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Aheron S, Paredes-Vincent A, Patton ME, Gross J, Medley A, Mona G, Mtimkulu N, Nkuna K, Grund JM. Improving HIV Case Finding Through Index Testing: Findings from Health Facilities in 12 Districts of South Africa, October 2019-September 2021. AIDS Behav 2024; 28:1708-1718. [PMID: 38358586 PMCID: PMC11070287 DOI: 10.1007/s10461-024-04269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/16/2024]
Abstract
To assess the importance of index testing in HIV case finding, we analyzed quarterly data from October 2019 to September 2021 from 371 facilities in 12 districts in South Africa. Index testing accounted for 2.6% of all HIV tests (index and non-index) (n = 163,633), but 17.8% of all HIV-positive results, with an HIV-positivity 4-times higher than non-index testing modalities (4.1%). Despite twice as many adult females ≥ 15 years accepting index testing (n = 206,715) compared to adult males ≥ 15 years (n = 102,180), females identified fewer contacts (n = 91,123) than males (n = 113,939). Slightly more than half (51.2%) of all contacts elicited were tested (n = 163,633/319,680), while 19.7% (n = 62,978) of elicited contacts were previously diagnosed as HIV-positive and not eligible for further testing. These findings indicate index testing can be effective in increasing HIV diagnoses in South Africa. Further operational research is needed to address gaps identified in the index testing cascade, including elicitation and testing of contacts.
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Affiliation(s)
- Sarah Aheron
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa.
| | - Ariana Paredes-Vincent
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa
| | - Monica E Patton
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa
| | - Jessica Gross
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Amy Medley
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Gugu Mona
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa
| | | | - Khensani Nkuna
- Wits Reproductive Health and HIV Institute (WRHI), Johannesburg, South Africa
| | - Jonathan M Grund
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa
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2
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Secor AM, Ihnatiuk A, Shapoval A, McDowell M, Hetman L, Wagner AD, Pintye J, Beima-Sofie K, Golden MR, Puttkammer N. Does HIV index testing bring patients into treatment at earlier stages of HIV disease? Results from a retrospective study in Ukraine. BMC Infect Dis 2024; 24:328. [PMID: 38500055 PMCID: PMC10949801 DOI: 10.1186/s12879-024-09190-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Over one-third of people living with HIV (PLH) in Ukraine are not on treatment. Index testing services, which link potentially exposed partners (named partners) of known PLH (index patients) with testing and treatment services, are being scaled in Ukraine and could potentially close this gap. METHODS This retrospective study included patient data from 14,554 adult PLH who initiated antiretroviral treatment (ART) between October 2018 and May 2021 at one of 35 facilities participating in an intervention to strengthen index testing services. Mixed effects modified Poisson models were used to assess differences between named partners and other ART initiators, and an interrupted time series (ITS) analysis was used to assess changes in ART initiation over time. RESULTS Compared to other ART initiators, named partners were significantly less likely to have a confirmed TB diagnosis (aRR = 0.56, 95% CI = 0.40, 0.77, p < 0.001), a CD4 count less than 200 cells/mm3 (aRR = 0.84, 95% CI = 0.73, 0.97, p = 0.017), or be categorized as WHO HIV stage 4 (aRR = 0.68, 9% CI = 0.55, 0.83, p < 0.001) at the time of ART initiation, and were significantly more likely to initiate ART within seven days of testing for HIV (aRR = 1.36, 95% CI = 1.22, 1.50, p < 0.001). Our ITS analysis showed a modest 2.34% (95% CI = 0.26%, 4.38%; p = 0.028) month-on-month reduction in mean ART initiations comparing the post-intervention period to the pre-intervention period, although these results were likely confounded by the COVID epidemic. CONCLUSION Our findings suggest that index testing services may be beneficial in bringing PLH into treatment at an earlier stage of HIV disease and decreasing delays between HIV testing and ART initiation, potentially improving patient outcomes and retention in the HIV care cascade.
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Affiliation(s)
- Andrew M Secor
- Department of Global Health, University of Washington, Hans Rosling Center, 3980 15th Ave NE, 98105, Seattle, WA, USA.
| | - Alyona Ihnatiuk
- International Training and Education Center for Health (I-TECH), Kyiv, Ukraine
| | - Anna Shapoval
- International Training and Education Center for Health (I-TECH), Kyiv, Ukraine
| | - Misti McDowell
- International Training and Education Center for Health (I-TECH), Seattle, WA, USA
| | - Larisa Hetman
- Public Health Center (PHC) of the Ministry of Health (MoH) of Ukraine, Kyiv, Ukraine
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Hans Rosling Center, 3980 15th Ave NE, 98105, Seattle, WA, USA
| | - Jillian Pintye
- Department of Global Health, University of Washington, Hans Rosling Center, 3980 15th Ave NE, 98105, Seattle, WA, USA
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Hans Rosling Center, 3980 15th Ave NE, 98105, Seattle, WA, USA
| | - Matthew R Golden
- Department of Medicine, University of Washington, Seattle, WA, USA
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA
| | - Nancy Puttkammer
- Department of Global Health, University of Washington, Hans Rosling Center, 3980 15th Ave NE, 98105, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), Seattle, WA, USA
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3
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O’Bryan G, Chirairo H, Munyayi F, Ensminger A, Barnabee G, Dzinotyiweyi E, Mwandingi L, Ashipala L, Forster N, O’Malley G, Golden MR. Assisted Partner Notification Services in Namibia: Comparison of Case-Finding in Persons With New and Previously Diagnosed Human Immunodeficiency Virus, and Success as a Platform for PrEP Referral. Sex Transm Dis 2024; 51:214-219. [PMID: 38412468 PMCID: PMC10901442 DOI: 10.1097/olq.0000000000001922] [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: 02/29/2024]
Abstract
BACKGROUND Assisted partner notification services (APS) are widely implemented throughout sub-Saharan Africa. The effectiveness of APS among persons with previously diagnosed human immunodeficiency virus (HIV) infection is uncertain, and there are few published data on the success of integrating referrals for HIV preexposure prophylaxis (PrEP) into APS. METHODS Staff in 22 Namibian Ministry of Health and Social Service clinics offered APS to patients newly and previously diagnosed with HIV (index cases [ICs]) between October 2019 and June 2021. Counselors used a structured interview guide to elicit ICs' sex partners and biological children and assisted ICs to arrange testing of contacts. Contacts testing HIV-positive were linked to HIV services and those 14 years or older testing negative were offered PrEP. The primary outcome was the case-finding index (contacts testing HIV-positive ÷ ICs receiving APS). RESULTS Staff provided APS to 1222 (78%) of 1557 newly diagnosed ICs eliciting 1155 sex partners and 649 biological children. Among 280 previously diagnosed ICs, 279 sex partners and 158 biological children were elicited. The case-finding index was higher among ICs with newly diagnosed HIV compared with previously diagnosed HIV (0.14 vs 0.09, P = 0.46), though this difference was not statistically significant. Most sex partners testing HIV-negative were initiated on PrEP (67% in sex partners from newly diagnosed ICs; 74% in sex partners from previously diagnosed ICs). CONCLUSIONS Assisted partner notification services successfully identified sex partners and biological children with undiagnosed HIV infection when provided to both newly and previously diagnosed ICs. Integration of referral to PrEP resulted in many HIV-negative partners initiating PrEP.
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Affiliation(s)
- Gillian O’Bryan
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Harugumi Chirairo
- Department of Global Health, University of Washington, Seattle, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Farai Munyayi
- Department of Global Health, University of Washington, Seattle, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Alison Ensminger
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Gena Barnabee
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | | | | | - Laimi Ashipala
- Ministry of Health and Social Services (MHSS), Windhoek, Namibia
| | - Norbert Forster
- Department of Global Health, University of Washington, Seattle, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Gabrielle O’Malley
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Matthew R. Golden
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, USA
- Center for AIDS and STD, University of Washington, USA
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Tomlinson M, Marlow M, Stewart J, Makhetha M, Sekotlo T, Mohale S, Lombard C, Murray L, Cooper PJ, Morley N, Rabie S, Gordon S, van der Merwe A, Bachman G, Hunt X, Sherr L, Cluver L, Skeen S. A community-based child health and parenting intervention to improve child HIV testing, health, and development in rural Lesotho (Early Morning Star): a cluster-randomised, controlled trial. Lancet HIV 2024; 11:e42-e51. [PMID: 38142113 DOI: 10.1016/s2352-3018(23)00265-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 09/30/2023] [Accepted: 10/12/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND When caregivers live in remote settings characterised by extreme poverty, poor access to health services, and high rates of HIV/AIDS, their caregiving ability and children's development might be compromised. We aimed to test the effectiveness of a community-based child health and parenting intervention to improve child HIV testing, health, and development in rural Lesotho. METHODS We implemented a matched cluster-randomised, controlled trial in the Mokhotlong district in northeastern Lesotho with 34 community clusters randomly assigned to intervention or wait-list control groups within a pair. Eligible clusters were villages with non-governmental organisation partner presence and an active preschool. Participants were caregiver-child dyads, where the child was 12-60 months old at baseline. The intervention consisted of eight group sessions delivered at informal preschools to all children in each village. Mobile health events were hosted for all intervention (n=17) and control (n=17) clusters, offering HIV testing and other health services to all community members. Primary outcomes were caregiver-reported child HIV testing, child language development, and child attention. Assessments were done at baseline, immediately post-intervention (3 months post-baseline), and 12 months post-intervention. We assessed child language by means of one caregiver-report measure (MacArthur-Bates Communicative Development Inventory [CDI]) and used two observational assessments of receptive language (the Mullen Scales of Early Learning receptive language subscale, and the Peabody Picture Vocabulary Test 4th edn). Child attention was assessed by means of the Early Childhood Vigilance Task. Assessors were masked to group assignment. Analysis was by intention to treat. This trial was registered with ISRCTN.com, ISRCTN16654287 and is completed. FINDINGS Between Aug 8, 2015, and Dec 10, 2017, 1040 children (531 intervention; 509 control) and their caregivers were enrolled in 34 clusters (17 intervention; 17 control). Compared with controls, the intervention group reported significantly higher child HIV testing at the 12-month follow-up (relative risk [RR] 1·46, 95% CI 1·29 to 1·65, p<0·0001), but not immediately post-intervention. The intervention group showed significantly higher child receptive language on the caregiver report (CDI) at immediate (effect size 3·79, 95% CI 0·78 to 6·79, p=0·028) but not at 12-month follow-up (effect size 2·96, 95% CI -0·10 to 5·98, p=0·056). There were no significant group differences for the direct assessments of receptive language. Child expressive language and child attention did not differ significantly between groups. INTERPRETATION Integrated child health and parenting interventions, delivered by trained and supervised lay health workers, can improve both child HIV testing and child development. FUNDING United States Agency for International Development (USAID) and the President's Emergency Plan for AIDS Relief (PEPFAR).
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Affiliation(s)
- Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Marguerite Marlow
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jackie Stewart
- Division of Global Surgery, University of Cape Town, Cape Town, South Africa
| | - Moroesi Makhetha
- Institute for Life Course Health Research Lesotho Satellite Site, Stellenbosch University, Maseru, Lesotho
| | - Tholoana Sekotlo
- Institute for Life Course Health Research Lesotho Satellite Site, Stellenbosch University, Maseru, Lesotho
| | - Sebuoeng Mohale
- Institute for Life Course Health Research Lesotho Satellite Site, Stellenbosch University, Maseru, Lesotho
| | - Carl Lombard
- Division of Epidemiology and Biostatistics, Stellenbosch University, Belleville, South Africa; Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Lynne Murray
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Peter J Cooper
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Nathene Morley
- Baylor International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, Texas, USA
| | - Stephan Rabie
- HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa
| | - Sarah Gordon
- Centre for Evidence-Based Health Care, Stellenbosch University, Belleville, South Africa
| | - Amelia van der Merwe
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gretchen Bachman
- Office of Global HIV/AIDS, US Agency for International Development, Washington, DC, USA
| | - Xanthe Hunt
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lorraine Sherr
- Institute of Global Health, University College London, London, UK
| | - Lucie Cluver
- Centre for Evidence-Based Social Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands
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Hussen MA, Kadire D, Kefeni BT, Abdu Z, Chilo E. Index Case HIV Testing Uptake and its Associated Factors at Oromia, Ethiopia. J Int Assoc Provid AIDS Care 2024; 23:23259582241274028. [PMID: 39129380 PMCID: PMC11320704 DOI: 10.1177/23259582241274028] [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: 02/02/2024] [Revised: 05/22/2024] [Accepted: 07/10/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Lack of index case testing increased the risk of contracting HIV among the families of index clients, partners, and biological children. The aim of this study was to determine the prevalence of index case HIV testing uptake and its associated factors at Oromia, Ethiopia. METHODS An institutional-based cross-sectional study was conducted. A face-to-face interviewer administered structured questionnaire and chart review checklist were used to collect data. The data were analyzed using SPSS version 25. Logistic regressions were executed and statistical significance was declared at P < .05. RESULTS The prevalence of index case testing was 80.2%. Factors associated with index case HIV testing uptake included HIV status disclosure (AOR = 5.4, 95% CI: 2.1, 14.0), discussed about HIV with family (AOR = 3.1, 95% CI: 1.2, 7.5), counseling of the index case (AOR = 3.3, 95% CI: 1.7, 10.6), perceived benefit of the index case tested (AOR = 3.2, 95% CI: 1.5, 8.7), being on ART 12 months or more (AOR = 2.6, 95% CI: 1.1, 6.1), and maintained privacy (AOR = 3.1, 95% CI: 1.3, 7.1). CONCLUSIONS The uptake of index case HIV testing was moderately high. Additionally, factors such as HIV status disclosure, discussion of HIV with family, counseling of the index case, perception of the benefits of HIV testing for the index case, duration of clients on ART, and privacy maintenance during service delivery were significantly associated with index case HIV testing. To enhance index case testing, it is crucial to raise awareness and ensure client privacy during the initial HTC visit. Encouraging HIV status disclosure through discussion and promoting adherence to HIV medication is also recommended.
