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Zuma T, Busang J, Hlongwane S, Chidumwa G, Gumede D, Luthuli M, Dreyer J, Herbst C, Okesola N, Chimbindi N, McGrath N, Sherr L, Seeley J, Shahmanesh M. A mixed methods process evaluation: understanding the implementation and delivery of HIV prevention services integrated within sexual reproductive health (SRH) with or without peer support amongst adolescents and young adults in rural KwaZulu-Natal, South Africa. Trials 2024; 25:448. [PMID: 38961492 DOI: 10.1186/s13063-024-08279-3] [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: 01/28/2024] [Accepted: 06/20/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Combination prevention interventions, when integrated with community-based support, have been shown to be particularly beneficial to adolescent and young peoples' sexual and reproductive health. Between 2020 and 2022, the Africa Health Research Institute in rural South Africa conducted a 2 × 2 randomised factorial trial among young people aged 16-29 years old (Isisekelo Sempilo) to evaluate whether integrated HIV and sexual and reproductive health (HIV/SRH) with or without peer support will optimise delivery of HIV prevention and care. Using mixed methods, we conducted a process evaluation to provide insights to and describe the implementation of a community-based peer-led HIV care and prevention intervention targeting adolescents and young people. METHODS The process evaluation was conducted in accordance with the Medical Research Council guidelines using quantitative and qualitative approaches. Self-completed surveys and clinic and programmatic data were used to quantify the uptake of each component of the intervention and to understand intervention fidelity and reach. In-depth individual interviews were used to understand intervention experiences. Baseline sociodemographic factors were summarised for each trial arm, and proportions of participants who accepted and actively engaged in various components of the intervention as well as those who successfully linked to care were calculated. Qualitative data were thematically analysed. RESULTS The intervention was feasible and acceptable to young people and intervention implementing teams. In particular, the STI testing and SRH components of the intervention were popular. The main challenges with the peer support implementation were due to fidelity, mainly because of the COVID-19 pandemic. The study found that it was important to incorporate familial support into interventions for young people's sexual health. Moreover, it was found that psychological and social support was an essential component to combination HIV prevention packages for young people. CONCLUSION The results demonstrated that peer-led community-based care that integrates SRH services with HIV is a versatile model to decentralise health and social care. The family could be a platform to target restrictive gender and sexual norms, by challenging not only attitudes and behaviours related to gender among young people but also the gendered structures that surround them.
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Affiliation(s)
- Thembelihle Zuma
- Africa Health Research Institute, KwaZulu-Natal, South Africa.
- University College London, London, UK.
- University of KwaZulu-Natal, Durban, South Africa.
| | - Jacob Busang
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Glory Chidumwa
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Dumsani Gumede
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Manono Luthuli
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Jaco Dreyer
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Carina Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Natsayi Chimbindi
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University College London, London, UK
- University of KwaZulu-Natal, Durban, South Africa
| | - Nuala McGrath
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, South Africa
- University of Southampton, Southampton, UK
| | | | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
- University of KwaZulu-Natal, Durban, South Africa
| | - Maryam Shahmanesh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University College London, London, UK
- University of KwaZulu-Natal, Durban, South Africa
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Brooks HL, Graves E, De Schacht C, Emílio A, Matino A, Aboobacar A, Audet CM. "If It Weren't for This, We'd Be Sick"-Perspectives From Participants of a Couple-Based HIV Treatment and Support Program During Prenatal and Postpartum Periods in Zambézia Province, Mozambique. J Acquir Immune Defic Syndr 2024; 96:304-310. [PMID: 38032747 PMCID: PMC11128476 DOI: 10.1097/qai.0000000000003351] [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: 06/02/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Engagement in HIV care and treatment services during pregnancy is key to eliminating vertical transmission. One barrier to retention of pregnant and lactating women is insufficient support from male partners. Reframing HIV services as couple-based may increase adherence among men and women. As part of a cluster randomized trial evaluating an intervention offering seroconcordant couples living with HIV joint follow-up in HIV services and sessions with a health counselor and couple peer educators, we assessed participants' perspectives and experiences regarding the intervention. SETTING Zambézia Province is a rural, low-income, and medically underserved region of central Mozambique. METHODS We conducted semistructured interviews with a subset of participants enrolled in the intervention arm. The objectives were to explore participants' (1) experiences with couples-based HIV care and the educational/support sessions; (2) perceived impacts of the intervention; and (3) suggestions for intervention improvement. Interviews conducted by experienced interviewers were audio-recorded, transcribed, and deductively coded. RESULTS Sixty-four participants were interviewed. Participants described the counselor and the peer educators as trustworthy and the sessions as improving their HIV-related knowledge. Receiving joint HIV services was convenient and motivated some participants to remain adherent to care. Participants provided few suggestions to improve the intervention, although a few female participants did state that they wished their male partners had participated more readily in the joint sessions and medication pick-ups at the health facilities. CONCLUSIONS Participants described positive experiences with and perceived benefits from the intervention, making this intervention acceptable within the local context.
