Francisco, San Francisco, California, United States of America
| | - Stefan D. Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - George Rutherford
- Division of Infectious Disease and Global Epidemiology, Department of Epidemiology and Biostatistics, and Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Elvin H. Geng
- Division of Infectious Diseases, School of Medicine, Washington University at St Louis, St Louis, Missouri, United States of America
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St Louis, Missouri, United States of America
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Taylor M, Thomas R, Oliver S, Garner P. Community views on mass drug administration for filariasis: a qualitative evidence synthesis. Cochrane Database Syst Rev 2022; 2:CD013638. [PMID: 35174482 PMCID: PMC8851040 DOI: 10.1002/14651858.cd013638.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The World Health Organization (WHO) recommends mass drug administration (MDA), giving a drug at regular intervals to a whole population, as part of the strategy for several disease control programmes in low- and middle-income countries. MDA is currently WHO policy for areas endemic with lymphatic filariasis, which is a parasitic disease that can result in swollen limbs and disability. The success depends on communities adhering to the drugs given, and this will be influenced by the perception of the drug, the programme, and those delivering it. OBJECTIVES: To synthesize qualitative research evidence about community experience with, and understanding and perception of, MDA programmes for lymphatic filariasis. To explore whether programme design and delivery influence the community experience identified in the analysis. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and seven other databases up to 8 April 2021, together with reference checking, citation searching, and contact with study authors to identify additional studies. SELECTION CRITERIA This review synthesized qualitative research and mixed-methods studies when it was possible to extract qualitative data. Eligible studies explored community experiences, perceptions, or attitudes towards MDA programmes for lymphatic filariasis in any country, conducted between 2000 and 2019. DATA COLLECTION AND ANALYSIS: We extracted data on study design including: authors, aims, participants, methods, and qualitative data collection methods. We also described programme delivery factors including: country, urban or rural setting, endemicity, drug regimen, rounds of MDA received at the time of the study, who delivered the drugs, how the drugs were delivered, use of health education, and sensitization and adherence monitoring. We conducted a thematic analysis and developed codes inductively using ATLAS.ti software. We examined codes for underlying ideas, connections, and interpretations and, from this, generated analytical themes. We assessed the confidence in the findings using the GRADE-CERQual approach, and produced a conceptual model to display our findings. MAIN RESULTS: From 902 results identified in the search, 29 studies met our inclusion criteria. The studies covered a broad range of countries in Africa, South-East Asia, and South America, and explored the views and experiences of community members and community drug distributors in low-income countries endemic for lymphatic filariasis. Four themes emerged. People weigh up benefits and harms before participating. People understand the potential benefits in terms of relief of suffering, stigma, and avoiding costs (high confidence); however, these theoretical benefits do not always mesh with their experiences (high confidence). In particular, adverse effects are frightening and unwelcome (high confidence); and these effects are amplified through rumour and social media (moderate confidence). Many people are suspicious of MDA programmes. When people lack a scientific explanation for the programme and their experiences of it, they often develop social explanations instead. These are largely shaped on the historical backdrop and level of trust people have in relevant authority figures (high confidence), although some have unwavering faith in their government and, by extension, the programme (moderate confidence). Programmes expect compliance, and this can become coercive and blaming. Health workers and community members stigmatize non-compliance, which can become coercive (moderate confidence), so communities may appear to comply publicly, but privately reject treatment (moderate confidence). Community distributors are often not respected or valued. They have little authority (moderate confidence), and the behaviour of some distributors damages the MDA programme's reputation (high confidence). Communities want information about programmes to help make decisions about participation, but drug distributors are not sufficiently informed, or skilled in this communication (high confidence). We intended to assess whether programme designs influenced communities' perceptions of the programme and decision to adhere but were unable to do so as few studies adequately reported the design and implementation of the local programme. We have moderate to high confidence in the evidence contributing to the review themes and subthemes. AUTHORS' CONCLUSIONS Adherence with MDA for filariasis is influenced by individual direct experience of benefit and harm; social influences in the community; political influences and their relationship to government; and historical influences. Fear of adverse effects was frequently described and this appears to be particularly important for communities. When views were negative, we were surprised by the strength of feeling expressed. Enthusiasm for these schemes as a strategy in global policy needs debate in the light of these findings.
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Affiliation(s)
- Melissa Taylor
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Rebecca Thomas
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sandy Oliver
- EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London, London, UK
- Africa Centre for Evidence, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Paul Garner
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Spooner E, Reddy T, Mchunu N, Reddy S, Daniels B, Ngomane N, Luthuli N, Kiepiela P, Coutsoudis A. Point-of-care CD4 testing: Differentiated care for the most vulnerable. J Glob Health 2022; 12:04004. [PMID: 35136596 PMCID: PMC8818294 DOI: 10.7189/jogh.12.04004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background South Africa, with the highest burden of HIV infection globally, has made huge strides in its HIV/ART programme, but AIDS deaths have not decreased proportionally to ART uptake. Advanced HIV disease (CD4 < 200 cells/mm3) persists, and CD4 count testing is being overlooked since universal test-and-treat was implemented. Point-of-care CD4 testing could address this gap and assure differentiated care to these vulnerable patients with low CD4 counts. Methods A time randomised implementation trial was conducted, enrolling 603 HIV positive non-ART, not pregnant patients at a primary health care clinic in Durban, South Africa. Weeks were randomised to either point-of-care CD4 testing (n = 305 patients) or standard-of-care central laboratory CD4 testing (n = 298 patients) to assess the proportion initiating ART at 3 months. Cox regression, with robust standard errors adjusting for clustering by week, were used to assess the relationship between treatment initiation and arm. Results Among the 578 (299 point-of-care and 279 standard-of-care) patients eligible for analysis, there was no significant difference in the number of eligible patients initiating ART within 3 months in the point-of-care (73%) and the standard-of-care (68%) groups (P = 0.112). The time-to-treat analysis was not significantly different in patients with CD4 counts of 201-500 cells/mm3 which could have been due to appointment scheduling to cope with the large burden of cases. However, in patients with advanced HIV disease (CD4 < 200cells/mm3) 65% more patients started ART earlier in the point-of-care group (HR 1.65 (95% confidence interval (CI) = 0.99-2.75; P = 0.052) compared to the standard-of-care group. Conclusions Point-of-care testing decreased time-to-treatment in those with advanced HIV disease. With universal test and treat for HIV, rollout of simple point-of-care CD4 testing would ensure early diagnosis of advanced HIV disease and facilitate differentiated care for these vulnerable patients as per the World Health Organisation 2020 target product profile for point-of-care CD4 testing. Trial registration ISRCTN14220457.