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Affiliation(s)
- Mustefa Adem Hussen
- Department of Midwifery, College of Health Science, Mattu University, Oromia, Ethiopia
| | - Dawud Kadire
- Department of Public Health, College of Health Science, Mattu University, Oromia, Ethiopia
| | | | - Zakir Abdu
- Department of Psychiatry, College of Health Science, Mattu University, Oromia, Ethiopia
| | - Eshetu Chilo
- Department of Biomedical Science, College of Health Science, Mattu University, Oromia, Ethiopia
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Chisenga T, Chihana M, Chishimba P, Chitembo L, Mulenga L, Silumesii A, Maman D, Johnson C. Maintaining HIV testing and treatment services in Zambia during COVID-19: a story of success and resilience. Glob Health Action 2023; 16:2175992. [PMID: 36809236 PMCID: PMC9946302 DOI: 10.1080/16549716.2023.2175992] [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] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by a virus called severe acute respiratory syndrome coronavirus. As countries struggled to control the spread of the virus through among other measures closure of health facilities, repurposing of health care workers, and restrictions on people's movement, HIV service delivery was affected. OBJECTIVES To assess the impact of COVID-19 on HIV service delivery in Zambia by comparing uptake of HIV services before and during COVID-19. METHODS We used repeated cross-sectional quarterly and monthly data on HIV testing, HIV positivity rate, people living with HIV initiating ART and use of essential hospital services from July 2018 to December 2020. We assessed quarterly trends and measured proportionate changes comparing periods before and during COVID-19 divided into three different comparison time frames: (1) annual comparison 2019 versus 2020; (2) April to December 2019 versus same period in 2020; and (3) Quarter 1 of 2020 as base period versus each of the other quarters of year 2020. RESULTS Annual HIV testing dropped by 43.7% (95%CI 43.6-43.7) in 2020 compared to 2019 and was similar by sex. Overall, annual recorded number of newly diagnosed PLHIV fell by 26.5% (95% CI 26.37-26.73) in 2020 compared to 2019, but HIV positivity rate was higher in 2020, 6.44% (95%CI 6.41-6.47) compared to 4.94% (95% CI 4.92-4.96) in 2019. Annual ART initiation dropped by 19.9% (95%CI 19.7-20.0) in 2020 compared to 2019 while use of essential hospital services dropped during the early months of COVID-19 April to August 2020 but picked up later in the year. CONCLUSION While COVID-19 had a negative impact on health service delivery, its impact on HIV service delivery was not huge. HIV policies that were implemented before COVID-19 on testing made it easier to adopt COVID-19 control measures and to continue providing HIV testing services without much disruption.
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Affiliation(s)
- Tina Chisenga
- Ministry of Health Zambia, Department of Communicable Diseases, Lusaka, Zambia
| | - Menard Chihana
- World Health Organization, Global HIV, Hepatitis and STI Programmes, Geneva, Switzerland,CONTACT Menard Chihana 760 Stellenberg Road, Roberts Place Unit 36, Equestria, Pretoria, Gauteng Province0184, South Africa
| | - Paul Chishimba
- Ministry of Health Zambia, Department of Monitoring and Evaluation, Lusaka, Zambia
| | - Lastone Chitembo
- World Health Organization, Department of HIV, Viral Hepatitis and STIs, Lusaka, Zambia
| | - Lloyd Mulenga
- Department of Infectious Disease, University Teaching Hospital, Lusaka, Zambia
| | - Andrew Silumesii
- Ministry of Health Zambia, Department of Monitoring and Evaluation, Lusaka, Zambia
| | - David Maman
- World Health Organization, Global HIV, Hepatitis and STI Programmes, Geneva, Switzerland,The Global Fund, Technical Advice and Partnership Department, Geneva, Switzerland
| | - Cheryl Johnson
- World Health Organization, Global HIV, Hepatitis and STI Programmes, Geneva, Switzerland
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Fajardo E, Lastrucci C, Bah N, Mingiedi CM, Ba NS, Mosha F, Lule FJ, Paul MAS, Hughes L, Barr-DiChiara M, Jamil MS, Sands A, Baggaley R, Johnson C. Country adoption of WHO 2019 guidance on HIV testing strategies and algorithms: a policy review across the WHO African region. BMJ Open 2023; 13:e071198. [PMID: 38154882 PMCID: PMC10759095 DOI: 10.1136/bmjopen-2022-071198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 11/08/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVES In 2019, the WHO released guidelines on HIV testing service (HTS). We aim to assess the adoption of six of these recommendations on HIV testing strategies among African countries. DESIGN Policy review. SETTING 47 countries within the WHO African region. PARTICIPANTS National HTS policies from the WHO African region as of December 2021. PRIMARY AND SECONDARY OUTCOME MEASURES Uptake of WHO recommendations across national HTS policies including the standard three-test strategy; discontinuation of a tiebreaker test to rule in HIV infection; discontinuation of western blotting (WB) for HIV diagnosis; retesting prior to antiretroviral treatment (ART) initiation and the use of dual HIV/syphilis rapid diagnostic tests (RDTs) in antenatal care. Country policy adoption was assessed on a continuum, based on varying levels of complete adoption. RESULTS National policies were reviewed for 96% (n=45/47) of countries in the WHO African region, 38% (n=18) were published before 2019 and 60% (n=28) adopted WHO guidance. Among countries that had not fully adopted WHO guidance, not yet adopting a three-test strategy was the most common reason for misalignment (45%, 21/47); of which 31% and 22% were in low-prevalence (<5%) and high-prevalence (≥5%) countries, respectively. Ten policies (21%) recommended the use of WB and 49% (n=23) recommended retesting before ART initiation. Dual HIV/syphilis RDTs were recommended in 45% (n=21/47) of policies. CONCLUSIONS Many countries in the African region have adopted WHO-recommended HIV testing strategies; however, efforts are still needed to fully adopt WHO guidance. Countries should accelerate their efforts to adopt and implement a three-test strategy, retesting prior to ART initiation and the use of dual HIV/syphilis RDTs.
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Affiliation(s)
- Emmanuel Fajardo
- Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Céline Lastrucci
- Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Nayé Bah
- World Health Organization Regional Office for Africa, Bamako, Mali
| | - Casimir Manzengo Mingiedi
- Inter-country support team for Central Africa, World Health Organization Regional Office for Africa, Libreville, Gabon
| | - Ndoungou Salla Ba
- Inter-country support team for Western and Central Africa, World Health Organization Regional Office for Africa, Ouagadougou, Burkina Faso
| | - Fausta Mosha
- Inter-country support team for Eastern and Southern Africa, World Health Organization Regional Office for Africa, Harare, Zimbabwe
| | - Frank John Lule
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Lago Hughes
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Muhammad S Jamil
- Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Anita Sands
- Regulation and Prequalification, World Health Organization, Geneva, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl Johnson
- Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland
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OUÉDRAOGO SMAÏLA, KABORE AHMED, DIALLO ISMAËL, SARIGDA MAURICE, DAHOUROU DÉSIRÉLUCIEN, KABRE KUILGABENJAMIN, ROMBA ISSA, YONLI BAPOUGOUNIPHILIPPECHRISTIAN, DAH TERTIEROELIAS, MEDA NICOLAS. Knowledge, attitudes, and practices of healthcare workers regarding human immunodeficiency virus index testing in 2021, Burkina Faso. J Public Health Afr 2023; 14:2459. [PMID: 37908385 PMCID: PMC10615157 DOI: 10.4081/jphia.2023.2459] [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: 01/11/2023] [Accepted: 02/14/2023] [Indexed: 11/02/2023] Open
Abstract
Although knowing one's HIV status is a necessary step in initiating antiretroviral treatment, more than a quarter of Burkinabe who are HIV-positive do not know their status. To reach the target of screening at least 95% of people living with HIV (PLHIV), the country has opted for HIV index testing (screening of sexual partners, children and partners of intravenous drug users). This study assessed the knowledge, attitudes and practices of health workers on HIV index testing. A cross-sectional study was conducted among health workers on index testing pilot sites in Burkina Faso. We constructed scores of health workers' knowledge, attitudes and practices regarding HIV index testing. A total of 132 health workers were surveyed, 62.8% of whom were female. Regarding profiles, 44.7% of the participants were nurses and 5.3% were midwives; physicians and psychosocial counselors accounted for 16.7 and 33.3%, respectively. Most of the participants worked in public health centers (60.6%). Overall, the majority of the participants had poor or average knowledge (85.6%) of the index testing strategy and harmful or inadequate practices (87.1%). Less than half (40.9%) had favorable attitudes toward the strategy. Our study showed that the knowledge of health workers was generally average, their attitudes were not very favorable and their practices were mostly inadequate with regard to HIV index testing. In order to increase the chances of reaching the first 95% of UNAIDS, trainings on the topic must be designed for health workers.
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Affiliation(s)
- SMAÏLA OUÉDRAOGO
- Department of Public Health, Research Training Unit (RTU)/Health Sciences (HS), University Joseph Ki-Zerbo, Ouagadougou
| | - AHMED KABORE
- Department of Public Health, Research Training Unit (RTU)/Health Sciences (HS), University Joseph Ki-Zerbo, Ouagadougou
| | - ISMAËL DIALLO
- Department of Medicine and Medical Specialties, RTU/HS, University Joseph Ki-Zerbo, Ouagadougou
| | - MAURICE SARIGDA
- Department of Sociology, RTU/Human Sciences, University Thomas Sankara, Ouagadougou
| | - DÉSIRÉ LUCIEN DAHOUROU
- Department of Biomedicine/Public Health, Institute for Research in Health Sciences, National Center for Scientific and Technologic Research, Ouagadougou
| | - KUILGA BENJAMIN KABRE
- Department of Public Health, Research Training Unit (RTU)/Health Sciences (HS), University Joseph Ki-Zerbo, Ouagadougou
| | - ISSA ROMBA
- Permanent secretary office of the national council responding to HIV/AIDS and sexually transmitted infections, Ouagadougou
| | | | - TER TIERO ELIAS DAH
- Department of Public Health, University of Ouahigouya, Ouahigouya, Burkina Faso
| | - NICOLAS MEDA
- Department of Public Health, Research Training Unit (RTU)/Health Sciences (HS), University Joseph Ki-Zerbo, Ouagadougou
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Golden MR, Mamudo A, Vio F, Branigan E, Paredes Z, Maiela A, Augusto O, Couto A, Amane G, Chicuecue N, Wate J, Mudender F. Assisted Partner Notification Services Are Safe and Effective as They Are Brought to Scale in Mozambique. J Acquir Immune Defic Syndr 2023; 93:305-312. [PMID: 37040123 DOI: 10.1097/qai.0000000000003203] [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] [Received: 04/15/2022] [Accepted: 01/03/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND The World Health Organization recommends that persons diagnosed with HIV be offered assisted partner notification services (APS). There are limited data on the safety of APS as implemented in public health programs. SETTING Three public health centers in Maputo, Mozambique, 2016-2019. METHODS Counselors offered APS to persons with newly diagnosed HIV and, as part of a program evaluation, prospectively assessed the occurrence of adverse events (AEs), including (1) pushing, abandonment, or yelling; (2) being hit; and (3) loss of financial support or being expelled from the house. RESULTS Eighteen thousand nine hundred sixty-five persons tested HIV-positive in the 3 clinics, 13,475 (71%) were evaluated for APS eligibility, 9314 were eligible and offered APS, and 9219 received APS. Index cases (ICs) named 8933 partners without a previous HIV diagnosis, of whom 6137 tested and 3367 (55%) were diagnosed with HIV (case-finding index = 0.36). APS counselors collected follow-up data from 6680 (95%) of 7034 index cases who had untested partners who were subsequently notified; 78 (1.2%) experienced an AE. Among 270 ICs who reported a fear of AEs at their initial APS interview, 211 (78%) notified ≥1 sex partner, of whom 5 (2.4%) experienced an AE. Experiencing an AE was associated with fear of loss of support (odds ratio [OR] 4.28; 95% confidence interval [CI]: 1.50 to 12.19) and having a partner who was notified, but not tested (OR 3.47; 95% CI: 1.93 to 6.26). CONCLUSION Case-finding through APS in Mozambique is high and AEs after APS are uncommon. Most ICs with a fear of AEs still elect to notify partners with few experiencing AEs.