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Affiliation(s)
- Hannah L Brooks
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Erin Graves
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Arifo Aboobacar
- Provincial Health Directorate of Zambézia, Quelimane, Mozambique; and
| | - Carolyn M Audet
- Departments of Health Policy and Epidemiology, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
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Shahmanesh M, Chimbindi N, Busang J, Chidumwa G, Mthiyani N, Herbst C, Okesola N, Dreyer J, Zuma T, Luthuli M, Gumede D, Hlongwane S, Mdluli S, Msane S, Smit T, Molina JM, Khoza T, Behuhuma NO, McGrath N, Seeley J, Harling G, Sherr L, Copas A, Baisley K. Effectiveness of integrating HIV prevention within sexual reproductive health services with or without peer support among adolescents and young adults in rural KwaZulu-Natal, South Africa (Isisekelo Sempilo): 2 × 2 factorial, open-label, randomised controlled trial. Lancet HIV 2024; 11:e449-e460. [PMID: 38925731 DOI: 10.1016/s2352-3018(24)00119-x] [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: 11/05/2023] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Approximately 200 000 South Africans acquired HIV in 2021 despite the availability of universal HIV test and treat and pre-exposure prophylaxis (PrEP). The aim of this study was to test the effectiveness of sexual and reproductive health services or peer support, or both, on the uptake of serostatus neutral HIV services or reduction of sexually transmissible HIV. METHODS We did an open-label, 2 × 2 randomised factorial trial among young people in a mostly rural area of KwaZulu-Natal, South Africa. Inclusion criteria included being aged 16-29 years, living in the mapped geographical areas that were accessible to the area-based peer navigators, being willing and able to provide informed consent, and being willing to provide a dried blood spot for anonymous HIV testing and HIV viral load measurement at 12 months. Participants were randomly allocated by computer-generated algorithm to one of four groups: those in the standard-of-care group were referred to youth-friendly services for differentiated HIV prevention (condoms, universal HIV test and treat with antiretroviral therapy, and PrEP if eligible); those in the sexual and reproductive health services group received baseline self-collected specimens for sexually transmitted infection (STI) testing and referral to integrated sexual and reproductive health and HIV prevention services; those in the peer support group were referred to peer navigators for health promotion, condom provision, and facilitation of attendance for differentiated HIV prevention services; and those in the final group received a combination of sexual and reproductive health services and peer support. Coprimary outcomes were linkage to clinical services within 60 days of enrolment, proportion of participants who had sexually transmissible HIV at 12 months after enrolment, and proportion of sampled individuals who consented to participation and gave a dried blood spot for HIV testing at 12 months. Logistic regression was used for analyses, and adjusted for age, sex, and rural or peri-urban area of residence. This study is registered with ClinicalTrials.gov (NCT04532307) and is closed. FINDINGS Between March 2, 2020, and July 7, 2022, 1743 (75·7%) of 2301 eligible individuals were enrolled and followed up. 12-month dried blood spots were collected from 1168 participants (67·0%). The median age of the participants was 21 years (IQR 18-25), 51·4% were female, and 51·1% had secondary level education. Baseline characteristics and 12-month outcome ascertainment were similar between groups. 755 (43·3%) linked to services by 60 days. 430 (49·8%) of 863 who were in the sexual reproductive health services group were linked to care compared with 325 (36·9%) of 880 who were not in the sexual and reproductive health services group (adjusted odds ratio [aOR] 1·68; 95% CI 1·39-2·04); peer support had no effect: 385 (43·5%) of 858 compared with 370 (43·1%) of 885 (1·02, 0·84-1·23). At 12 months, 227 (19%) tested ELISA-positive for HIV, of whom 41 (18%) had viral loads of 400 copies per mL; overall prevalence of transmissible HIV was 3·5%. 22 (3·7%) of 578 participants in the sexual and reproductive health services group had transmissible HIV compared with 19 (3·3%) of 590 not in the sexual and reproductive health services group (aOR 1·12; 95% CI 0·60-2·11). The findings were also non-significant for peer support: 21 (3·3%) of 565 compared with 20 (3·3%) of 603 (aOR 1·03; 95% CI 0·55-1·94). There were no serious adverse events or deaths during the study. INTERPRETATION This study provides evidence that STI testing and sexual and reproductive health services create demand for serostatus neutral HIV prevention in adolescents and young adults in Africa. STI testing and integration of HIV and sexual health has the potential to reach those at risk and tackle unmet sexual health needs. FUNDING US National Institute of Health, Bill & Melinda Gates Foundation, and 3ie.