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Affiliation(s)
- Elizabeth Spooner
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Tarylee Reddy
- South African Medical Research Council, Biostatistics Unit, Durban, South Africa
| | - Nobuhle Mchunu
- South African Medical Research Council, Biostatistics Unit, Durban, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | | | - Brodie Daniels
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | | | | | | | - Anna Coutsoudis
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
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Mwamba C, Mukamba N, Sharma A, Lumbo K, Foloko M, Nyirenda H, Simbeza S, Sikombe K, Holmes CB, Sikazwe I, Moore CB, Mody A, Geng E, Beres LK. "Provider discretionary power practices to support implementation of patient-centered HIV care in Lusaka, Zambia". FRONTIERS IN HEALTH SERVICES 2022; 2:918874. [PMID: 36925865 PMCID: PMC10012689 DOI: 10.3389/frhs.2022.918874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022]
Abstract
Introduction Traditional patient-provider relationships privilege the providers, as they possess the formal authority and clinical knowledge applied to address illness, but providers also have discretion over how they exercise their power to influence patients' services, benefits, and sanctions. In this study, we assessed providers' exercise of discretionary power in implementing patient-centered care (PCC) practices in Lusaka, Zambia. Methods HIV clinical encounters between patients on antiretroviral therapy (ART) and providers across 24 public health facilities in Lusaka Province were audio recorded and transcribed verbatim. Using qualitative content analysis, we identified practices of discretionary power (DP) employed in the implementation of PCC and instances of withholding DP. A codebook of DP practices was inductively and iteratively developed. We compared outcomes across provider cadres and within sites over time. Results We captured 194 patient-provider interactions at 24 study sites involving 11 Medical Officers, 58 Clinical Officers and 10 Nurses between August 2019 to May 2021. Median interaction length was 7.5 min. In a hierarchy where providers dominate patients and interactions are rapid, some providers invited patients to ask questions and responded at length with information that could increase patient understanding and agency. Others used inclusive language, welcomed patients, conducted introductions, and apologized for delayed services, narrowing the hierarchical distance between patient and provider, and facilitating recognition of the patient as a partner in care. Although less common, providers shared their decision-making powers, allowing patients to choose appointment dates and influence regimens. They also facilitated resource access, including access to services and providers outside of scheduled appointment times. Application of DP was not universal and missed opportunities were identified. Conclusion Supporting providers to recognize their power and intentionally share it is both inherent to the practice of PCC (e.g., making a patient a partner), and a way to implement improved patient support. More research is needed to understand the application of DP practices in improving the patient-centeredness of care in non-ART settings.
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Affiliation(s)
- Chanda Mwamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Njekwa Mukamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Kasapo Lumbo
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Marksman Foloko
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Herbert Nyirenda
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sandra Simbeza
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Kombatende Sikombe
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Charles B Holmes
- Department of Medicine, Georgetown University Medical Centre, Georgetown University, Washington, DC, United States
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Aaloke Mody
- Washington University School of Medicine, St. Louis, MO, United States
| | - Elvin Geng
- Washington University School of Medicine, St. Louis, MO, United States
| | - Laura K Beres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Bassett IV, Yan J, Govere S, Khumalo A, Ngobese N, Shazi Z, Nzuza M, Bunda BA, Wara NJ, Stuckwisch A, Zionts D, Dube N, Tshabalala S, Bogart LM, Parker RA. Uptake of community- versus clinic-based antiretroviral therapy dispensing in the Central Chronic Medication Dispensing and Distribution program in South Africa. J Int AIDS Soc 2022; 25:e25877. [PMID: 35077611 PMCID: PMC8789242 DOI: 10.1002/jia2.25877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/28/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION South Africa's government-led Central Chronic Medication Dispensing and Distribution (CCMDD) program offers people living with HIV the option to collect antiretroviral therapy at their choice of community- or clinic-based pick-up points intended to increase convenience and decongest clinics. To understand CCMDD pick-up point use among people living with HIV, we evaluated factors associated with uptake of a community- versus clinic-based pick-up point at CCMDD enrolment. METHODS We collected baseline data from October 2018 to March 2020 on adults (≥18 years) who met CCMDD clinical eligibility criteria (non-pregnant, on antiretroviral therapy for ≥1 year and virologically suppressed) as part of an observational cohort in seven public clinics in KwaZulu-Natal. We identified factors associated with community-based pick-up point uptake and fit a multivariable logistic regression model, including age, gender, employment status, self-perceived barriers to care, self-efficacy, HIV-related discrimination, and perceived benefits and challenges of CCMDD. RESULTS AND DISCUSSION Among 1521 participants, 67% were females, with median age 36 years (IQR 30-44). Uptake of a community-based pick-up point was associated with younger age (aOR 1.18 per 10-year decrease, 95% CI 1.05-1.33), being employed ≥40 hours per week (aOR 1.42, 95% CI 1.10-1.83) versus being unemployed, no self-perceived barriers to care (aOR 1.42, 95% CI 1.09-1.86) and scoring between 36 and 39 (aOR 1.44, 95% CI 1.03-2.01) or 40 (aOR 1.91, 95% CI 1.39-2.63) versus 10-35 on the self-efficacy scale, where higher scores indicate greater self-efficacy. Additional factors included more convenient pick-up point location (aOR 2.32, 95% CI 1.77-3.04) or hours (aOR 5.09, 95% CI 3.71-6.98) as perceived benefits of CCMDD, and lack of in-clinic follow-up after a missed collection date as a perceived challenge of CCMDD (aOR 4.37, 95% CI 2.30-8.31). CONCLUSIONS Uptake of community-based pick-up was associated with younger age, full-time employment, and systemic and structural factors of living with HIV (no self-perceived barriers to care and high self-efficacy), as well as perceptions of CCMDD (convenient pick-up point location and hours, lack of in-clinic follow-up). Strategies to facilitate community-based pick-up point uptake should be tailored to patients' age, employment, self-perceived barriers to care and self-efficacy to maximize the impact of CCMDD in decongesting clinics.