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Affiliation(s)
- Matthew R Golden
- University of Washington Center for AIDS and STD, Seattle, WA
- International Training and Education Center for Health-Mozambique, Maputo, Mozambique
| | - Allend Mamudo
- International Training and Education Center for Health-Mozambique, Maputo, Mozambique
| | - Ferruccio Vio
- International Training and Education Center for Health-Mozambique, Maputo, Mozambique
| | - Erin Branigan
- International Training and Education Center for Health-Seattle, Seattle, WA
| | - Zulmira Paredes
- International Training and Education Center for Health-Mozambique, Maputo, Mozambique
| | - Adelina Maiela
- International Training and Education Center for Health-Mozambique, Maputo, Mozambique
| | - Orvalho Augusto
- Faculdade de Medicina, Universidade Eduardo Mondlane, Cidade de Maputo, Mozambique
- Department of Global Health, University of Washington, Seattle, WA; and
| | | | | | | | - Joaquim Wate
- International Training and Education Center for Health-Mozambique, Maputo, Mozambique
| | - Florindo Mudender
- International Training and Education Center for Health-Mozambique, Maputo, Mozambique
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Mulawa MI, Knippler ET, Al-Mujtaba M, Wilkinson TH, Ravi VK, Ledbetter LS. Interventions to Improve Adolescent HIV Care Outcomes. Curr HIV/AIDS Rep 2023; 20:218-230. [PMID: 37300592 PMCID: PMC10528099 DOI: 10.1007/s11904-023-00663-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE OF REVIEW This review of recent studies evaluating interventions to improve HIV care outcomes among adolescents with HIV (AHIV) was conducted to provide a comprehensive overview of the recent evidence, highlight promising approaches, and suggest directions for future research. RECENT FINDINGS Our scoping review revealed 65 studies evaluating a variety of interventions and using a range of study designs at various stages of research. Effective approaches included community-based, integrated service delivery models with case management, trained community adolescent treatment supporters, and consideration of social determinants of health. Recent evidence also supports the feasibility, acceptability, and preliminary efficacy of other innovative approaches, including mental health interventions as well as technology-delivered approaches; however, more research is needed to build the evidence base for these interventions. Our review's findings suggest that interventions providing comprehensive, individualized support are essential to improving HIV care outcomes among adolescents. More research is needed to build the evidence base for such interventions and ensure effective, equitable implementation to support the global target of ending the AIDS epidemic by 2030.
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Affiliation(s)
- Marta I Mulawa
- School of Nursing, Duke University, DUMC 3322, Durham, NC, 27710, USA.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | | | - Maryam Al-Mujtaba
- School of Nursing, Duke University, DUMC 3322, Durham, NC, 27710, USA
| | | | | | - Leila S Ledbetter
- Duke University Medical Center Library and Archives, Durham, NC, USA
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Songane M, Magaia CC, Couto A, Dengo N, Cassamo AR, Nhantumbo R, Mahumane C, Mabote A, Mikusova S, Nhangave A, Bhatt N, Mukherjee SS. HIV community index testing reaches proportionally more males than facility-based testing and is cost-effective: A study from Gaza province, Mozambique. PLoS One 2023; 18:e0286458. [PMID: 37235565 DOI: 10.1371/journal.pone.0286458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND In Mozambique, 38.7% of women and 60.4% of men ages 15-59 years old living with HIV do not know their HIV status. A pilot home-based HIV counseling and testing program based on index cases in the community was implemented in eight districts in Gaza province (Mozambique). The pilot targeted the sexual partners, biological children under 14 years old living in the same household, and parents (for pediatric cases) of people living with HIV. The study aimed to estimate the cost-efficiency and effectiveness of community index testing and compare the HIV testing outputs with facility-based testing. METHODS Community index testing costs included the following categories: human resources, HIV rapid tests, travel and transportation for supervision and home visits, training, supplies and consumables, and review and coordination meetings. Costs were estimated from a health systems perspective using a micro-costing approach. All project costs were incurred between October 2017 and September 2018 and converted to U.S. dollars ($) using the prevailing exchange rate. We estimated the cost per individual tested, per new HIV diagnosis, and per infection averted. RESULTS A total of 91,411 individuals were tested for HIV through community index testing, of which 7,011 were newly diagnosed with HIV. Human resources (52%), purchase of HIV rapid tests (28%) and supplies (8%) were the major cost drivers. The cost per individual tested was $5.82, per new HIV diagnosis was $65.32, and per infection averted per year was $1,813. Furthermore, the community index testing approach proportionally tested more males (53%) than facility-based testing (27%). CONCLUSION These data suggest that expansion of the community index case approach may be an effective and efficient strategy to increase the identification of previously undiagnosed HIV-positive individuals, particularly males.
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Affiliation(s)
- Mário Songane
- Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique
| | - Célia C Magaia
- Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique
| | - Aleny Couto
- Programa Nacional de Controle de HIV/SIDA, Maputo, Ministério da Saúde, Mozambique
| | - Nataniel Dengo
- Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique
| | - Abdul R Cassamo
- Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique
| | - Rene Nhantumbo
- Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique
| | - Carlos Mahumane
- Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique
| | - Atanásio Mabote
- Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique
| | - Silvia Mikusova
- Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique
| | - Amâncio Nhangave
- Direção Provincial de Saúde de Gaza, Xai-Xai, Ministério da Saúde, Mozambique
| | - Nilesh Bhatt
- Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, United States of America
| | - Sushant S Mukherjee
- Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, United States of America
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Nwanja E, Nwaokoro P, Akpan U, Toyo O, Ezeh G, Elechi I, Idiong H, Badru T, Sanwo O, Idemudia A, Pandey SR, Khamofu H, Bateganya M. Improved access to HIV diagnosis and linkage to antiretroviral therapy among children in Southern Nigeria: a before-after study. BMC Pediatr 2023; 23:253. [PMID: 37210497 DOI: 10.1186/s12887-023-04050-w] [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] [Received: 07/27/2022] [Accepted: 04/29/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Globally, two out of five children living with HIV (CLHIV) are unaware of their HIV status, and a little more than 50% are receiving antiretroviral therapy (ART). This paper describes case-finding strategies and their contribution to identifying CLHIV and linking them to ART in Nigeria. METHODS This before-after study used program data abstracted during the implementation of different paediatric-focused strategies (provider-initiated testing and counselling, orphans and vulnerable children testing, family-based index testing, early infant diagnosis (EID), community-driven EID, and community-based testing) delivered in health facilities and in communities to improve HIV case identification. Data were abstracted for children (0 to 14 years) who received HIV testing services and were initiated on ART in Akwa Ibom State, Nigeria during the pre-implementation period (April-June 2021) and during the implementation period (July-September 2021). Descriptive statistics were used to describe the testing coverage, positivity rate (proportion of tests that were positive for HIV), linkage to ART, and ART coverage, by age, sex, and testing modality. Interrupted time series analysis (ITSA) on STATA 14 was used to estimate the effect of the implementation of these strategies on HIV testing uptake and positivity rate at a 0.05 significance level. RESULTS A total of 70,210 children were tested for HIV within the six-month period, and 1,012 CLHIV were identified. A total of 78% (n = 54,821) of the tests and 83.4% (n = 844) CLHIV were diagnosed during the implementation period. During implementation, the HIV positivity rate increased from 1.09% (168/15,389) to 1.54% (844/54,821), while linkage to ART increased from 99.4% (167/168) to 99.8% (842/844). The contribution from community-based modalities to CLHIV identified increased from 63% (106/168) to 84% (709/844) during the implementation, with the majority, 60.8% (431/709), from community-based index testing. Overall, ART coverage increased from 39.7 to 55.6% at the end of the intervention period. CONCLUSION The findings show that expanding differentiated HIV testing approaches provided mostly in the community significantly increased pediatric case identification. However, ART coverage remains low, especially for younger age groups, and requires further efforts.
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Affiliation(s)
- Esther Nwanja
- Achieving Health Nigeria Initiative (AHNi), Abuja, Nigeria.
| | | | - Uduak Akpan
- Achieving Health Nigeria Initiative (AHNi), Abuja, Nigeria
| | - Otoyo Toyo
- Achieving Health Nigeria Initiative (AHNi), Abuja, Nigeria
| | - Golda Ezeh
- Achieving Health Nigeria Initiative (AHNi), Abuja, Nigeria
| | | | - Helen Idiong
- Achieving Health Nigeria Initiative (AHNi), Abuja, Nigeria
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Dringus S, Davis K, Simms V, Bernays S, Redzo N, Bandason T, Chikodzore R, Sibanda E, Webb K, Ncube G, Kranzer K, Ferrand RA, Dziva Chikwari C. Delivery of index-linked HIV testing for children: learnings from a qualitative process evaluation of the B-GAP study in Zimbabwe. BMC Infect Dis 2023; 23:262. [PMID: 37101147 PMCID: PMC10131435 DOI: 10.1186/s12879-023-08088-0] [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: 03/05/2022] [Accepted: 02/16/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Index-linked HIV testing for children, whereby HIV testing is offered to children of individuals living with HIV, has the potential to identify children living with undiagnosed HIV. The "Bridging the Gap in HIV Testing and Care for Children in Zimbabwe" (B-GAP) study implemented and evaluated the provision of index-linked HIV testing for children aged 2-18 years in Zimbabwe. We conducted a process evaluation to understand the considerations for programmatic delivery and scale-up of this strategy. METHODS We used implementation documentation to explore experiences of the field teams and project manager who delivered the index-linked testing program, and to describe barriers and facilitators to index-linked testing from their perspectives. Qualitative data were drawn from weekly logs maintained by the field teams, monthly project meeting minutes, the project coordinator's incident reports and WhatsApp group chats between the study team and the coordinator. Data from each of the sources was analysed thematically and synthesised to inform the scale-up of this intervention. RESULTS Five main themes were identified related to the implementation of the intervention: (1) there was reduced clinic attendance of potentially eligible indexes due to community-based differentiated HIV care delivery and collection of HIV treatment by proxy individuals; (2) some indexes reported that they did not live in the same household as their children, reflecting the high levels of community mobility; (3) there were also thought to be some instances of 'soft refusal'; (4) further, delivery of HIV testing was limited by difficulties faced by indexes in attending health facilities with their children for clinic-based testing, stigma around community-based testing, and the lack of familiarity of indexes with caregiver provided oral HIV testing; (5) and finally, test kit stockouts and inadequate staffing also constrained delivery of index-linked HIV testing. CONCLUSIONS There was attrition along the index-linked HIV testing cascade of children. While challenges remain at all levels of implementation, programmatic adaptations of index-linked HIV testing approaches to suit patterns of clinic attendance and household structures may strengthen implementation of this strategy. Our findings highlight the need to tailor index-linked HIV testing to subpopulations and contexts to maximise its effectiveness.