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Affiliation(s)
- Maryam Shahmanesh
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa; Institute for Global Health, University College London, London, UK; University of KwaZulu-Natal, Durban, South Africa.
| | - Natsayi Chimbindi
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa; Institute for Global Health, University College London, London, UK; University of KwaZulu-Natal, Durban, South Africa
| | - Jacob Busang
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Glory Chidumwa
- University of the Witwatersrand, Johannesburg, South Africa
| | - Nondumiso Mthiyani
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa; Institute for Global Health, University College London, London, UK
| | - Carina Herbst
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Nonhlanhla Okesola
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Jaco Dreyer
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Thembelihle Zuma
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa; Institute for Global Health, University College London, London, UK; University of KwaZulu-Natal, Durban, South Africa
| | - Manono Luthuli
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Dumsani Gumede
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | | | - Simphiwe Mdluli
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Sithembile Msane
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Theresa Smit
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Jean-Michel Molina
- Department of Infectious Diseases, Hospitals Saint-Louis and Lariboisière, Paris, France; University of Paris Cité, Paris, France
| | - Thandeka Khoza
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | | | - Nuala McGrath
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa; University of Southampton, Southampton, UK
| | - Janet Seeley
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa; London School of Hygiene & Tropical Medicine, London, UK
| | - Guy Harling
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa; Institute for Global Health, University College London, London, UK; University of KwaZulu-Natal, Durban, South Africa; University of the Witwatersrand, Johannesburg, South Africa
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Kathy Baisley
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa; London School of Hygiene & Tropical Medicine, London, UK
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Suraratdecha C, MacKellar D, Steiner C, Rwabiyago OE, Cham HJ, Msumi O, Maruyama H, Kundi G, Byrd J, Weber R, Mkemwa G, Kazaura K, Justman J, Rwebembera A. Cost-outcome analysis of HIV testing and counseling, linkage, and defaulter tracing services in Bukoba, Tanzania. AIDS Care 2024; 36:744-751. [PMID: 37607238 PMCID: PMC10881889 DOI: 10.1080/09540121.2023.2247959] [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: 08/24/2023]
Abstract
Effective services along the HIV continuum of care from HIV testing and counseling to linkage, and from linkage to antiretroviral therapy (ART) initiation and retention, are key to improved health outcomes of persons living with HIV. A comprehensive analysis of the costs and outcomes of cascade services is needed to help allocate and prioritize resources to achieve UNAIDS targets. We evaluated the costs and population-level impact of a community-wide, integrated scale-up of testing, linkage, and defaulter-tracing programs implemented in Bukoba Municipal Council, Tanzania. Costs per identified HIV-positive client for provider-initiated, and home- and venue-based testing and counseling were $92.64 United States dollars (USD), $256.33 USD, and $281.57 USD, respectively. Costs per patient linked to HIV care and ART were $47.69 USD and $74.12 USD, respectively, during all ART-eligibility periods combined. Costs per defaulter traced and returned to HIV care were $47.56 USD and $206.77 USD, respectively. The provider-initiated testing and counseling was the most cost-effective modality. Testing approaches targeted to populations groups and geographic location with high testing positivity rates may improve the overall efficiency of testing services. The expansion of ART eligibility criteria and high linkage rate also result in efficiency gains and economies of scale of linkage services.