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Affiliation(s)
- Ingrid V. Bassett
- Massachusetts General HospitalDivision of Infectious DiseasesBostonMassachusettsUSA
- Massachusetts General HospitalMedical Practice Evaluation CenterBostonMassachusettsUSA
- Center for AIDS Research (CFAR)Harvard UniversityBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Joyce Yan
- Massachusetts General HospitalBiostatistics CenterBostonMassachusettsUSA
| | | | | | | | | | | | - Bridget A. Bunda
- Massachusetts General HospitalMedical Practice Evaluation CenterBostonMassachusettsUSA
| | - Nafisa J. Wara
- Massachusetts General HospitalMedical Practice Evaluation CenterBostonMassachusettsUSA
| | - Ashley Stuckwisch
- Massachusetts General HospitalMedical Practice Evaluation CenterBostonMassachusettsUSA
| | - Dani Zionts
- Massachusetts General HospitalMedical Practice Evaluation CenterBostonMassachusettsUSA
| | | | | | | | - Robert A. Parker
- Center for AIDS Research (CFAR)Harvard UniversityBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
- Massachusetts General HospitalBiostatistics CenterBostonMassachusettsUSA
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Beres LK, Mody A, Sikombe K, Nicholas LH, Schwartz S, Eshun-Wilson I, Somwe P, Simbeza S, Pry JM, Kaumba P, McGready J, Holmes CB, Bolton-Moore C, Sikazwe I, Denison JA, Geng EH. The effect of tracer contact on return to care among adult, "lost to follow-up" patients living with HIV in Zambia: an instrumental variable analysis. J Int AIDS Soc 2021; 24:e25853. [PMID: 34921515 PMCID: PMC8683971 DOI: 10.1002/jia2.25853] [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: 04/09/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Tracing patients lost to follow-up (LTFU) from HIV care is widely practiced, yet we have little knowledge of its causal effect on care engagement. In a prospective, Zambian cohort, we examined the effect of tracing on return to care within 2 years of LTFU. METHODS We traced a stratified, random sample of LTFU patients who had received HIV care between August 2013 and July 2015. LTFU was defined as a gap of >90 days from last scheduled appointment in the routine electronic medical record. Extracting 2 years of follow-up visit data through 2017, we identified patients who returned. Using random selection for tracing as an instrumental variable (IV), we used conditional two-stage least squares regression to estimate the local average treatment effect of tracer contact on return. We examined the observational association between tracer contact and return among patient sub-groups self-confirmed as disengaged from care. RESULTS Of the 24,164 LTFU patients enumerated, 4380 were randomly selected for tracing and 1158 were contacted by a tracer within a median of 14.8 months post-loss. IV analysis found that patients contacted by a tracer because they were randomized to tracing were no more likely to return than those not contacted (adjusted risk difference [aRD]: 3%, 95% CI: -2%, 8%, p = 0.23). Observational data showed that among contacted, disengaged patients, the rate of return was higher in the week following tracer contact (IR 5.74, 95% CI: 3.78-8.71) than in the 2 weeks to 1-month post-contact (IR 2.28, 95% CI: 1.40-3.72). There was a greater effect of tracing among patients lost for >6 months compared to those contacted within 3 months of loss. CONCLUSIONS Overall, tracer contact did not causally increase LTFU patient return to HIV care, demonstrating the limited impact of tracing in this program, where contact occurred months after patients were LTFU. However, observational data suggest that tracing may speed return among some LTFU patients genuinely out-of-care. Further studies may improve tracing effectiveness by examining the mechanisms underlying the impact of tracing on return to care, the effect of tracing at different times-since-loss and using more accurate identification of patients who are truly disengaged to target tracing.