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Affiliation(s)
- Stefanie Dringus
- Public Health, Environments and Society Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
| | - Katherine Davis
- MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
| | - Victoria Simms
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Sarah Bernays
- Global Health Department, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, University of Sydney, Sydney, Australia
| | - Nicol Redzo
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rudo Chikodzore
- Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| | - Edwin Sibanda
- City Health Department, Bulawayo City Council, Bulawayo, Zimbabwe
| | - Karen Webb
- Organization for Public Health Interventions and Development, Harare, Zimbabwe
| | - Getrude Ncube
- Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| | - Katharina Kranzer
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Division of Infectious and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - Rashida A Ferrand
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
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14
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Kefale A, Daka K, Abebe A, Haile D, Paulos K, Sherfa A, Addis A, Gunta M, Ayza A, Wolde J. Prevalence of HIV seropositive status and associated factors among family members of index cases of antiretroviral clinical attendants in Sodo Town, Southern Ethiopia. PLoS One 2023; 18:e0280571. [PMID: 36780456 PMCID: PMC9924999 DOI: 10.1371/journal.pone.0280571] [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: 03/02/2022] [Accepted: 01/03/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus is primarily transmitted through sexual contact with an infected partner and babies born to mothers infected with the virus. Partners of people living with HIV and children whose parents have HIV are at higher risk of contracting HIV unless they take preventive measures. This study aimed at identifying prevalence and determinants of HIV infection among family members of index cases on antiretroviral treatment (ART). METHODS A community-based cross-sectional study was conducted among 623 randomly selected family members of HIV index cases in Sodo Town from February to June 2021. A pre-tested structural questionnaire was used to collect data. Binary logistic regression was used to identify variables independently associated with the outcome variable. The adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to show the strength of association, and a P-value 0.05 was used as a cut-off point to determine the level of statistical significance of point estimate. RESULTS This study revealed that 31.5% (95%CI: 27.6-35.2%) of family members of index cases were HIV seropositive. In subgroup analysis, this study also revealed that 11.1% (95%CI 8.4-14.5%) of biological children and 69.6% (95%CI 63.1-75.6%) of spousal partners of index cases were HIV seropositive. Immediate ART initiation of index cases (AOR = 0.148, 95%CI: 0.067-0.325), being bedridden or ambulatory functional status at enrollment (AOR = 7.71, 95%CI: 3.5-17), and baseline CD4 level of 350 cells/ml (AOR = 8.06, 95%CI: 1.8-36) were statistically significant with the outcome variable among biological children. Among spousal partners, STI history or symptoms (AOR = 5.7, 95%CI: 1.86-17.5), early disclosure (AOR = 0.062, 95%CI: 0.024-0.159), immediate ART initiation (AOR = 0.172, 95%CI: 0.044-0.675), and duration of infection (AOR = 5.09, 95%CI: 1.8-14.4) were statistically associated with the outcome variable. CONCLUSION As evidenced by our data, the risk of HIV among family members of index cases is high. Interventions like immediate ART initiation, early disclosure, screening, and early treatment of STIs for minimizing HIV transmission might be given.
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Affiliation(s)
- Alemayehu Kefale
- Wolaita Zone Health Department, Wolaita Sodo, Southern Ethiopia
- * E-mail: (AK); (DH)
| | - Kassa Daka
- School of Public Health, Wolaita Sodo University, Sodo, Southern Ethiopia
| | - Amene Abebe
- School of Public Health, Wolaita Sodo University, Sodo, Southern Ethiopia
| | - Dereje Haile
- School of Public Health, Wolaita Sodo University, Sodo, Southern Ethiopia
- * E-mail: (AK); (DH)
| | - Kebreab Paulos
- School of Public Health, Wolaita Sodo University, Sodo, Southern Ethiopia
| | - Abdulbasit Sherfa
- Department of Public Health, Werabe University, Werabe, Southern Ethiopia
| | - Animut Addis
- Department of Disease Prevention and Control Core Process, ICAP, Hawassa, Ethiopia
| | - Muluken Gunta
- Wolaita Zone Health Department, Wolaita Sodo, Southern Ethiopia
| | - Asaminew Ayza
- Wolaita Zone Health Department, Wolaita Sodo, Southern Ethiopia
| | - Jegnaw Wolde
- Wolaita Zone Health Department, Wolaita Sodo, Southern Ethiopia
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Implementation process and challenges of index testing in Côte d'Ivoire from healthcare workers' perspectives. PLoS One 2023; 18:e0280623. [PMID: 36753518 PMCID: PMC9907845 DOI: 10.1371/journal.pone.0280623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 01/04/2023] [Indexed: 02/09/2023] Open
Abstract
A major limiting factor in combatting the HIV epidemic has been the identification of people living with HIV. Index testing programs were developed to face that challenge. Index testing is a focused HIV testing service approach in which family members and partners of people living with HIV are offered testing. Despite the implementation of index testing, there is still a gap between the estimated number of people living with HIV and those who know their status in Côte d'Ivoire. This study aimed to understand the implementation process of index testing in Côte d'Ivoire and to identify implementation challenges from healthcare workers perspectives. In January and February 2020, we conducted a qualitative study through 105 individual semi-structured interviews regarding index testing with clinical providers (physicians, nurses, and midwives) and non-clinical providers (community counselors and their supervisors) at 16 rural health facilities across four regions of Côte d'Ivoire. We asked questions regarding the index testing process, index client intake, contact tracing and testing, the challenges of implementation, and solicited recommendations on improving index testing in Côte d'Ivoire. The interviews revealed that index testing is implemented by non-clinical providers. Passive referral, by which the index client brought their contact to be tested, and providers referral, by which a healthcare worker reached out to the index client's contact, were the preferred contact tracing and testing strategies. There was not statistically significant difference between immediate and delayed notification. Reported challenges of index testing implementation included index cases refusing to give their partner's information or a partner refusing to be tested, fear of divorce, societal stigma, long distances, lack of appropriate training in index testing strategies, and lack of a private room for counseling. The recommendations given by providers to combat these was to reinforce HIV education among the population, to train healthcare workers on index testing strategies, and to improve infrastructure, transportation, and communication resources. The study showed that the elements that influenced the process of index testing in Côte d'Ivoire were multifactorial, including individual, interpersonal, health systems, and societal factors. Thus, a multi-faceted approach to overcoming challenges of index testing in Côte d'Ivoire is needed to improve the yield of index testing.
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Joel JN, Awuor P, Blanco N, Lavoie MCC, Lascko T, Ngunu C, Mwangi J, Mutisya I, Ng'eno C, Wangusi R, Koech E. Scale-up of HIV index testing in an urban population: Experiences and achievements from Nairobi County, Kenya. Trop Med Int Health 2023; 28:116-125. [PMID: 36538038 DOI: 10.1111/tmi.13843] [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: 12/24/2022]
Abstract
OBJECTIVE To describe the implementation strategies of the index testing program across Nairobi County in Kenya, assess outcomes along the HIV index testing cascade (acceptance, elicitation ratio, HIV positivity and linkage to treatment), and assess annual changes along the HIV index testing cascade during the first 2 years of implementation. METHODS Retrospective analysis of programmatic aggregate data collected from October 2017 to September 2019 after the roll-out of index testing services in 48 health facilities in Nairobi County. Proportions and ratios were calculated for acceptance, elicitation ratio, testing uptake and HIV positivity. We compared these outcomes between years using a chi-squared test, Fisher's exact test or Wilcoxon sign test, and we assessed trends using the Mann-Kendall test. RESULTS Testing among eligible partners increased from 42.4% (1471/3470) to 74.9% (6114/8159) in the general population, and the positivity yield remained high across both years (25.2% in year 1 and 24.1% in year 2). Index testing positivity yield remained significantly higher than other testing modalities (24.3% vs. 1.3%, p < 0.001). The contribution of index testing services to the total number of HIV-positive individuals identified increased from 7.5% in the first year to 28.6% in the second year (p < 0.001). More men were tested, but the positivity yield was higher among women (30.0%) and those aged 50 years or older (32.4%). Testing eligible partners in key populations (KPs) decreased from 52.4% (183/349) to 40.7% (109/268) (p = 0.674); however, the HIV positivity yield increased from 8.6% to 23.9% (p < 0.001) by the second year of implementation. The HIV positivity yield from index testing remained higher than other testing modalities (14% vs. 0.9%, p < 0.001) for KPs. CONCLUSION Index testing was well-accepted and effective in identifying individuals living with HIV in a Kenyan urban setting across both general populations and KPs. Ongoing adaptations to the strategies deployed as part of index testing services helped improve most of the outcomes along the index testing cascade.
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Affiliation(s)
- Javies Ngui Joel
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation, Nairobi, Kenya
| | - Patrick Awuor
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation, Nairobi, Kenya
| | - Natalia Blanco
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Marie-Claude C Lavoie
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Taylor Lascko
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Carol Ngunu
- Department of Health, Nairobi Metropolitan Services, Nairobi, Kenya
| | - Jonathan Mwangi
- Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control & Prevention, Nairobi, Kenya
| | - Immaculate Mutisya
- Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control & Prevention, Nairobi, Kenya
| | - Caroline Ng'eno
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation, Nairobi, Kenya
| | - Rebecca Wangusi
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation, Nairobi, Kenya
| | - Emily Koech
- Chief Executive Officer, Center for International Health, Education, and Biosecurity-Kenya, Nairobi, Kenya
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Nwaokoro P, Sanwo O, Toyo O, Akpan U, Nwanja E, Elechi I, Ukpong KA, Idiong H, Gana B, Badru T, Idemudia A, Ogbechie MD, Imohi P, Achanya A, Oqua D, Kakanfo K, Olatunbosun K, Umoh A, Essiet P, Usanga I, Ezeanolue E, Obiora-Okafo C, James E, Iyortim I, Chiegil R, Khamofu H, Pandey SR, Bateganya M. Achieving HIV epidemic control through integrated community and facility-based strategies: Lessons learnt from ART-surge implementation in Akwa Ibom, Nigeria. PLoS One 2022; 17:e0278946. [PMID: 36542606 PMCID: PMC9770335 DOI: 10.1371/journal.pone.0278946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
This study examines the lessons learnt from the implementation of a surge program in Akwa Ibom State, Nigeria as part of the Strengthening Integrated Delivery of HIV/AIDS Services (SIDHAS) Project. In this analysis, we included all clients who received HIV counseling and testing services, tested HIV positive, and initiated ART in SIDHAS-supported local government areas (LGAs) from April 2017 to March 2021. We employed descriptive and inferential statistics to analyze our results. A total of 2,018,082 persons were tested for HIV. Out of those tested, 102,165 (5.1%) tested HIV-positive. Comparing the pre-surge and post-surge periods, we observed an increase in HIV testing from 490,450 to 2,018,082 (p≤0.031) and in HIV-positive individuals identified from 21,234 to 102,165 (p≤0.001) respectively. Of those newly identified positives during the surge, 98.26% (100,393/102,165) were linked to antiretroviral therapy compared to 99.24% (21,073/21,234) pre-surge. Retention improved from 83.3% to 92.3% (p<0.001), and viral suppression improved from 73.5% to 96.2% (p<0.001). A combination of community and facility-based interventions implemented during the surge was associated with the rapid increase in case finding, retention, and viral suppression; propelling the State towards HIV epidemic control. HIV programs should consider a combination of community and facility-based interventions in their programming.
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Affiliation(s)
- Pius Nwaokoro
- Family Health International, Abuja, Nigeria
- * E-mail:
| | | | - Otoyo Toyo
- Achieving Health Nigeria Initiative (AHNi), Abuja, Nigeria
| | - Uduak Akpan
- Achieving Health Nigeria Initiative (AHNi), Abuja, Nigeria
| | - Esther Nwanja
- Achieving Health Nigeria Initiative (AHNi), Abuja, Nigeria
| | | | | | - Helen Idiong
- Achieving Health Nigeria Initiative (AHNi), Abuja, Nigeria
| | - Bala Gana
- Achieving Health Nigeria Initiative (AHNi), Abuja, Nigeria
| | | | | | | | | | | | - Dorothy Oqua
- Howard University Global Initiative, Abuja, Nigeria
| | | | | | | | | | | | - Echezona Ezeanolue
- Center for Translation & Implementation Research College of Medicine, University of Nigeria, Nsukka, Nigeria
| | | | | | | | - Robert Chiegil
- Family Health International, Durham, NC, United States of America
| | | | | | - Moses Bateganya
- Family Health International, Durham, NC, United States of America
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Driver M, Katz DA, Manyeki V, Mungala C, Otiso L, Mugo C, McClelland S, Kohler P, Simoni JM, Inwani I, Wilson K. Condom Use Behaviors, Risk Perception, and Partner Communication Following Oral HIV Self-testing Among Adolescents and Young Adults in Kenya: A Cohort Study. AIDS Behav 2022; 27:1727-1740. [PMID: 36520337 DOI: 10.1007/s10461-022-03904-1] [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] [Accepted: 10/15/2022] [Indexed: 12/23/2022]
Abstract
HIV self-testing (HIVST) can improve testing completion among adolescents and young adults (AYA), although its influence on sexual behaviors is unclear. We evaluated whether HIVST was associated with changes in talking with sexual partners about HIVST, condom use, and HIV risk perception among AYA ages 15-24 years in a study of HIVST distribution through homes, pharmacies, and nightclubs in Nairobi, Kenya. All participants had negative HIVST results. Regression models were used to evaluate changes between pre-HIVST and 4 months post-HIVST. Overall, there was a significant increase in talking with sexual partners about HIVST. There was a significant reduction in number of condomless sex acts among AYA recruited through pharmacies and homes. Unexpectedly, among females, there was a significant decrease in consistent condom use with casual partners. HIVST services for AYA may benefit from including strategies to support condom use and partner communication about self-testing adapted to specific populations and partnerships.