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Affiliation(s)
- Chutima Suraratdecha
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Duncan MacKellar
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Haddi Jatou Cham
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Omari Msumi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | | | - Gerald Kundi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | | | - Rachel Weber
- Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Grace Mkemwa
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | | | | | - Anath Rwebembera
- National AIDS Control Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
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Alarcón Gutiérrez M, Palma Díaz D, Forns Cantón ML, Fernández-López L, García de Olalla P, Rius Gibert C. Trends in Sexual Health of Gay, Bisexual, and Other Men Who Have Sex with Men, and Transgender Individuals: Apps Driven Testing Program for HIV and Other STIs in Barcelona, Spain (2016-2023). J Community Health 2024; 49:429-438. [PMID: 38063976 PMCID: PMC10981613 DOI: 10.1007/s10900-023-01310-9] [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: 11/08/2023] [Indexed: 04/02/2024]
Abstract
Gay, bisexual and other men who have sex with men (GBMSM) and transgender individuals face heightened risks of HIV and other sexually transmitted infections (STIs). Surveillance within these populations is critical, and community testing services play a pivotal role in preventing and controlling HIV and STIs. This study investigates the trends in HIV, syphilis and hepatitis C (HCV) infections among participants in an apps-driven rapid test program from 2016 to 2023 in Barcelona, Spain, examining associated factors. Trend analysis utilized Wilcoxon-type test and associated factors were determined through multivariate logistic analysis. The prevalence of new HIV diagnosis was 1.81% (CI 1.18-2.64), active syphilis was 3.37% (CI 2.46-4.50) and acute HCV was 0.40% (CI 0.11-1.02). While infection rates showed no significant changes, there was significant increasing in sex work and chemsex and decreasing in condom use. Additionally, a peak in dating apps use for sex and a specific reduction in number of sexual partners were observed in 2020. Factors associated with HIV diagnoses included migrant status (aOR = 11.19; CI 2.58-48.53) and inconsistent condom use during the previous 12 months (aOR = 3.12; CI 1.02-9.51). For syphilis, associated factors were migrant status (aOR = 2.46; CI 1.14-5.29), inconsistent condom use (aOR = 3.38; CI 1.37-8.36), and chemsex practice during the previous 12 months (aOR = 2.80; CI 1.24-6.30). Our findings emphasize the need for tailored interventions, including culturally sensitive outreach for migrants and comprehensive strategies addressing substance use in sexual contexts. Technological innovations and targeted educational initiatives could reduce the burden of HIV and STIs within the GBMSM and transgender communities, providing valuable insights for public health strategies.
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Affiliation(s)
- Miguel Alarcón Gutiérrez
- Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Epidemiology Service, Agència de Salut Pública de Barcelona, Barcelona, Spain.
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain.
| | - David Palma Díaz
- Epidemiology Service, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Department of International Health, Care and Public Health Research Institute-CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Laura Fernández-López
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Patricia García de Olalla
- Epidemiology Service, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau, Barcelona, Spain
| | - Cristina Rius Gibert
- Epidemiology Service, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau, Barcelona, Spain
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Pitpitan EV, Horvath KJ, Aldous J, Stockman JK, Patterson TL, Liang M, Barrozo C, Moore V, Penninga K, Smith LR. Peers plus mobile app for treatment in HIV (PATH): protocol for a randomized controlled trial to test a community-based integrated peer support and mHealth intervention to improve viral suppression among Hispanic and Black people living with HIV. Trials 2024; 25:212. [PMID: 38520030 PMCID: PMC10958824 DOI: 10.1186/s13063-024-08042-8] [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: 12/21/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Significant disparities continue to exist in the HIV care continuum, whereby Hispanic and Black people living with HIV (PLWH) are less likely to achieve viral suppression compared to their White counterparts. Studies have shown that intervention approaches that involve peer navigation may play an important role in supporting patients to stay engaged in HIV care. However, implementation may be challenging in real-world settings where there are limited resources to support peer navigators. Combining a peer navigation approach with scalable mobile health (mHealth) technology may improve impact and implementation outcomes. METHODS We combined a peer navigation intervention with a mHealth application and are conducting a randomized controlled trial (RCT) to test the efficacy of this integrated "Peers plus mobile App for Treatment in HIV" (PATH) intervention to improve HIV care engagement, and ultimately sustained viral suppression, among Hispanic and Black PLWH. We will enroll up to 375 PLWH into a two-arm prospective RCT, conducting follow-up assessments every 3 months up to 12 months post-baseline. Participants randomized to the control arm will continue to receive usual care Ryan White Program case management services. Individuals randomized to receive the PATH intervention will receive usual care plus access to two main intervention components: (1) a peer navigation program and (2) a mHealth web application. The primary outcome is sustained HIV viral suppression (undetectable viral load observed at 6- and 12-month follow-up). Secondary outcomes are retention in HIV care, gaps in HIV medical visits, and self-reported ART adherence. Recruitment for the RCT began in November 2021 and will continue until June 2024. Follow-up assessments and medical chart abstractions will be conducted to collect measurements of outcome variables. DISCUSSION The efficacy trial of PATH will help to fill gaps in our scientific understanding of how a combined peer navigation and mHealth approach may produce effects on HIV care outcomes while addressing potential implementation challenges of peer navigation in Ryan White-funded clinics. TRIAL REGISTRATION The PATH trial is registered at the United States National Institutes of Health National Library of Medicine (ClinicalTrials.gov) under ID # NCT05427318 . Registered on 22 June 2022.