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Affiliation(s)
- Laura K Beres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aaloke Mody
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Lauren Hersch Nicholas
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ingrid Eshun-Wilson
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Paul Somwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sandra Simbeza
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Jake M Pry
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.,Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Paul Kaumba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - John McGready
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Charles B Holmes
- Center for Innovation in Global Health, Georgetown University, Washington, DC, USA.,Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carolyn Bolton-Moore
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Julie A Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elvin H Geng
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Hempel S, Ferguson L, Bolshakova M, Yagyu S, Fu N, Motala A, Gruskin S. Frameworks, measures, and interventions for HIV-related internalised stigma and stigma in healthcare and laws and policies: systematic review protocol. BMJ Open 2021; 11:e053608. [PMID: 34887280 PMCID: PMC8663079 DOI: 10.1136/bmjopen-2021-053608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is strong global commitment to eliminate HIV-related stigma. Wide variation exists in frameworks and measures, and many strategies to prevent, reduce or mitigate stigma have been proposed but critical factors determining success or failure remain elusive. METHODS AND ANALYSIS Building on existing knowledge syntheses, we designed a systematic review to identify frameworks, measures and intervention evaluations aiming to address internalised stigma, stigma and discrimination in healthcare, and stigma and discrimination at the legal or policy level. The review addresses four key questions (KQ): KQ1: Which conceptual frameworks have been proposed to assess internal stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? KQ2: Which measures of stigma have been proposed and what are their descriptive properties? KQ3: Which interventions have been evaluated that aimed to reduce these types of stigma and discrimination or mitigate their adverse effects and what are the effectiveness and unintended consequences? KQ4: What common 'critical factors for success or failure' can be identified across interventions that have been evaluated? We will search PubMed, PsycINFO, Web of Science, Universal Human Rights Index, HeinOnline, PAIS, HIV Legal Network, CDSR, Campbell Collaboration, PROSPERO and Open Science Framework. Critical appraisal will assess the source, processes and consensus finding for frameworks; COnsensus-based Standards for the selection of health Measurement Instruments criteria for measures; and risk of bias for interventions. Quality of evidence grading will apply . A gap analysis will provide targeted recommendations for future research. We will establish a compendium of frameworks, a comprehensive catalogue of available measures, and a synthesis of intervention characteristics to advance the science of HIV-related stigma. PROSPERO REGISTRATION NUMBER CRD42021249348.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sachi Yagyu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Ning Fu
- Department of Economics, Shanghai University of Finance and Economics, Shanghai, China
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
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Kiekens A, Mosha IH, Zlatić L, Bwire GM, Mangara A, Dierckx de Casterlé B, Decouttere C, Vandaele N, Sangeda RZ, Swalehe O, Cottone P, Surian A, Killewo J, Vandamme AM. Factors Associated with HIV Drug Resistance in Dar es Salaam, Tanzania: Analysis of a Complex Adaptive System. Pathogens 2021; 10:1535. [PMID: 34959490 PMCID: PMC8707982 DOI: 10.3390/pathogens10121535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
HIV drug resistance (HIVDR) is a complex problem with multiple interconnected and context dependent causes. Although the factors influencing HIVDR are known and well-studied, HIVDR remains a threat to the effectiveness of antiretroviral therapy. To understand the complexity of HIVDR, a comprehensive, systems approach is needed. Therefore, a local systems map was developed integrating all reported factors influencing HIVDR in the Dar es Salaam Urban Cohort Study area in Tanzania. The map was designed based on semi-structured interviews and workshops with people living with HIV and local actors who encounter people living with HIV during their daily activities. We visualized the feedback loops driving HIVDR, compared the local map with a systems map for Sub-Saharan Africa, previously constructed from interviews with international HIVDR experts, and suggest potential interventions to prevent HIVDR. We found several interconnected balancing and reinforcing feedback loops related to poverty, stigmatization, status disclosure, self-esteem, knowledge about HIVDR and healthcare system workload, among others, and identified three potential leverage points. Insights from this local systems map were complementary to the insights from the Sub-Saharan systems map showing that both viewpoints are needed to fully understand the system. This study provides a strong baseline for quantitative modelling, and for the identification of context-dependent, complexity-informed leverage points.
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Affiliation(s)
- Anneleen Kiekens
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, 3000 Leuven, Belgium; (L.Z.); (G.M.B.); (A.-M.V.)
| | - Idda H. Mosha
- Department of Behavioural Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65015, Tanzania;
| | - Lara Zlatić
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, 3000 Leuven, Belgium; (L.Z.); (G.M.B.); (A.-M.V.)
- FISPPA Department, Università degli Studi di Padova, 35139 Padova, Italy; (P.C.); (A.S.)
| | - George M. Bwire
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, 3000 Leuven, Belgium; (L.Z.); (G.M.B.); (A.-M.V.)
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65013, Tanzania;
| | - Ally Mangara
- Dar es Salaam Urban Cohort Study, Dar es Salaam 65013, Tanzania;
| | - Bernadette Dierckx de Casterlé
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, 3000 Leuven, Belgium;
| | - Catherine Decouttere
- Faculty of Economics and Business, Access to Medicine Research Center, KU Leuven, 3000 Leuven, Belgium; (C.D.); (N.V.)
| | - Nico Vandaele
- Faculty of Economics and Business, Access to Medicine Research Center, KU Leuven, 3000 Leuven, Belgium; (C.D.); (N.V.)
| | - Raphael Z. Sangeda
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65013, Tanzania;
| | - Omary Swalehe
- Department of Business Studies, School of Business, Mzumbe University, Dar es Salaam 20266, Tanzania;
| | - Paolo Cottone
- FISPPA Department, Università degli Studi di Padova, 35139 Padova, Italy; (P.C.); (A.S.)
| | - Alessio Surian
- FISPPA Department, Università degli Studi di Padova, 35139 Padova, Italy; (P.C.); (A.S.)
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65001, Tanzania;
| | - Anne-Mieke Vandamme
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, 3000 Leuven, Belgium; (L.Z.); (G.M.B.); (A.-M.V.)