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Affiliation(s)
- Matthew Driver
- Department of Epidemiology, University of Washington, Seattle, USA
| | - David A Katz
- Department of Global Health, University of Washington, Seattle, USA
| | - Vivianne Manyeki
- University of Nairobi/Kenyatta National Hospital, Nairobi, Kenya
| | - Caroline Mungala
- University of Nairobi/Kenyatta National Hospital, Nairobi, Kenya
| | | | - Cyrus Mugo
- Department of Global Health, University of Washington, Seattle, USA
- University of Nairobi/Kenyatta National Hospital, Nairobi, Kenya
| | - Scott McClelland
- Department of Epidemiology, University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
- Department of Medicine, University of Washington, Seattle, USA
| | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, USA
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, USA
| | - Jane M Simoni
- Department of Global Health, University of Washington, Seattle, USA
- Department of Psychology, University of Washington, Seattle, USA
| | - Irene Inwani
- University of Nairobi/Kenyatta National Hospital, Nairobi, Kenya
| | - Kate Wilson
- Department of Global Health, University of Washington, Seattle, USA.
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19
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Pollard R, Enugu A, Sriudomporn S, Bell J, Ghosh SC, Arumugam V, Mugundu P, Singh A, McFall AM, Mehta SH, Patenaude BN, Solomon SS. COVID-19 impact on index testing services and programmatic cost in 5 high HIV prevalence Indian districts. BMC Infect Dis 2022; 22:918. [PMID: 36482363 PMCID: PMC9733361 DOI: 10.1186/s12879-022-07912-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Restrictions to curb the first wave of COVID-19 in India resulted in a decline in facility-based HIV testing rates, likely contributing to increased HIV transmission and disease progression. The programmatic and economic impact of COVID-19 on index testing, a standardized contact tracing strategy, remains unknown. METHODS Retrospective programmatic and costing data were analyzed under a US government-supported program to assess the pandemic's impact on the programmatic outcomes and cost of index testing implemented in two Indian states (Maharashtra and Andhra Pradesh). We compared index testing continuum outcomes during lockdown (April-June 2020) and post-lockdown (July-Sept 2020) relative to pre-lockdown (January-March 2020) by estimating adjusted rate ratios (aRRs) using negative binomial regression. Startup and recurrent programmatic costs were estimated across geographies using a micro-costing approach. Per unit costs were calculated for each index testing continuum outcome. RESULTS Pre-lockdown, 2431 index clients were offered services, 3858 contacts were elicited, 3191 contacts completed HIV testing, 858 contacts tested positive, and 695 contacts initiated ART. Compared to pre-lockdown, the number of contacts elicited decreased during lockdown (aRR = 0.13; 95% CI: 0.11-0.16) and post-lockdown (aRR = 0.49; 95% CI: 0.43-0.56); and the total contacts newly diagnosed with HIV also decreased during lockdown (aRR = 0.22; 95% CI: 0.18-0.26) and post-lockdown (aRR = 0.52; 95% CI: 0.45-0.59). HIV positivity increased from 27% pre-lockdown to 40% during lockdown and decreased to 26% post-lockdown. Further, ART initiation improved from 81% pre-lockdown to 88% during lockdown and post-lockdown. The overall cost to operate index testing was $193,457 pre-lockdown and decreased during lockdown to $132,177 (32%) and $126,155 (35%) post-lockdown. Post-lockdown unit cost of case identification rose in facility sites ($372) compared to pre-lockdown ($205), however it decreased in community-based sites from pre-lockdown ($277) to post-lockdown ($166). CONCLUSIONS There was a dramatic decline in the number of index testing clients in the wake of COVID-19 restrictions that resulted in higher unit costs to deliver services; yet, improved linkage to ART suggests that decongesting centres could improve efficiency. Training index testing staff to provide support across services including non-facility-based HIV testing mechanisms (i.e., telemedicine, HIV self-testing, community-based approaches) may help optimize resources during public health emergencies.
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Affiliation(s)
- Rose Pollard
- grid.21107.350000 0001 2171 9311Department of International Health, The Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Ajay Enugu
- grid.21107.350000 0001 2171 9311Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 1830 E. Monument St, Baltimore, MD 21205 USA
| | - Salin Sriudomporn
- grid.21107.350000 0001 2171 9311International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, 415 N Washington St, Baltimore, MD 21231 USA
| | - Jade Bell
- grid.21107.350000 0001 2171 9311Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 1830 E. Monument St, Baltimore, MD 21205 USA
| | - Subash Chandra Ghosh
- grid.433847.f0000 0000 9555 1294Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), 58 Harrington Road, Chetput, Chennai, 600031 India
| | - Visvanathan Arumugam
- grid.433847.f0000 0000 9555 1294Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), 58 Harrington Road, Chetput, Chennai, 600031 India
| | - Parthasarathy Mugundu
- grid.21107.350000 0001 2171 9311Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 1830 E. Monument St, Baltimore, MD 21205 USA
| | - Aditya Singh
- grid.21107.350000 0001 2171 9311Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 1830 E. Monument St, Baltimore, MD 21205 USA
| | - Allison M. McFall
- grid.21107.350000 0001 2171 9311Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Shruti H. Mehta
- grid.21107.350000 0001 2171 9311Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Bryan N. Patenaude
- grid.21107.350000 0001 2171 9311Department of International Health, The Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Sunil S. Solomon
- grid.21107.350000 0001 2171 9311Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 1830 E. Monument St, Baltimore, MD 21205 USA
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20
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Edosa M, Merdassa E, Turi E. Acceptance of Index Case HIV Testing and Its Associated Factors Among HIV/AIDS Clients on ART Follow-Up in West Ethiopia: A Multi-Centered Facility-Based Cross-Sectional Study. HIV AIDS (Auckl) 2022; 14:451-460. [PMID: 36199377 PMCID: PMC9528797 DOI: 10.2147/hiv.s372795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Index case HIV/AIDS testing (ICHT) is a good approach for addressing and improving the efficiency and yield of testing among high-risk populations. Partners and families of people living with HIV/AIDS are among the high-risk populations for contracting HIV/AIDS. However, there is limited study on index case HIV testing among HIV patients attending Anti-Retroviral Therapy (ART). Hence, this study was aimed at assessing the magnitude and factors associated with ICHT among HIV patients attending ART in Nekemte town public health facilities. Methods An institution-based cross-sectional study was conducted at Nekemte town public health facilities from May 20 to July 21, 2020. A systematic random sampling method was used to select the study participants. Multivariable logistic regression analysis was used to determine the predictors of acceptance of ICHT among HIV patients. Results The ICHT acceptance was 85.2% (95% CI=84.9–91.1%). Disclosure of their HIV status (AOR=9.74, 95% CI=4.11–23.06), having good knowledge of ICHT (AOR=4.70, 95% CI=1.92–11.61), believing HIV index case testing has benefits (AOR=3.43, 95% CI=1.27–9.29), and being on ART for more than 1 year (AOR=4.78, 95% CI=2.13–10.76) were significantly associated with index case HIV test acceptance. Conclusion and Recommendation This study revealed a significant proportion of index case HIV testing acceptance. HIV status disclosure of index cases, knowledge of ICHT, the perceived benefit of ICHT, and long duration on ART were found to be significantly associated with acceptance of ICHT. Hence, it is essential to give attention to counseling on the importance of ICHT, enhance people living with HIV (PLWHIV) to have positive belief on the advantage of ICHT, strengthen disclosure counseling, and assist HIV status disclosure in health facilities.
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Affiliation(s)
- Misganu Edosa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Emiru Merdassa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Ebisa Turi
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- Correspondence: Ebisa Turi, Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia, Tel +251917686021, Fax +251576617980, Email
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21
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Jones HS, Hensen B, Musemburi S, Chinyanganya L, Takaruza A, Chabata ST, Matambanadzo P, Rice B, Cowan FM, Hargreaves JR. Interpreting declines in HIV test positivity: an analysis of routine data from Zimbabwe's national sex work programme, 2009–2019. J Int AIDS Soc 2022; 25:e25943. [PMID: 35773959 PMCID: PMC9247303 DOI: 10.1002/jia2.25943] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 05/19/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction Methods Results Conclusions
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Affiliation(s)
- Harriet S. Jones
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine London UK
| | - Bernadette Hensen
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine London UK
| | - Sithembile Musemburi
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe Harare Zimbabwe
| | - Lilian Chinyanganya
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe Harare Zimbabwe
| | - Albert Takaruza
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe Harare Zimbabwe
| | - Sungai T. Chabata
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe Harare Zimbabwe
| | | | - Brian Rice
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine London UK
| | - Frances M. Cowan
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe Harare Zimbabwe
- Faculty of Global Health, Liverpool School of Tropical Medicine Liverpool UK
| | - James R. Hargreaves
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine London UK
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22
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Lavoie MCC, Blanco N, Keapoletswe K, Marima R, Ntwayagae OA, Sebina KB, Loeto P, Mogomotsi PG, Saleeb PG, Ndwapi N, Stafford KA. Testing modality associated with fast-track ART initiation in Botswana. Trop Med Int Health 2022; 27:537-543. [PMID: 35298082 DOI: 10.1111/tmi.13745] [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: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to identify community testing modalities associated with fast-track ART initiation in Botswana. METHODS We conducted a retrospective cohort study that included all Botswana citizens 15 years or older who were newly identified as HIV-positive from 1 May 2017 to 31 January 2019, in Mahalapye and Southern districts. We used Poisson regression with robust error variance and generalised linear mixed models to control for cluster effects to model risk of ART initiation within 7 and 30 days of HIV diagnosis, testing modality factors. RESULTS A total of 1436 individuals were newly identified HIV-positive, with men accounting for 60% across all testing modalities. 22% of all HIV-positive individuals were initiated on ART within 7 days. Clients diagnosed through index testing were more likely to be started on ART within 7 days (adjusted risk ratio [aRR] = 1.38, 95% CI 1.37-1.38) and 30 days (aRR = 1.17, 95% CI 1.09-1.26) than those diagnosed through mobile/outreach testing. CONCLUSIONS Community HIV testing can complement facility-based testing by reaching individuals who may be less likely to seek HIV services at a facility, such as men. Monitoring ART initiation by testing modalities is critical to identify the optimal ones and to guide continuous programme improvement.
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Affiliation(s)
- Marie-Claude C Lavoie
- Center for International Health, Education, and Biosecurity (Ciheb), Institute of Human Virology (IHV), University of Maryland Baltimore School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Natalia Blanco
- Center for International Health, Education, and Biosecurity (Ciheb), Institute of Human Virology (IHV), University of Maryland Baltimore School of Medicine, Baltimore, Maryland, USA
| | - Koona Keapoletswe
- Botswana-University of Maryland School of Medicine Health Initiative (Bummhi) Gaborone, Gaborone, Botswana
| | - Reson Marima
- Botswana-University of Maryland School of Medicine Health Initiative (Bummhi) Gaborone, Gaborone, Botswana
| | - Ookeditse A Ntwayagae
- Botswana-University of Maryland School of Medicine Health Initiative (Bummhi) Gaborone, Gaborone, Botswana
| | - Kagiso B Sebina
- Botswana-University of Maryland School of Medicine Health Initiative (Bummhi) Gaborone, Gaborone, Botswana
| | - Peter Loeto
- Centers for Disease Control and Prevention, Gaborone, Botswana
| | - Panky G Mogomotsi
- Health Services Management, Ministry of Health and Wellness, Gaborone, Botswana
| | - Paul G Saleeb
- Center for International Health, Education, and Biosecurity (Ciheb), Institute of Human Virology (IHV), University of Maryland Baltimore School of Medicine, Baltimore, Maryland, USA
| | - Ndwapi Ndwapi
- Botswana-University of Maryland School of Medicine Health Initiative (Bummhi) Gaborone, Gaborone, Botswana
| | - Kristen A Stafford
- Center for International Health, Education, and Biosecurity (Ciheb), Institute of Human Virology (IHV), University of Maryland Baltimore School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
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23
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Williams D, MacKellar D, Dlamini M, Byrd J, Dube L, Mndzebele P, Mazibuko S, Ao T, Pathmanathan I, Beyer A, Ryan C. HIV testing and ART initiation among partners, family members, and high-risk associates of index clients participating in the CommLink linkage case management program, Eswatini, 2016-2018. PLoS One 2021; 16:e0261605. [PMID: 34928998 PMCID: PMC8687549 DOI: 10.1371/journal.pone.0261605] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
To help diagnose and initiate antiretroviral therapy (ART) for ≥95% of all persons living with HIV (PLHIV), the World Health Organization (WHO) recommends offering HIV testing to biological children, and sexual and needle-sharing partners of all PLHIV (index-client testing, ICT). Many index clients, however, do not identify or have contactable partners, and often substantially fewer than 95% of HIV-positive partners initiate ART soon after index testing. To help improve early HIV diagnosis and ART initiation in Eswatini (formerly Swaziland), we implemented a community-based HIV testing and peer-delivered, linkage case management program (CommLink) that provided ICT as part of a comprehensive package of WHO recommended linkage services. CommLink was implemented June 2015 -March 2017 (Phase I), and April 2017 -September 2018 (Phase II). In addition to biological children and partners, HIV testing was offered to adult family members (Phases I and II) and high-risk associates including friends and acquaintances (Phase II) of CommLink index clients. Compared with Phase I, in Phase II proportionally more CommLink clients disclosed their HIV-infection status to a partner or family member [94% (562/598) vs. 75% (486/652)], and had ≥1 partners, family members, or high-risk associates (contacts) tested through CommLink [41% (245/598) vs. 18% (117/652)]. Of 537 contacts tested, 253 (47%) were HIV-positive and not currently in HIV care, including 17% (17/100) of family members aged <15 years, 42% (78/187) of non-partner family members aged ≥15 years, 60% (73/121) of sexual partners, and 66% (85/129) of high-risk associates. Among 210 HIV-positive contacts aged ≥15 years who participated in CommLink, nearly all received recommended linkage services including treatment navigation (95%), weekly telephone follow-up (93%), and ≥3 counseling sessions (94%); peer counselors resolved 76% (306/404) of identified barriers to care (e.g., perceived wellness); and 200 (95%) initiated ART at a healthcare facility, of whom 196 (98%) received at least one antiretroviral refill before case-management services ended. To help countries achieve ≥90% ART coverage among all PLHIV, expanding ICT for adult family members and high-risk associates of index clients, and providing peer-delivered linkage case management for all identified PLHIV, should be considered.