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Affiliation(s)
- Eileen V Pitpitan
- School of Social Work, San Diego State University, San Diego, USA.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA.
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, USA
| | | | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, USA
| | - Megan Liang
- San Diego State University Research Foundation, San Diego, USA
| | | | | | | | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA
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Eshetu BK, Tafere TZ, Asrade G, Haile TG. Process evaluation of the 90-90-90 targets of surge project in Addis Ababa, Ethiopia: a case study evaluation. BMC Health Serv Res 2024; 24:5. [PMID: 38166848 PMCID: PMC10763381 DOI: 10.1186/s12913-023-10415-9] [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: 06/19/2022] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV) is a major public health problem that continues to pose an enormous challenge to mankind's survival worldwide. In urban Ethiopia, the HIV prevalence among adults aged 15-49 years is 2.9%, while in Addis Ababa, it is 3.4%. To take the edge off, the Ethiopian government has been implementing the 90-90-90 strategy also known as the surge project, in urban cities. However, the implementation of the program has not been evaluated. Thus, we evaluated the process of the 90-90-90 targets of the surge project in Addis Ababa, Ethiopia. METHODS We conducted a case study with concurrent mixed-methods evaluation. We used indicator-driven evaluation dimensions -availability and accommodation dimensions from the health services access and compliance and fidelity from implementation fidelity frameworks to test the program process theory with a total of 52 indicators. We interviewed a total of 419 clients and 210 healthcare providers and reviewed 417 clients' cards and 17 registries. We also conducted 30 key informant interviews and resource inventory. A binary logistic regression analysis was done to identify factors associated with clients' satisfaction. We transcribed and translated the qualitative data and analysed thematically. Finally, we judged the overall process of the surge project based on the pre-seated judgmental criteria as; needs urgent improvement, needs improvement and well implemented. RESULTS We found that 90% of the project process was as per the program process theory measured by the availability of resources (95.8%), compliance (88.0%), fidelity (84.7%), and accommodation of services (89.3%). We found a shortage of human power, test kits, and viral load testing machines. The commitment of health care providers, provider-client interaction, and clients' satisfaction with the service at card rooms were found to be poor. Moreover, being aged 15-24, being married and government government-employed were negatively associated with clients' satisfaction with antiretroviral therapy services. CONCLUSION The process of the surge project needs improvement. Moreover, the achievements of the first two 90-90 targets were poor. Therefore, implementers need to take intensified action for the availability of resources and to improve the commitment of healthcare providers through refreshment training.
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Affiliation(s)
| | - Tesfahun Zemene Tafere
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia.
| | - Geta Asrade
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia
| | - Tsegaye Gebremedhin Haile
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia
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Coll P, Jarrín I, Martínez E, Martínez-Sesmero JM, Domínguez-Hernández R, Castro-Gómez A, Casado MŸ. Achieving the UNAIDS goals by 2030 in people living with HIV: A simulation model to support the prioritization of health care interventions. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:589-595. [PMID: 36710166 DOI: 10.1016/j.eimce.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/29/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE We simulated the impact of implementing different health interventions to improve the HIV continuum of care for people diagnosed, on treatment, and virologically suppressed in Spain for the 2020-2030 period. METHODS The model was carried out in four phases involving a multidisciplinary expert panel: (1) literature review; (2) selection/definition of the interventions and their effectiveness; (3) consensus meeting; and (4) development of an analytical decision model to project the impact of implementing/strengthening these interventions to improve the HIV continuum of care, corresponding to 2017-2019 (87% diagnosed, 97% on treatment, 90% with viral suppression), through the creation of different scenarios for 2020-2030. A total of 19 interventions were selected based on expanding the offer of HIV rapid tests and implementing training/peer programmes, electronic alerts, multidisciplinary care, and mHealth, among others. The effectiveness of the interventions was defined by the percentage increases in diagnosis, treatment, and viral suppression after their implementation, targeting the entire population and specific groups at high-risk (men who have sex with men, migrants, female sex workers, transgender people, and people who inject drugs). RESULTS Implementing eight interventions for diagnosis, three for treatment, and eight for viral suppression for the target populations during 2020-2030 would increase the continuum of care to approximately 100% diagnosed (remaining residual undetectable cases), 98% treated, and 96% virologically suppressed. CONCLUSIONS Planification, prioritization, and implementation of selected interventions based on the current HIV continuum of care could allow achievement of the 95-95-95 UNAIDS goals in Spain by 2030.