- Center for Global Health and Tropical Medicine, Unidade de Microbiologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisbon, Portugal
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Predictors of Loss to Follow-Up among HIV-Infected Adults after Initiation of the First-Line Antiretroviral Therapy at Arba Minch General Hospital, Southern Ethiopia: A 5-Year Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8659372. [PMID: 34805406 PMCID: PMC8601861 DOI: 10.1155/2021/8659372] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 12/02/2022]
Abstract
Background Loss to follow-up (LTFU) from antiretroviral therapy (ART) reduces treatment benefits and leads to treatment failure. Hence, this study was aimed at determining the incidence of loss to follow-up and predictors among HIV-infected adults who began first-line antiretroviral therapy at Arba Minch General Hospital. Methods We carried out an institutional-based retrospective cohort study, and data were collected from the charts of 508 patients who were selected using a simple random sampling technique. All the data management and statistical analyses were conducted using STATA version 14. Cumulative survival probability was estimated and presented in the life table, and the Kaplan-Meir survival curves were compared using the log-rank test. The Cox proportional hazard model was used to identify the independent predictors. Results We followed 508 patients for 871.9 person-years. A total of 46 (9.1%) experienced loss to follow-up, yielding an overall incidence rate of 5.3 (95% CI: 3.9-7.1) per 100 person-years. The cumulative survival probability was 90%, 88%, 86%, and 86% at the end of one, two, three, and four years, respectively. The predictors identified were age less than 35 years (adjusted hazard ratio (aHR = 1.96; 95% CI: 1.92-4.00)), rural residence (aHR = 1.98; 95% CI: 1.02-3.83), baseline body weight greater than 60 kilograms (aHR = 2.19; 95% CI: 1.11-4.37), a fair level of adherence (aHR = 11.5; 95% CI: 2.10-61.10), and a poor level of adherence (aHR = 12.03; 95% CI: 5.4-26.7). Conclusions In this study, the incidence rate of loss to follow-up was low. Younger adults below the age of 35 years, living in rural areas, with a baseline weight greater than 60 kilograms, which had a fair and poor adherence level were more likely to be lost from treatment. Therefore, health professionals working in ART clinics and potential stakeholders in HIV/AIDS care and treatment should consider adult patients with these characteristics to prevent LTFU.
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Testing for saturation in qualitative evidence syntheses: An update of HIV adherence in Africa. PLoS One 2021; 16:e0258352. [PMID: 34665831 PMCID: PMC8525762 DOI: 10.1371/journal.pone.0258352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 09/24/2021] [Indexed: 11/22/2022] Open
Abstract
Background A systematic review of randomised trials may be conclusive signalling no further research is needed; or identify gaps requiring further research that may then be included in review updates. In qualitative evidence synthesis (QES), the rationale, triggers, and methods for updating are less clear cut. We updated a QES on adherence to anti-retroviral treatment to examine if thematic saturation renders additional research redundant. Methods We adopted the original review search strategy and eligibility criteria to identify studies in the subsequent three years. We assessed studies for conceptual detail, categorised as ‘rich’ or ‘sparse’, coding the rich studies. We sought new codes, and appraised whether findings confirmed, extended, enriched, or refuted existing themes. Finally, we examined if the analysis impacted on the original conceptual model. Results After screening 3895 articles, 301 studies met the inclusion criteria. Rich findings from Africa were available in 82 studies; 146 studies were sparse, contained no additional information on specific populations, and did not contribute to the analysis. New studies enriched our understanding on the relationship between external and internal factors influencing adherence, confirming, extending and enriching the existing themes. Despite careful evaluation of the new literature, we did not identify any new themes, and found no studies that refuted our theory. Conclusions Updating an existing QES using the original question confirmed and sometimes enriched evidence within themes but made little or no substantive difference to the theory and overall findings of the original review. We propose this illustrates thematic saturation. We propose a thoughtful approach before embarking on a QES update, and our work underlines the importance of QES priority areas where further primary research may help, and areas where further studies may be redundant.
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Leyva-Moral JM, Palmieri PA, Loayza-Enriquez BK, Vander Linden KL, Elias-Bravo UE, Guevara-Vasquez GM, Davila-Olano LY, Aguayo-Gonzalez MP. 'Staying alive' with antiretroviral therapy: a grounded theory study of people living with HIV in Peru. BMJ Glob Health 2021; 6:e006772. [PMID: 34711579 PMCID: PMC8557298 DOI: 10.1136/bmjgh-2021-006772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/05/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To achieve an optimal quality of life through chronic disease management, people living with HIV (PLHIV) must adhere to antiretroviral therapy (ART). ART has been available throughout Peru since 2004 without cost in all regions; yet only 60% (43 200) of PLHIV receive ART and 32% are virally suppressed. Despite the low adherence, little is known about the experience of PLHIV with ART adherence in the context of Latin America. METHODS A constructivist grounded theory design was used to understand the ART adherence experiences of PLHIV in Northern Peru. Unstructured interviews were conducted with 18 participants resulting in theoretical saturation. All interviews were recorded, immediately transcribed and analysed concurrently with data collection using constant comparative analysis with Atlas.ti (V.8) software. Rigour was maintained through openness, reflexivity, audit trail, memo writing, debriefings, member checks and positionality. RESULTS The core category 'staying alive' emerged through the interaction of four categories, including: (1) overcoming barriers; (2) working with the healthcare team; (3) tailoring self-care strategies; and (4) appreciating antiretrovirals. Adherence is not a spontaneous outcome, instead, the surprise of HIV diagnosis transitions to living with HIV as a chronic disease. The healthcare team helps PLHIV realise ART is their life source by enhancing, supporting and facilitating self-care and overcoming barriers. CONCLUSION Adherence emerges from experiential learning as PLHIV recognised ART as their life source in balance with their desire to continue living a normal life. Social support and healthcare team interventions help PLHIV implement tailored self-care strategies to overcome personal, social, and structural barriers to adherence. Healthcare professionals need to recognise the challenges confronted by PLHIV as they learn how to continue living while trying to stay alive.