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Affiliation(s)
- Daniel Williams
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Duncan MacKellar
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Makhosazana Dlamini
- Eswatini Country Program, Population Services International, Mbabane, Eswatini
| | - Johnita Byrd
- ICF International, Atlanta, Georgia, United States of America
| | - Lenhle Dube
- National AIDS Programme, Eswatini Ministry of Health, Mbabane, Eswatini
| | - Phumzile Mndzebele
- Eswatini Country Office, U.S. Centers for Disease Control and Prevention, Mbabane, Eswatini
| | - Sikhathele Mazibuko
- Eswatini Country Office, U.S. Centers for Disease Control and Prevention, Mbabane, Eswatini
| | - Trong Ao
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ishani Pathmanathan
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alysha Beyer
- Abt Associates Inc, Rockville, Maryland, United States of America
| | - Caroline Ryan
- Eswatini Country Office, U.S. Centers for Disease Control and Prevention, Mbabane, Eswatini
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24
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Jonnalagadda S, Auld A, Jahn A, Saito S, Bello G, Sleeman K, Ogollah FM, Cuervo-Rojas J, Radin E, Kayira D, Kim E, Payne D, Burnett J, Hrapcak S, Patel H, Voetsch AC. Opportunities for Closing the Gap in HIV Diagnosis, Treatment, and Viral Load Suppression in Children in Malawi: Results From a 2015-2016 Population-based HIV Impact Assessment Survey. Pediatr Infect Dis J 2021; 40:1011-1018. [PMID: 34382613 DOI: 10.1097/inf.0000000000003288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Control of the pediatric HIV epidemic is hampered by gaps in diagnosis and linkage to effective treatment. The 2015-2016 Malawi Population-based HIV impact assessment data were analyzed to identify gaps in pediatric HIV diagnosis, treatment, and viral load suppression. METHODS In half of the surveyed households, children ages ≥18 months to <15 years were tested using the national HIV rapid test algorithm. Children ≤18 months reactive by the initial rapid test underwent HIV total nucleic acid polymerase chain reaction confirmatory testing. Blood from HIV-positive children was tested for viral load (VL) and presence of antiretroviral drugs. HIV diagnosis and antiretroviral treatment (ART) use were defined using guardian-reporting or antiretroviral detection. RESULTS Of the 6166 children tested, 99 were HIV-positive for a prevalence of 1.5% (95% confidence intervals [CI]: 1.1-1.9) and 8.0% (95% CI: 5.6-10.5) among HIV-exposed children. The prevalence of 1.5% was extrapolated to a national estimate of 119,501 (95% CI: 89,028-149,974) children living with HIV (CLHIV), of whom, 30.7% (95% CI: 20.3-41.1) were previously undiagnosed. Of the 69.3% diagnosed CLHIV, 86.1% (95% CI: 76.8-95.6) were on ART and 57.9% (95% CI: 41.4-74.4) of those on ART had suppressed VL (<1000 HIV RNA copies/mL). Among all CLHIV, irrespective of HIV diagnosis or ART use, 57.7% (95% CI: 45.0-70.5) had unsuppressed VL. CONCLUSIONS Critical gaps in HIV diagnosis in children persist in Malawi. The large proportion of CLHIV with unsuppressed VL reflects gaps in diagnosis and need for more effective first- and second-line ART regimens and adherence interventions.
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Affiliation(s)
| | - Andrew Auld
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Andreas Jahn
- Ministry of Health, Government of Malawi, Lilongwe, Malawi
| | | | - George Bello
- Ministry of Health, Government of Malawi, Lilongwe, Malawi
| | - Katrina Sleeman
- From the Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Juliana Cuervo-Rojas
- ICAP at Columbia University, New York, NY
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Dumbani Kayira
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Evelyn Kim
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Danielle Payne
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Janet Burnett
- From the Centers for Disease Control and Prevention, Atlanta, GA
| | - Susan Hrapcak
- From the Centers for Disease Control and Prevention, Atlanta, GA
| | - Hetal Patel
- From the Centers for Disease Control and Prevention, Atlanta, GA
| | - Andrew C Voetsch
- From the Centers for Disease Control and Prevention, Atlanta, GA
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25
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Vasantharoopan A, Maheswaran H, Simms V, Dziva Chikwari C, Chigwenah T, Chikodzore R, Nyathi K, Ncube G, Ferrand RA, Guinness L. A costing analysis of B-GAP: index-linked HIV testing for children and adolescents in Zimbabwe. BMC Health Serv Res 2021; 21:1082. [PMID: 34641871 PMCID: PMC8507161 DOI: 10.1186/s12913-021-07070-3] [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: 01/24/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background By testing children and adolescents of HIV positive caretakers, index-linked HIV testing, a targeted HIV testing strategy, has the ability to identify high risk children and adolescents earlier and more efficiently, compared to blanket testing. We evaluated the incremental cost of integrating index-linked HIV testing via three modalities into HIV services in Zimbabwe. Methods A mixture of bottom-up and top-down costing was employed to estimate the provider cost per test and per HIV diagnosis for 2–18 year olds, through standard of care testing, and the incremental cost of index-linked HIV testing via three modalities: facility-based testing, home-based testing by a healthcare worker, and testing at home by the caregiver using an oral mucosal transudate test. In addition to interviews, direct observation and study process data, facility registries were abstracted to extract outcome data and resource use. Costs were converted to 2019 constant US$. Results The average cost per standard of care test in urban facilities was US$5.91 and US$7.15 at the rural facility. Incremental cost of an index-linked HIV test was driven by the uptake and number of participants tested. The lowest cost approach in the urban setting was home-based testing (US$6.69) and facility-based testing at the rural clinic (US$5.36). Testing by caregivers was almost always the most expensive option (rural US$62.49, urban US$17.49). Conclusions This is the first costing analysis of index-linked HIV testing strategies. Unit costs varied across sites and with uptake. When scaling up, alternative testing solutions that increase efficiency such as index-linked HIV testing of the entire household, as opposed to solely targeting children/adolescents, need to be explored. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07070-3.
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Affiliation(s)
- Arthi Vasantharoopan
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Victoria Simms
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- Biomedical Research and Training Institute, Harare, Zimbabwe.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Tariro Chigwenah
- Health Economics Unit, University of Cape Town, Cape Town, South Africa
| | - Rudo Chikodzore
- Matebeleland South, Ministry of Health and Child Care, Bulawayo, Zimbabwe
| | - Khulamuzi Nyathi
- City Health Department, Bulawayo City Council, Bulawayo, Zimbabwe
| | | | - Rashida A Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Lorna Guinness
- London School of Hygiene and Tropical Medicine, London, UK
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Asamoah Ampofo E, Commey Tetteh I, Adu-Gyamfi R, Ebu Enyan NI, Agyare E, Ayisi Addo S, Obiri-Yeboah D. Family-Based Index testing for HIV; a qualitative study of acceptance, barriers/challenges and facilitators among clients in Cape Coast, Ghana. AIDS Care 2021; 34:856-861. [PMID: 34554887 DOI: 10.1080/09540121.2021.1981818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ABSTRACTFamily-based Index HIV Testing, (FBIT) approach is known to be associated with a relatively higher testing yield compared to Provider-Initiated Testing and Counselling. The implementation of this strategy in several countries has exposed some barriers to optimal FBIT outcomes. With the scale up of FBIT in Ghana, stakeholder engagement is key in identifying and addressing barriers to implementation. This study explored acceptance, barriers/challenges and facilitators of FBIT. Seventeen in-depth qualitative interviews were conducted among clients who had been offered FBIT at the Cape Coast Teaching Hospital using a semi-structured interview guide. Data were analysed using Braun and Clarke's [(2006)] thematic analysis framework and found that (1) participants accepted the strategy and were willing to use it; (2) lack of awareness of the strategy among the general public, fear of disclosure/stigmatization, issues with confidentiality and privacy are barriers/challenges associated with the FBIT approach, and (3) increasing public education on HIV in general and FBIT in particular, ensuring confidentiality and privacy regarding testing are facilitators for increasing uptake of FBIT. It is concluded that despite acceptance of FBIT as a good strategy among index clients, general HIV education to reduce stigma and addressing confidentiality can optimize uptake.
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Affiliation(s)
- Evelyn Asamoah Ampofo
- Department of Maternal and Child Health, School of Nursing and Midwifery, College of Health and Allied Sciences (CoHAS), University of Cape Coast, Cape Coast, Ghana
| | - Isaac Commey Tetteh
- Department of Mental Health, School of Nursing and Midwifery, CoHAS, University of Cape Coast, Cape Coast, Ghana
| | - Raphael Adu-Gyamfi
- National AIDS/STI's Control Program, Ghana Health Services, Accra, Ghana
| | - Nancy Innocentia Ebu Enyan
- Department of Adult Health, School of Nursing and Midwifery, CoHAS, University of Cape Coast, Cape Coast, Ghana
| | - Elizabeth Agyare
- Clinical Microbiology/Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Stephen Ayisi Addo
- National AIDS/STI's Control Program, Ghana Health Services, Accra, Ghana
| | - Dorcas Obiri-Yeboah
- Clinical Microbiology/Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana.,Department of Microbiology and Immunology, School of Medical Sciences, CoHAS, University of Cape Coast, Cape Coast, Ghana
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Jahun I, Dirlikov E, Odafe S, Yakubu A, Boyd AT, Bachanas P, Nzelu C, Aliyu G, Ellerbrock T, Swaminathan M. Ensuring Optimal Community HIV Testing Services in Nigeria Using an Enhanced Community Case-Finding Package (ECCP), October 2019-March 2020: Acceleration to HIV Epidemic Control. HIV AIDS (Auckl) 2021; 13:839-850. [PMID: 34471388 PMCID: PMC8403567 DOI: 10.2147/hiv.s316480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/19/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose The 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) showed Nigeria’s progress toward the UNAIDS 90-90-90 targets: 47% of HIV-positive individuals knew their status; of these, 96% were receiving antiretroviral therapy (ART); and of these, 81% were virally suppressed. To improve identification of HIV-positive individuals, Nigeria developed an Enhanced Community Case-Finding Package (ECCP). We describe ECCP implementation in nine states and assess its effect. Methods ECCP included four core strategies (small area estimation [SAE] of people living with HIV [PLHIV], map of HIV-positive patients by residence, HIV risk-screening tool [HRST], and index testing [IT]) and four supportive strategies (alternative healthcare outlets, performance-based incentives for field testers, Project Extension for Community Healthcare Outcomes, and interactive dashboards). ECCP was deployed in nine of 10 states prioritized for ART scale-up. Weekly program data (October 2019–March 2020) were tracked and analyzed. Results Of the total 774 LGAs in Nigeria, using SAE, 103 (13.3%) high-burden LGAs were identified, in which 2605 (28.0%) out of 9,294 hotspots were prioritized by mapping newly identified PLHIV by residential addresses. Over 22 weeks, among 882,449 individuals screened using HRST, 723,993 (82.0%) were eligible and tested for HIV (state range, 43.7–90.4%), out of which 20,616 were positive. Through IT, an additional 3,724 PLHIV were identified. In total, 24,340 PLHIV were identified and 97.4% were linked to life-saving antiretroviral therapy. The number of newly identified PLHIV increased 17-fold over 22 weeks (week 1: 89; week 22: 1,632). Overall mean HIV positivity rate by state was 3.3% (range, 1.8–6.4%). Conclusion Using ECCP in nine states in Nigeria increased the number of PLHIV in the community who knew their status, allowing them to access life-saving care and decreasing the risk of HIV transmission.