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Affiliation(s)
- Pep Coll
- IrsiCaixa-AIDS Research Institute, Germans Trias I Pujol Hospital, Badalona, Barcelona, Spain
| | - Inma Jarrín
- National Center for Epidemiology, Institute of Health Carlos III (ISCIII), Madrid, Spain; Spanish HIV/AIDS Research Network (CoRIS), Madrid, Spain; CIBER de Enfermedades Infecciosas, Madrid, Spain
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Conserve DF, Tun W, Hickson DA, Gomez- Berrospi J, Janson S, Rinola B, Durkin M, Buchanan C, Morris C, Saleeban A, Olughu K, Pulerwitz J, Kerrigan D. Adapting a community-based intervention to address social determinants of health influencing pre-exposure prophylaxis services for Black adults in Washington, District of Columbia: A study protocol. PLoS One 2023; 18:e0290631. [PMID: 37922262 PMCID: PMC10624286 DOI: 10.1371/journal.pone.0290631] [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: 05/04/2023] [Accepted: 08/09/2023] [Indexed: 11/05/2023] Open
Abstract
Community-based HIV treatment initiation and continuation helps to address social determinants of health (SDOH) barriers to care and increase antiretroviral therapy (ART) uptake and adherence. Similarly, community-based pre-exposure prophylaxis (cbPrEP) services can help address SDOH barriers such as transportation costs and stigma. However, few studies have examined cbPrEP programming in the Washington, District of Columbia (DC) area where more Blacks are disproportionately affected by HIV and have low PrEP uptake. This study aims to adapt and pilot a community-based ART intervention (cbART) intervention for cbPrEP service delivery for Black adults in the Washington, DC area. The adaptation of the cbART intervention will be informed by the ADAPT-ITT framework and the Consolidated Framework for Implementation Research. For Aim 1, in-depth and key informant interviews will be conducted with PrEP program managers at community-based organizations (N = 10), DC health department representatives (N = 8), PrEP providers (N = 10) and current and potential Black PrEP users (n = 24). The interviews will provide an initial assessment of barriers and facilitators to PrEP services and inform the decisions on how to adapt the cbART intervention for cbPrEP services. In Aim 2, we will train and pilot test the cbPrEP intervention for acceptability, feasibility, and appropriateness with Black adults (n = 60). Enrolled participants will complete a survey at baseline and at 45 days post-enrollment. In-depth interviews will be conducted with a subset (N = 16) of participants, those who did not enroll (N = 10) and providers implementing the cbPrEP intervention (N = 8). Alternative strategies to PrEP service delivery are needed to increase PrEP uptake among those most in need in the DC area. If cbPrEP delivery is found to be acceptable, feasible, and appropriate, it could have a significant impact on DC's Ending the HIV Epidemic efforts and will inform future efforts to investigate the intervention's efficacy on PrEP uptake and continuation among Black adults in DC.
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Affiliation(s)
- Donaldson F. Conserve
- George Washington University, Milken Institute School of Public Health, Washington, DC, United States of America
| | - Waimar Tun
- Population Council, Washington, DC, United States of America
| | - DeMarc A. Hickson
- Us Helping US, People Into Living, Inc., Washington, DC, United States of America
| | - Jennifer Gomez- Berrospi
- George Washington University, Milken Institute School of Public Health, Washington, DC, United States of America
| | - Samuel Janson
- George Washington University, Milken Institute School of Public Health, Washington, DC, United States of America
| | - Bukola Rinola
- George Washington University, Milken Institute School of Public Health, Washington, DC, United States of America
| | - Mallory Durkin
- George Washington University, Milken Institute School of Public Health, Washington, DC, United States of America
| | | | - Christian Morris
- Us Helping US, People Into Living, Inc., Washington, DC, United States of America
| | - Alia Saleeban
- Howard University, Washington, DC, United States of America
| | - Kelia Olughu
- George Washington University, Milken Institute School of Public Health, Washington, DC, United States of America
| | - Julie Pulerwitz
- Population Council, Washington, DC, United States of America
| | - Deanna Kerrigan
- George Washington University, Milken Institute School of Public Health, Washington, DC, United States of America
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Z S, S S, N A H, S A I. Women's Experiences of Infant Feeding Practices While Living With HIV in Malaysia: A Community-Based Qualitative Study. J Hum Lact 2023; 39:701-710. [PMID: 37675867 DOI: 10.1177/08903344231195580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
BACKGROUND With the advancement of antiretroviral therapy scale-up, it is possible for women living with HIV to breastfeed safely. However, this practice has not been adopted in Malaysia. Instead, infants are provided with subsidized human milk substitutes for their first 2 years of life. RESEARCH AIM This study describes the infant feeding experiences of women living with HIV in Malaysia. METHODS From August to October 2021, a nationwide, community-based qualitative study was conducted among women living with HIV and who received care from the Malaysian Ministry of Health. Using purposive sampling, participants who met the inclusion criteria were recruited. Interview and focus group transcripts were coded based on a secondary thematic analysis. RESULTS Six in-depth interviews and five focus group discussions were conducted among 32 participants. Study participants were mostly Malay secondary school graduates in their 30s and 40s. Due to the fear of vertical transmission, which was explained by healthcare providers to the participants, none of the women breastfed their infants. The three primary themes that emerged from analyzing the women's infant feeding experiences were (1) a human milk substitute was the only option and was encouraged; (2) feeding infants with a human milk substitute made the women feel incomplete as mothers; and (3) the women encountered difficulties in obtaining the subsidized human milk substitute. CONCLUSION Women living with HIV in Malaysia have been advised to provide human milk substitutes to their infants in fear of HIV transmission.