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Affiliation(s)
- Juan Manuel Leyva-Moral
- Grup de Recerca Infermera en Vulnerabilitat i Salut (GRIVIS), Departament d'Infermeria, Universitat Autonoma de Barcelona, Barcelona, Spain
- Qualitative Health Research, Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
| | - Patrick Albert Palmieri
- South American Center for Qualitative Research, Universidad Privada Norbert Wiener, Lima, Peru
- College of Graduate Health Studies, A.T. Still University, Kirksville, Missouri, USA
| | - Blanca Katiuzca Loayza-Enriquez
- Qualitative Health Research, Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- Facultad de Medicina Humana, Universidad San Martin de Porres, Chiclayo, Peru
| | - Kara Lynette Vander Linden
- Department of Research, Saybrook University, Pasadena, California, USA
- Glaser Center for Grounded Theory, Institute for Research and Theory Methodologies, Poway, California, USA
| | - Ursula Elisa Elias-Bravo
- Escuela de Enfermería, Universidad Cientifica del Sur, Miraflores, Peru
- Estrategia Sanitaria de Prevención y Control de VIH-SIDA, Hospital Regional Lambayeque, Chiclayo, Peru
| | - Genesis Masiel Guevara-Vasquez
- Qualitative Health Research, Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- Departamento del Desarrollo de Investigación Básica Clínica, Hospital Regional Lambayeque, Chiclayo, Peru
| | | | - Mariela Patricia Aguayo-Gonzalez
- Grup de Recerca Infermera en Vulnerabilitat i Salut (GRIVIS), Departament d'Infermeria, Universitat Autonoma de Barcelona, Barcelona, Spain
- Qualitative Health Research, Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
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Engel N, Ochodo EA, Karanja PW, Schmidt BM, Janssen R, Steingart KR, Oliver S. Rapid molecular tests for tuberculosis and tuberculosis drug resistance: provider and recipient views. Hippokratia 2021. [DOI: 10.1002/14651858.cd014877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Nora Engel
- Department of Health, Ethics & Society, School of Public Health and Primary Care (CAPHRI); Maastricht University; Maastricht Netherlands
| | - Eleanor A Ochodo
- Centre for Evidence-based Health Care, Department of Global Health, Faculty of Medicine and Health Sciences; Stellenbosch University; Cape Town South Africa
- Centre for Global Health Research; Kenya Medical Research Institute; Kisumu Kenya
| | | | - Bey-Marrié Schmidt
- School of Public Health; University of the Western Cape; Cape Town South Africa
| | - Ricky Janssen
- Department of Health, Ethics & Society, School of Public Health and Primary Care (CAPHRI); Maastricht University; Maastricht Netherlands
| | - Karen R Steingart
- Honorary Research Fellow; Department of Clinical Sciences, Liverpool School of Tropical Medicine; Liverpool UK
| | - Sandy Oliver
- EPPI-Centre, Social Science Research Unit, UCL Institute of Education; University College London; London UK
- Africa Centre for Evidence, Faculty of Humanities; University of Johannesburg; Johannesburg South Africa
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Bisnauth MA, Davies N, Monareng S, Buthelezi F, Struthers H, McIntyre J, Rees K. Why do patients interrupt and return to antiretroviral therapy? Retention in HIV care from the patient's perspective in Johannesburg, South Africa. PLoS One 2021; 16:e0256540. [PMID: 34473742 PMCID: PMC8412245 DOI: 10.1371/journal.pone.0256540] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/09/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Retention in care is required for optimal clinical outcomes in people living with HIV (PLHIV). Although most PLHIV in South Africa know their HIV status, only 70% are on antiretroviral therapy (ART). Improved retention in care is needed to get closer to sustained ART for all. In January 2019, Anova Health Institute conducted a campaign to encourage patients who had interrupted ART to return to care. METHODS Data collection was conducted in one region of Johannesburg. This mixed methods study consisted of two components: 1) healthcare providers entered data into a structured tool for all patients re-initiating ART at nine clinics over a nine-month period, 2) Semi-structured interviews were conducted with a sub-set of patients. Responses to the tool were analysed descriptively, we report frequencies, and percentages. A thematic approach was used to analyse participant experiences in-depth. RESULTS 562 people re-initiated ART, 66% were women, 75% were 25-49 years old. The three most common reasons for disengagement from care were mobility (30%), ART related factors (15%), and time limitations due to work (10%). Reasons for returning included it becoming easier to attend the clinic (34%) and worry about not being on ART (19%). Mobile interview participants often forgot their medical files and expressed that managing their ART was difficult because they often needed a transfer letter to gain access to ART at another facility. On the other hand, clinics that had flexible and extended hours facilitated retention in care. CONCLUSION In both the quantitative data, and the qualitative analysis, changing life circumstances was the most prominent reason for disengagement from care. Health services were not perceived to be responsive to life changes or mobility, leading to disengagement. More client-centred and responsive health services should improve retention on ART.