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Affiliation(s)
- Ibrahim Jahun
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health - Nigeria, Abuja Federal Capital Territory, Nigeria
| | - Emilio Dirlikov
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health, Atlanta, GA, USA
| | - Solomon Odafe
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health - Nigeria, Abuja Federal Capital Territory, Nigeria
| | - Aminu Yakubu
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health - Nigeria, Abuja Federal Capital Territory, Nigeria
| | - Andrew T Boyd
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health, Atlanta, GA, USA
| | - Pamela Bachanas
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health, Atlanta, GA, USA
| | | | - Gambo Aliyu
- National Agency for the Control of AIDS (NACA), Abuja, Federal Capital Territory, Nigeria
| | - Tedd Ellerbrock
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health, Atlanta, GA, USA
| | - Mahesh Swaminathan
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health - Nigeria, Abuja Federal Capital Territory, Nigeria
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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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29
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Neary J, Wagner AD, Omondi V, Otieno V, Mugo C, Wamalwa DC, Maleche-Obimbo E, John-Stewart GC, Slyker JA, Njuguna IN. Male Caregiver Barriers to HIV Index Case Testing of Untested Children. J Acquir Immune Defic Syndr 2021; 87:e229-e231. [PMID: 33633034 PMCID: PMC8500355 DOI: 10.1097/qai.0000000000002669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: Index case testing (ICT) for children—testing children of HIV-positive index adults—reveals a high prevalence of undiagnosed pediatric HIV; however, uptake of ICT is sub-optimal. Methods: During recruitment for a randomized trial (NCT03049917 ), data were collected from sequential clients attending HIV care regarding whether they had children ages 0–12 years of unknown HIV status. We assessed male caregiver barriers to ICT and identified reasons children could not be tested for HIV through ICT. Results: A higher proportion of males receiving HIV care reported untested children ≤12 years of age (7% [483/7,267]) compared to females (2% [358/15,008]; p<0.001). Among caregivers with untested children ≤12 years, 34% (166/483) of males and 89% (320/358) of females were eligible for ICT (p<0.001). Among caregivers who were ineligible for ICT, 29% (141/483) of male and 9% (31/358) of female caregivers were ineligible for ICT due to inability to physically access their children (p<0.001). A higher proportion of males than females did not have access to their children due to separation or divorce (82% [116/141] vs. 52% [16/31]). Overall, a higher proportion of male caregivers declined participation in the trial compared to females (11% [19/166] vs. 5% [15/320]; p=0.006), with 47% (9/19) of those males declining participation because they wanted to consult with their partner compared to 7% (1/15) of female caregivers (p=0.010). Conclusion: As programs scale up ICT, male caregiver barriers to ICT must be addressed to effectively reach untested children.
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Affiliation(s)
| | | | - Vincent Omondi
- Kenya Pediatric Research Consortium, Kenya Pediatric Association, Nairobi, Kenya
| | - Verlinda Otieno
- Kenya Pediatric Research Consortium, Kenya Pediatric Association, Nairobi, Kenya
| | - Cyrus Mugo
- Departments of Epidemiology
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Dalton C Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | | | - Grace C John-Stewart
- Departments of Epidemiology
- Global Health, University of Washington, Seattle, WA
- Departments of Pediatrics and Medicine, University of Washington, Seattle, WA
| | - Jennifer A Slyker
- Departments of Epidemiology
- Global Health, University of Washington, Seattle, WA
| | - Irene N Njuguna
- Global Health, University of Washington, Seattle, WA
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
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Chamie G, Napierala S, Agot K, Thirumurthy H. HIV testing approaches to reach the first UNAIDS 95% target in sub-Saharan Africa. Lancet HIV 2021; 8:e225-e236. [PMID: 33794183 DOI: 10.1016/s2352-3018(21)00023-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 02/06/2023]
Abstract
HIV testing is a crucial first step to accessing HIV prevention and treatment services and to achieving the UNAIDS target of 95% of people living with HIV being aware of their status by 2030. Combined implementation of facility-based and community-based approaches has helped to achieve high levels of HIV testing coverage in many countries including those in sub-Saharan Africa. Approaches such as index testing and self-testing help to reach individuals at higher risk of acquiring HIV, men, and those less likely to use health facilities or community-based services. However, as the proportion of people living with HIV who are aware of their HIV status has risen, the challenge of reaching those who remain undiagnosed or those who are at high risk of acquiring HIV has grown. Demand generation and novel testing approaches will be necessary to reach undiagnosed people living with HIV and to promote frequent retesting among key and priority populations.
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Affiliation(s)
- Gabriel Chamie
- Division of HIV, Infectious Diseases & Global Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Sue Napierala
- RTI International, Women's Global Health Imperative, Berkeley, CA, USA
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Harsha Thirumurthy
- Perelman School of Medicine and Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
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31
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Dziva Chikwari C, Simms V, Kranzer K, Dringus S, Chikodzore R, Sibanda E, Webb K, Engelsmann B, Redzo N, Bandason T, Mujuru H, Apollo T, Ncube G, Hatzold K, Weiss HA, Ferrand RA. Comparison of index-linked HIV testing for children and adolescents in health facility and community settings in Zimbabwe: findings from the interventional B-GAP study. Lancet HIV 2021; 8:e138-e148. [PMID: 33197393 PMCID: PMC8011056 DOI: 10.1016/s2352-3018(20)30267-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 04/15/2023]
Abstract
BACKGROUND Index-linked HIV testing, whereby children of individuals with HIV are targeted for testing, increases HIV yield but relies on uptake. Community-based testing might address barriers to testing access. In the Bridging the Gap in HIV testing and care for children in Zimbabwe (B-GAP) study, we investigated the uptake and yield of index-linked testing in children and the uptake of community-based vs facility-based HIV testing in Zimbabwe. METHODS B-GAP was an interventional study done in the city of Bulawayo and the province of Matabeleland South between Jan 29 and Dec 12, 2018. All HIV-positive attendees (index patients) at six urban and three rural primary health-care clinics were offered facility-based or community-based HIV testing for children (age 2-18 years) living in their households who had never been tested or had tested as HIV-negative more than 6 months ago. Community-based options involved testing in the home by either a trained lay worker with a blood-based rapid diagnostic test (used in facility-based testing), or by the child's caregiver with an oral HIV test. Among consenting individuals, the primary outcome was testing uptake in terms of the proportion of eligible children tested. Secondary outcomes were uptake of the different HIV testing methods, HIV yield (proportion of eligible children who tested positive), and HIV prevalence (proportion of HIV-positive children among those tested). Logistic regression adjusting for within-index clustering was used to investigate index patient and child characteristics associated with testing uptake, and the uptake of community-based versus facility-based testing. FINDINGS Overall, 2870 index patients were linked with 6062 eligible children (3115 [51·4%] girls [sex unknown in seven], median age 8 years [IQR 5-13]). Testing was accepted by index patients for 5326 (87·9%) children, and 3638 were tested with a known test outcome, giving an overall testing uptake among 6062 eligible children of 60·0%. 39 children tested positive for HIV, giving an HIV prevalence among the 3638 children of 1·1% and an HIV yield among 6062 eligible children of 0·6%. Uptake was positively associated with female sex in the index patient (adjusted odds ratio [aOR] 1·56 [95% CI 1·38-1·77], p<0·0001) and child (aOR 1·10 [1·03-1·19], p=0·0080), and negatively associated with any financial cost of travel to a clinic (aOR 0·86 [0·83-0·88], p<0·0001), increased child age (6-9 years: aOR 0·99 (0·89-1·09); 10-15 years: aOR 0·91 [0·83-1·00]; and 16-18 years: aOR 0·75 [0·66-0·85]; p=0·0001 vs 2-5 years), and unknown HIV status of the mother (aOR 0·81 [0·68-0·98], p=0·027 vs HIV-positive status). Additionally, children had increased odds of being tested if community-based testing was chosen over facility-based testing at screening (1320 [73·9%] children tested of 1787 vs 2318 [65·5%] of 3539; aOR 1·49 [1·22-1·81], p=0·0001). INTERPRETATION The HIV yield of index-linked testing was low compared with blanket testing approaches in similar settings. Index-linked HIV testing can improve testing uptake among children, although strategies that improve testing uptake in older children are needed. Community based testing by lay workers is a feasible strategy that can be used to improve uptake of HTS among children and adolescents. FUNDING UK Medical Research Council, UK Department for International Development, Wellcome Trust.
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Affiliation(s)
- Chido Dziva Chikwari
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe.
| | - Victoria Simms
- Medical Research Council Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Katharina Kranzer
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Stefanie Dringus
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Karen Webb
- Organization for Public Health Interventions and Development, Harare, Zimbabwe
| | - Barbara Engelsmann
- Organization for Public Health Interventions and Development, Harare, Zimbabwe
| | - Nicol Redzo
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Hilda Mujuru
- Department of Paediatrics, University of Zimbabwe, Harare, Zimbabwe
| | - Tsitsi Apollo
- AIDS and Tuberculosis Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Getrude Ncube
- AIDS and Tuberculosis Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Helen A Weiss
- Medical Research Council Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Rashida A Ferrand
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe
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Njuguna IN, Wagner AD, Neary J, Omondi VO, Otieno VA, Orimba A, Mugo C, Babigumira JB, Levin C, Richardson BA, Maleche-Obimbo E, Wamalwa DC, John-Stewart G, Slyker J. Financial incentives to increase pediatric HIV testing: a randomized trial. AIDS 2021; 35:125-130. [PMID: 33048877 PMCID: PMC7791594 DOI: 10.1097/qad.0000000000002720] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Financial incentives can motivate desirable health behaviors, including adult HIV testing. Data regarding the effectiveness of financial incentives for HIV testing in children, who require urgent testing to prevent mortality, are lacking. METHODS In a five-arm unblinded randomized controlled trial, adults living with HIV attending 19 HIV clinics in Western Kenya, with children 0-12 years of unknown HIV status, were randomized with equal allocation to $0, $1.25, $2.50, $5 or $10. Payment was conditional on child HIV testing within 2 months. Block randomization with fixed block sizes was used; participants and study staff were unblinded at randomization. Primary analysis was intent-to-treat, with predefined primary outcomes of completing child HIV testing and time to testing. RESULTS Of 452 caregivers, 90, 89, 93, 92 and 88 were randomized to $0, $1.25, $2.50, $5.00, and $10.00, respectively. Of those, 31 (34%), 31 (35%), 44 (47%), 51 (55%), and 54 (61%) in the $0, $1.25, $2.50, $5.00, and $10.00 arms, respectively, completed child testing. Compared with the $0 arm, and adjusted for site, caregivers in the $10.00 arm had significantly higher uptake of testing [relative risk: 1.80 (95% CI 1.15--2.80), P = 0.010]. Compared with the $0 arm, and adjusted for site, time to testing was significantly faster in the $5.00 and $10.00 arms [hazard ratio: 1.95 (95% CI 1.24--3.07) P = 0.004, 2.42 (95% CI 1.55--3.79), P < 0.001, respectively). CONCLUSION Financial incentives are effective in improving pediatric HIV testing among caregivers living with HIV. REGISTRATION NCT03049917.