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Affiliation(s)
- Sulaiman Z
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Sukeri S
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Hamid N A
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ibrahim S A
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Ngcobo SJ, Makhado L, Sehularo LA. HIV Care Profiling and Delivery Status in the Mobile Health Clinics of eThekwini District in KwaZulu Natal, South Africa: A Descriptive Evaluation Study. NURSING REPORTS 2023; 13:1539-1552. [PMID: 37987408 PMCID: PMC10661302 DOI: 10.3390/nursrep13040129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/15/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
Mobile health clinics (MHCs) serve as an alternative HIV care delivery method for the HIV-burdened eThekwini district. This study aimed to describe and profile the HIV care services provided by the MHCs through process evaluation. A descriptive cross-sectional quantitative evaluation study was performed on 137 MHCs using total population sampling. An online data collection method using a validated 50-item researcher-developed instrument was administered to professional nurses who are MHC team leaders, following ethical approval from the local university and departments of health. Descriptive statistics were used to analyze the data. The results described that HIV care services are offered in open spaces (43%), community buildings (37%), solid built buildings called health posts (15%), vehicles (9%), and tents (2%) with no electricity (77%), water (55%), and sanitation (64%). Adults (97%) are the main recipients of HIV care in MHCs (90%) offering antiretroviral therapy (95%). Staff, monitoring, and retaining care challenges were noted, with good linkage (91%) and referral pathways (n = 123.90%). In conclusion, the standardization and prioritization of HIV care with specific contextual practice guidelines are vital.
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Affiliation(s)
| | - Lufuno Makhado
- Office of the Deputy Dean Research and Postgraduate Studies, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
| | - Leepile Alfred Sehularo
- NuMIQ Research Focus Area, Faculty of Health Sciences, North-West University, Mafikeng 2531, South Africa
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Pinto PFPS, Macinko J, Silva AF, Lua I, Jesus G, Magno L, Santos CAST, Ichihara MY, Barreto ML, Moucheraud C, Souza LE, Dourado I, Rasella D. The effect of primary health care on AIDS incidence and mortality: a cohort study of 3.4 million Brazilians. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.02.23296417. [PMID: 37873240 PMCID: PMC10593023 DOI: 10.1101/2023.10.02.23296417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Primary Health Care (PHC) is essential for the health and wellbeing of people living with HIV/AIDS. This study evaluated the effects of one of the largest community-based PHC programs in the world, the Brazilian Family Health Strategy (FHS), on AIDS incidence and mortality. Methods A retrospective cohort study carried out in Brazil, from January 1 2007 to December 31 2015. We conducted a quasi-experimental effect evaluation using a cohort of 3,435,068 ≥13 years low-income individuals who were members of the 100 Million Brazilians Cohort, linked to AIDS diagnoses and deaths registries. We evaluated the effect of FHS on AIDS incidence and mortality and comparing outcomes between residents of municipalities with no FHS coverage with those in municipalities with full FHS coverage. We used multivariable Poisson regressions adjusted for all relevant municipal and individual-level demographic, socioeconomic, and contextual variables, and weighted with inverse probability of treatment weighting (IPTW). We also estimated FHS effect by sex and age, and performed a wide range of sensitivity and triangulation analyses. Findings FHS coverage was associated with lower AIDS incidence (rate ratio [RR]:0.76, 95%CI:0.68-0.84) and mortality (RR:0.68,95%CI:0.56-0.82). FHS effect was similar between men and women, but was larger in people aged ≥35 years old both for incidence (RR 0.62, 95%CI:0.53-0.72) and mortality (RR 0.56, 95%CI:0.43-0.72). Conclusions AIDS should be an avoidable outcome for most people living with HIV today, and our study shows that FHS coverage could significantly reduce AIDS incidence and mortality among low-income populations in Brazil. Universal access to comprehensive healthcare through community-based PHC programs should be promoted to achieve the Sustainable Development Goals of ending AIDS by 2030.