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Affiliation(s)
| | | | | | | | - Helen Struthers
- Anova Health Institute, Johannesburg, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - James McIntyre
- Anova Health Institute, Johannesburg, South Africa
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kate Rees
- Anova Health Institute, Johannesburg, South Africa
- Department of Community Health, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Peh KQE, Kwan YH, Goh H, Ramchandani H, Phang JK, Lim ZY, Loh DHF, Østbye T, Blalock DV, Yoon S, Bosworth HB, Low LL, Thumboo J. An Adaptable Framework for Factors Contributing to Medication Adherence: Results from a Systematic Review of 102 Conceptual Frameworks. J Gen Intern Med 2021; 36:2784-2795. [PMID: 33660211 PMCID: PMC8390603 DOI: 10.1007/s11606-021-06648-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/28/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To summarize the available conceptual models for factors contributing to medication adherence based on the World Health Organization (WHO)'s five dimensions of medication adherence via a systematic review, identify the patient groups described in available conceptual models, and present an adaptable conceptual model that describes the factors contributing to medication adherence in the identified patient groups. METHODS We searched PubMed®, Embase®, CINAHL®, and PsycINFO® for English language articles published from inception until 31 March 2020. Full-text original publications in English that presented theoretical or conceptual models for factors contributing to medication adherence were included. Studies that presented statistical models were excluded. Two authors independently extracted the data. RESULTS We identified 102 conceptual models, and classified the factors contributing to medication adherence using the WHO's five dimensions of medication adherence, namely patient-related, medication-related, condition-related, healthcare system/healthcare provider-related, and socioeconomic factors. Eight patient groups were identified based on age and disease condition. The most universally addressed factors were patient-related factors. Medication-related, condition-related, healthcare system-related, and socioeconomic factors were represented to various extents depending on the patient group. By systematically examining how the WHO's five dimensions of medication adherence were applied differently across the eight different patient groups, we present a conceptual model that can be adapted to summarize the common factors contributing to medication adherence in different patient groups. CONCLUSION Our conceptual models can be utilized as a guide for clinicians and researchers in identifying the facilitators and barriers to medication adherence and developing future interventions to improve medication adherence. PROTOCOL REGISTRATION PROSPERO Identifier: CRD42020181316.
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Affiliation(s)
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Hendra Goh
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Hasna Ramchandani
- Department of Biology, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Jie Kie Phang
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore
| | - Zhui Ying Lim
- SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore
| | - Dionne Hui Fang Loh
- SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore
| | - Truls Østbye
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Family Medicine and Community Health, Duke University, Durham, NC USA
| | - Dan V. Blalock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC USA
| | - Sungwon Yoon
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Hayden Barry Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC USA
- Departments of Population Health Sciences and Psychiatry and Behavioral Sciences, School of Medicine, School of Nursing, Duke University, Durham, NC USA
| | - Lian Leng Low
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
| | - Julian Thumboo
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
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Morojele R. Concerns about starting antiretroviral treatment among pregnant women in Lesotho. Glob Public Health 2021; 17:1675-1688. [PMID: 34255609 DOI: 10.1080/17441692.2021.1954225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The recommendation to start antiretroviral treatment independently of CD4 or viral load count is adopted as a strategy for reducing HIV/AIDS incidence rates in countries with a high prevalence rate, such as Lesotho. For example, the number of new HIV infections has lowered from 20,000 in 2010 to 11,000 in 2018 [UNAIDS Country Factsheets. (2019). https://www.unaids.org/en/regionscountries/countries/lesotho]. Lesotho introduced the 'test and treat' strategy in 2013 to address the HIV/AIDS pandemic, representing a shift from the provider-initiated HIV testing and counselling guidelines. The purpose of this paper was to understand pregnant women's concerns about starting antiretroviral treatment to limit risks of mother-to-child HIV-transmission during the implementation of 'test and treat' protocol in Lesotho. The study used a qualitative research approach and collected information from Lesotho public antenatal clinics. In-depth interviews were conducted with eighteen pregnant women living with HIV/AIDS and data were analysed manually following the constructivist grounded theory. Findings reveal the sadness experienced at the diagnosis stage, concerns about accessing treatment and maintaining adherence, and concerns about disclosure. It was concluded that these factors stemmed from fears about triggering enacted stigma in the illness experience of pregnant women, which could hamper the implementation of the 'test and treat' protocol in Lesotho.
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Affiliation(s)
- Relebohile Morojele
- Department of Sociology and Social Work, The National University of Lesotho, Roma, Lesotho
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Misra S, Mehta HT, Eschliman EL, Rampa S, Poku OB, Wang WQ, Ho-Foster AR, Mosepele M, Becker TD, Entaile P, Arscott-Mills T, Opondo PR, Blank MB, Yang LH. Identifying "What Matters Most" to Men in Botswana to Promote Resistance to HIV-Related Stigma. QUALITATIVE HEALTH RESEARCH 2021; 31:1680-1696. [PMID: 33764233 PMCID: PMC9287436 DOI: 10.1177/10497323211001361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Despite a comprehensive national program of free HIV services, men living with HIV in Botswana participate at lower rates and have worse outcomes than women. Directed content analysis of five focus groups (n = 38) and 50 in-depth interviews with men and women with known and unknown HIV status in Gaborone, Botswana in 2017 used the "what matters most" (WMM) and "structural vulnerability" frameworks to examine how the most valued cultural aspects of manhood interact with HIV-related stigma. WMM for manhood in Botswana included fulfilling male responsibilities by being a capable provider and maintaining social status. Being identified with HIV threatened WMM, which fear of employment discrimination could further exacerbate. Our findings indicate how cultural and structural forces interact to worsen or mitigate HIV-related stigma for urban men in Botswana. These threats to manhood deter HIV testing and treatment, but interventions could capitalize on cultural capabilities for manhood to promote stigma resistance.