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Affiliation(s)
- Irene N Njuguna
- Department of Epidemiology
- Department of Global Health
- Research and Programs, Kenyatta National Hospital
| | | | | | - Vincent O Omondi
- Kenya Pediatric Research Consortium, Kenya Pediatric Association, Nairobi, Kenya
| | - Verlinda A Otieno
- Kenya Pediatric Research Consortium, Kenya Pediatric Association, Nairobi, Kenya
| | - Anita Orimba
- Kenya Pediatric Research Consortium, Kenya Pediatric Association, Nairobi, Kenya
| | - Cyrus Mugo
- Department of Global Health
- Research and Programs, Kenyatta National Hospital
| | - Joseph B Babigumira
- Department of Global Health
- Department of Pharmacy, University of Washington, Seattle, Washington, USA
| | | | - Barbra A Richardson
- Department of Global Health
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | | | - Dalton C Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Epidemiology
- Department of Global Health
- Department of Medicine
- Department of Pediatrics
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Abstract
OBJECTIVES This study estimates the costs of community-based HIV testing services (HTS) in Lesotho and assesses the potential efficiency gains achieved by adding HIV self-testing (HIVST) and then self-testing booths. DESIGN Micro-costing analysis using longitudinal data from a real-world intervention. METHODS We collected data prospectively on provider's costs and programmatic outcomes over three time periods of approximately 8 months each, between May 2017 and April 2019. The scope of services was extended during each period as follows: HTS only, HTS and HIVST, HTS and HIVST with individual HIVST booths wherein clients were encouraged to self-test on-site followed by on-site confirmative testing for those with reactive self-test. For each implementation period, we estimated the full financial and economic implementation costs, the incremental costs of adding HIVST onto conventional HTS and the cost per HIV positive case identified. RESULTS Costs per HIV-positive case identified increased between period 1 (US$956) and period 2 (US$1249) then dropped in period 3 (US$813). Full versus incremental cost analyses resulted in large differences in the magnitude of costs, attributable to methods rather than resource use: for example, in period 3, the average full and incremental cost estimates for HTS were US$34.3 and US$23.5 per person tested, and for HIVST were US$37.7 and US$14.0 per kit provided, respectively. CONCLUSION In Lesotho, adding HIVST to community-based HTS improves its overall affordability for HIV-positive case finding. The reporting of both full and incremental cost estimates increase transparency for use in priority setting, budgeting and financial planning for scale-up.
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Sindelar K, Maponga C, Lekoala F, Mandara E, Mohoanyane M, Sanders J, Joseph J. Beyond the facility: An evaluation of seven community-based pediatric HIV testing strategies and linkage to care outcomes in a high prevalence, resource-limited setting. PLoS One 2020; 15:e0236985. [PMID: 32877441 PMCID: PMC7467225 DOI: 10.1371/journal.pone.0236985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 07/18/2020] [Indexed: 11/18/2022] Open
Abstract
Diverse challenges in expanding pediatric HIV testing and treatment coverage persist, making the investigation and adoption of innovative strategies urgent. Evidence is mounting for the effectiveness of community-based testing in bringing such lifesaving services to those in need, particularly in resource-limited settings. The Mobilizing HIV Identification and Treatment project piloted seven community-based testing strategies to assess their effectiveness in reaching HIV-positive children and linking them to care in two districts of Lesotho from October 2015 to March 2018. Children testing HIV-positive were enrolled into the project's mHealth system where they received e-vouchers for transportation assistance to the facility for treatment initiation and were followed-up for a minimum of three months. An average of 7,351 HIV tests were conducted per month across all strategies for all age groups, with 46% of these tests on children 0-14 years. An average of 141.65 individuals tested positive each month; 9% were children. Among the children tested 55% were over 5 years. The yield in children was low (0.38%), however facility-based yields were only slightly higher (0.72%). Seventy-five percent of children were first-time testers and 86% of those testing HIV-positive were first-time testers. Seventy-one percent of enrolled children linked to care, all but one initiated treatment, and 82% were retained in care at three months. As facility-based testing remains the core of HIV programs, this evaluation demonstrates the effectiveness of community-based strategies in finding previously untested children and those over 5 years who have limited interactions with the conventional health system. Utilizing active follow-up mechanisms, linkage rates were high suggesting accessing treatment in a facility after community testing is not a barrier. Overall, these community-based testing strategies contributed markedly to the HIV testing landscape in which they were implemented, demonstrating their potential to help close the gap of unidentified HIV-positive children and achieve universal testing coverage.
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Affiliation(s)
- Kathleen Sindelar
- Clinton Health Access Initiative, Maseru, Lesotho
- * E-mail: (KS); (JJ)
| | | | | | | | | | - Jill Sanders
- Baylor College of Medicine Children’s Foundation – Lesotho, Maseru, Lesotho
| | - Jessica Joseph
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
- * E-mail: (KS); (JJ)
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Makurumidze R, Decroo T, Lynen L, Chinwadzimba ZK, Van Damme W, Hakim J, Rusakaniko S. District-level strategies to control the HIV epidemic in Zimbabwe: a practical example of precision public health. BMC Res Notes 2020; 13:393. [PMID: 32847619 PMCID: PMC7449062 DOI: 10.1186/s13104-020-05234-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/14/2020] [Indexed: 12/03/2022] Open
Abstract
Objective We conducted a descriptive cross-sectional study using survey and programme data to assess district-level performance along the HIV care cascade (HIV testing target achievement, linkage to ART and ART coverage) in order to formulate district-specific recommendations, taking into consideration prevalence and yield of testing. Results Data from 60 districts were analysed. Forty-eight districts (80.0%) surpassed 90% of their 2018 HIV testing targets. Linkage to ART was less than 90% in 40 districts (83.3%). Thirty districts (50.0%) had ART coverage above 90%. Of the 30 districts with suboptimal (< 90%) ART coverage, 18 districts had achieved high HIV testing target but with suboptimal linkage to ART, 6 had achieved high HIV testing targets and high linkage to ART, 4 had both suboptimal HIV testing target achievement and linkage to ART and 2 had suboptimal HIV testing target achievement and high linkage to ART. Priority should be given to districts with suboptimal ART coverage. Remediation strategies should be tailored to address the poorly performing stage of the cascade in each of the districts.
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Affiliation(s)
- Richard Makurumidze
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe. .,Institute of Tropical Medicine, Antwerp, Belgium. .,Gerontology, Faculty of Medicine & Pharmacy, Free University of Brussels (VUB), Brussels, Belgium.
| | - Tom Decroo
- Institute of Tropical Medicine, Antwerp, Belgium.,Research Foundation of Flanders, Brussels, Belgium
| | | | | | - Wim Van Damme
- Institute of Tropical Medicine, Antwerp, Belgium.,Gerontology, Faculty of Medicine & Pharmacy, Free University of Brussels (VUB), Brussels, Belgium
| | - James Hakim
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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36
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Abstract
We present recent literature describing interventions for linkage to HIV care in the era of Universal Test and Treat (UTT) policies. We also provide information for ongoing studies of linkage to care strategies registered with ClinicalTrials.gov.
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37
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Active pediatric HIV case finding in Kenya and Uganda: A look at missed opportunities along the prevention of mother-to-child transmission of HIV (PMTCT) cascade. PLoS One 2020; 15:e0233590. [PMID: 32484815 PMCID: PMC7266341 DOI: 10.1371/journal.pone.0233590] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 05/04/2020] [Indexed: 01/24/2023] Open
Abstract
Background Children living with HIV remain undiagnosed due to missed opportunities along the prevention of mother-to-child HIV transmission cascade. This study addresses programmatic gaps in the cascade by describing pregnancy and HIV-related services received by mothers of children newly identified as HIV-positive through active case finding. Methods This was a prospective observational cohort (2017–2018) of HIV-positive children <15 years of age newly diagnosed at study facilities and/or surrounding communities in Kenya and Uganda. At enrollment, caregivers were interviewed about maternal and child health and HIV history. Child medical and laboratory information was abstracted at two months post-diagnosis. Descriptive summary statistics were calculated; associations between selected factors and child age at HIV diagnosis were evaluated using generalized estimating equations. Results 174 HIV-positive children (median age 2.4 years) were enrolled. Among maternal caregivers, 110/132 (83.3%) attended antenatal care and 60 (45.5%) reported testing HIV-negative in antenatal care. Of 41 and 56 women known to be HIV-positive during pregnancy and breastfeeding respectively, 17 (41.5%) and 15 (26.8%) did not receive antiretroviral drugs. Despite known maternal HIV-positive status during pregnancy, 39% of these children were not diagnosed until after two years of age; children were diagnosed at younger ages in Uganda (p = 0.0074) and if mother was the caregiver (p<0.0001). The most common HIV testing points identifying children were outpatient (44.3%) and maternal/child health departments (29.9%). Nearly all children initiated antiretroviral therapy within two weeks of diagnosis. Conclusions Multiple missed opportunities for HIV prevention and delays in HIV testing of HIV-exposed children were identified in newly diagnosed children. Findings support critical prevention messaging and retesting of HIV-negative women during pregnancy and breastfeeding, strengthening HIV treatment initiation and follow-up systems and interventions to ensure HIV-positive women receive lifelong antiretroviral therapy throughout the cascade, and broader implementation of community case finding so children not engaged in care receive testing services.
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Mwango LK, Stafford KA, Blanco NC, Lavoie M, Mujansi M, Nyirongo N, Tembo K, Sakala H, Chipukuma J, Phiri B, Nzangwa C, Mwandila S, Nkwemu KC, Saadani A, Mwila A, Herce ME, Claassen CW. Index and targeted community-based testing to optimize HIV case finding and ART linkage among men in Zambia. J Int AIDS Soc 2020; 23 Suppl 2:e25520. [PMID: 32589360 PMCID: PMC7319128 DOI: 10.1002/jia2.25520] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Current healthcare systems fail to provide adequate HIV services to men. In Zambia, 25% of adult men living with HIV were unaware of their HIV status in 2018, and 12% of those who were unaware of their HIV statu were not receiving antiretroviral therapy (ART) due to pervasive barriers to HIV testing services (HTS) and linkage to ART. To identify men and key and priority populations living with HIV in Zambia, and link them to care and treatment, we implemented the Community Impact to Reach Key and Underserved Individuals for Treatment and Support (CIRKUITS) project. We present HTS and ART linkage results from the first year of CIRKUITS. METHODS CIRKUITS aimed to reach beneficiaries by training, mentoring, and deploying community health workers to provide index testing services and targeted community HTS. Community leaders and workplace supervisors were engaged to enable workplace HTS for men. To evaluate the effects of these interventions, we collected age- and sex-disaggregated routinely collected programme data for the first 12 months of the project (October 2018 to September 2019) across 37 CIRKUITS-supported facilities in three provinces. We performed descriptive statistics and estimated index cascades for indicators of interest, and used Chi square tests to compare indicators by age, sex, and district strata. RESULTS Over 12 months, CIRKUITS tested 38,255 persons for HIV, identifying 10,974 (29%) new people living with HIV, of whom 10,239 (93%) were linked to ART. Among men, CIRKUITS tested 18,336 clients and identified 4458 (24%) as HIV positive, linked 4132 (93%) to ART. Men who tested HIV negative were referred to preventative services. Of the men found HIV positive, and 13.0% were aged 15 to 24 years, 60.3% were aged 25 to 39, 20.9% were aged 40 to 49 and 5.8% were ≥50 years old. Index testing services identified 2186 (49%) of HIV-positive men, with a positivity yield of 40% and linkage of 88%. Targeted community testing modalities accounted for 2272 (51%) of HIV-positive men identified, with positivity yield of 17% and linkage of 97%. CONCLUSIONS Index testing and targeted community-based HTS are effective strategies to identify men living with HIV in Zambia. Index testing results in higher yield, but lower linkage and fewer absolute men identified compared to targeted community-based HTS.
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Affiliation(s)
- Linah K Mwango
- Maryland Global Initiatives Corporation ZambiaLusakaZambia
| | - Kristen A Stafford
- Center for International Health, Education, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMDUSA
- Institute of Human VirologyUniversity of Maryland School of MedicineBaltimoreMDUSA
- Department of Epidemiology and Public HealthUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Natalia C Blanco
- Center for International Health, Education, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMDUSA
- Institute of Human VirologyUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Marie‐Claude Lavoie
- Center for International Health, Education, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMDUSA
- Institute of Human VirologyUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Morley Mujansi
- Maryland Global Initiatives Corporation ZambiaLusakaZambia
| | - Nasho Nyirongo
- Maryland Global Initiatives Corporation ZambiaLusakaZambia
| | - Kalima Tembo
- Maryland Global Initiatives Corporation ZambiaLusakaZambia
| | - Henry Sakala
- Maryland Global Initiatives Corporation ZambiaLusakaZambia
| | | | - Beauty Phiri
- Maryland Global Initiatives Corporation ZambiaLusakaZambia
| | - Carol Nzangwa
- Maryland Global Initiatives Corporation ZambiaLusakaZambia
| | - Susan Mwandila
- Maryland Global Initiatives Corporation ZambiaLusakaZambia
| | | | - Ahmed Saadani
- U.S. Center for Disease Control and PreventionLusakaZambia
| | - Annie Mwila
- U.S. Center for Disease Control and PreventionLusakaZambia
| | - Michael E Herce
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina School of MedicineChapel HillNCUSA
- Centre for Infectious Disease Research in Zambia (CIDRZ)LusakaZambia
| | - Cassidy W Claassen
- Maryland Global Initiatives Corporation ZambiaLusakaZambia
- Center for International Health, Education, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMDUSA
- Institute of Human VirologyUniversity of Maryland School of MedicineBaltimoreMDUSA
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