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Affiliation(s)
- Supriya Misra
- Department of Public Health, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132, United States
| | - Haitisha T. Mehta
- Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, United States
| | - Evan L. Eschliman
- Mailman School of Public Health, Columbia University, 722 West 168th St. NY, NY 10032, United States
| | - Shathani Rampa
- Department of Psychology, University of Botswana, Private Bag UB 00705, Gaborone, Botswana
| | - Ohemaa B. Poku
- Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, United States
| | - Wei-Qian Wang
- Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, United States
| | - Ari R. Ho-Foster
- Faculty of Medicine, University of Botswana, Private Bag UB 0022, Gaborone, Botswana; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19104, United States
| | - Mosepele Mosepele
- Faculty of Medicine, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Timothy D. Becker
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States
| | - Patlo Entaile
- Botswana-UPenn Partnership, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Tonya Arscott-Mills
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19104, United States
| | - Phillip R. Opondo
- Department of Psychiatry, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Michael B. Blank
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19104, United States
| | - Lawrence H. Yang
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, 715 Broadway 12 Floor, New York, NY 10003, United States; Mailman School of Public Health, Columbia University, 722 West 168th St. NY, NY 10032, United States
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Sematlane NP, Knight L, Masquillier C, Wouters E. Adapting to, integrating and self-managing HIV as a chronic illness: a scoping review protocol. BMJ Open 2021; 11:e047870. [PMID: 34162650 PMCID: PMC8231044 DOI: 10.1136/bmjopen-2020-047870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/27/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The process of adapting to a life with a chronic illness, is a well-researched phenomenon for a number of common chronic illnesses. The construct, adaptation, embeds the notions of integration of the chronic illness into identity and self-management. Integration precedes self-management and is key to living positively with a chronic illness. Adaptation is an important concept in understanding trajectory and outcomes of living with a chronic illness. Applicability of these concepts to HIV as a chronic illness; when suppressive adherence has been achieved, however, is unknown. Specifically, the adaptation process to living with HIV as a chronic illness, the integration of HIV into identity and the resulting self-management behaviours by adults living with HIV are relatively unexplored. We describe a protocol for a scoping review of adaptation to living with HIV, we structure the enquiry around integration of HIV into identity and self-management and interrogate theories, models and frameworks that have been proposed and studied and we evaluate them for relevance and usefulness in the care and management of HIV. METHODS AND ANALYSIS Methods proposed by the Johanna Briggs Institute will be followed. The protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews and was registered with the Open Science Framework. MEDLINE, SCOPUS, Cochrane Library, CINHAL and SocINDEX databases will be searched. A search in Social Science Research Network eLibrary and Open Access Theses and Dissertations will gather grey literature and reference lists of included sources will be screened. Study selection process will involve a title and abstract review and full text review, guided by clearly defined inclusion and exclusion criteria. ETHICS AND DISSEMINATION Ethical approval is not required because this is a proposed review and collection of data on publicly available materials. The results will be published in a topic relevant journal and presented at related scientific events.
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Affiliation(s)
- Neo Phyllis Sematlane
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Bellville, South Africa
| | - Lucia Knight
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Bellville, South Africa
- Division of Social and Bahavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
| | - Caroline Masquillier
- Centre for Population, Family & Health, Department of Sociology, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Edwin Wouters
- Centre for Population, Family & Health, Department of Sociology, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
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Rohwer A, Taylor M, Ryan R, Garner P, Oliver S. Enhancing Public Health Systematic Reviews With Diagram Visualization. Am J Public Health 2021; 111:1029-1034. [PMID: 33950720 PMCID: PMC8101596 DOI: 10.2105/ajph.2021.306225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Anke Rohwer
- Anke Rohwer is with the Centre for Evidence-Based Health Care, Stellenbosch University, Stellenbosch, South Africa. Melissa Taylor and Paul Garner are with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Rebecca Ryan is with the Centre for Health Communication and Participation, La Trobe University, Melbourne, Australia. Sandy Oliver is with the Evidence for Policy and Practice Information and Co-ordinating Centre, Social Research Institute, University College London, London, UK, and the Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Melissa Taylor
- Anke Rohwer is with the Centre for Evidence-Based Health Care, Stellenbosch University, Stellenbosch, South Africa. Melissa Taylor and Paul Garner are with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Rebecca Ryan is with the Centre for Health Communication and Participation, La Trobe University, Melbourne, Australia. Sandy Oliver is with the Evidence for Policy and Practice Information and Co-ordinating Centre, Social Research Institute, University College London, London, UK, and the Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Rebecca Ryan
- Anke Rohwer is with the Centre for Evidence-Based Health Care, Stellenbosch University, Stellenbosch, South Africa. Melissa Taylor and Paul Garner are with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Rebecca Ryan is with the Centre for Health Communication and Participation, La Trobe University, Melbourne, Australia. Sandy Oliver is with the Evidence for Policy and Practice Information and Co-ordinating Centre, Social Research Institute, University College London, London, UK, and the Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Paul Garner
- Anke Rohwer is with the Centre for Evidence-Based Health Care, Stellenbosch University, Stellenbosch, South Africa. Melissa Taylor and Paul Garner are with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Rebecca Ryan is with the Centre for Health Communication and Participation, La Trobe University, Melbourne, Australia. Sandy Oliver is with the Evidence for Policy and Practice Information and Co-ordinating Centre, Social Research Institute, University College London, London, UK, and the Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Sandy Oliver
- Anke Rohwer is with the Centre for Evidence-Based Health Care, Stellenbosch University, Stellenbosch, South Africa. Melissa Taylor and Paul Garner are with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Rebecca Ryan is with the Centre for Health Communication and Participation, La Trobe University, Melbourne, Australia. Sandy Oliver is with the Evidence for Policy and Practice Information and Co-ordinating Centre, Social Research Institute, University College London, London, UK, and the Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
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