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Affiliation(s)
- Priscila FPS Pinto
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - James Macinko
- Departments of Health Policy and Management and Community Health Sciences, Fielding School of Public Health, University of California (UCLA), Los Angeles, California, The United States of America (USA)
| | - Andréa F Silva
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Iracema Lua
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Gabriela Jesus
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Laio Magno
- Department of Life Sciences, State University of Bahia (UNEB), Salvador, Brazil
| | - Carlos AS Teles Santos
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Maria Yury Ichihara
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Mauricio L Barreto
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Corrina Moucheraud
- Departments of Health Policy and Management and Community Health Sciences, Fielding School of Public Health, University of California (UCLA), Los Angeles, California, The United States of America (USA)
| | - Luis E Souza
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- Instituto de Salud Global Barcelona (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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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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Kouanfack C, Mvilongo M, Zemsi S, Fomete L, Mapa-Tassou C, Djam A, Zambou F, Ateudjieu J, Fouda PJ. Contribution of community-based organizations in the improvement of Joint United Nations Program on HIV and AIDS 90-90-90: case of the Yaoundé Central Hospital. Pan Afr Med J 2023; 45:173. [PMID: 37954437 PMCID: PMC10632170 DOI: 10.11604/pamj.2023.45.173.38466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/19/2023] [Indexed: 11/14/2023] Open
Abstract
Community-based organizations (CBOs) are one of the initiatives implemented in Cameroon to improve access to antiretroviral treatment and influence retention in treatment centers. Despite its importance in the decongestion of patients in health facilities, we do not have data to evaluate the overall impact of these organizations. We conducted a two-part observational study. The first part was a descriptive cross-sectional study, where we included patients screened and initiated on anti-retroviral treatment (ART) either by the approved Treatment center (ATC) of Yaoundé Central Hospital (YCH) or by any of our CBOs in 2020. Then, the second part was a retrospective cohort-type study including patients from the 2015 cohort followed up from 2018 to 2020 in order to assess viral load suppression. As regards the first "90", 7,234 screening tests were performed by CBOs in 2020 out of the 28,302 screening tests registered at the YCH, giving a contribution of 25.6%. From the 7,234 screening tests performed by CBOs, 314 people had an HIV-positive result and 230 (73.34%) were linked to ART through CBOs. From the 28,302 screening tests performed at YCH, 1,089 people had an HIV-positive test, and only 354 (32.50%) were linked to ART, giving a significant difference in the link to ART (P-value < 0.00). Concerning the 3rd ''90'', the viral load suppression rates were respectively in CBOs and at YCH of (95.12% vs 90.54%, RR= 0.51; P-value= 0.27 at 12 months); (95.96% vs 95.34%, relative risk (RR)= 0.85; P-value= 0.81 at 24 months); and (96.91% vs 94.15%, RR= 0.52; P-value = 0.24 at 36 months). In conclusion, we say that the follow-up of patients living with HIV in the community does not negatively affect the evolution of the disease as one might think.
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Affiliation(s)
- Charles Kouanfack
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Yaounde Central Hospital, Yaoundé, Cameroon
| | - Marie Mvilongo
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | | | | | - Clarisse Mapa-Tassou
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Alain Djam
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - François Zambou
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Jerome Ateudjieu
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Pierre Joseph Fouda
- Yaounde Central Hospital, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
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Busang J, Zuma T, Herbst C, Okesola N, Chimbindi N, Dreyer J, Mtshali N, Smit T, Ngubane S, Hlongwane S, Gumede D, Jalazi A, Mdluli S, Bird K, Msane S, Danisa P, Hanekom W, Lebina L, Behuhuma N, Hendrickson C, Miot J, Seeley J, Harling G, Jarolimova J, Sherr L, Copas A, Baisley K, Shahmanesh M. Thetha Nami ngithethe nawe (Let's Talk): a stepped-wedge cluster randomised trial of social mobilisation by peer navigators into community-based sexual health and HIV care, including pre-exposure prophylaxis (PrEP), to reduce sexually transmissible HIV amongst young people in rural KwaZulu-Natal, South Africa. BMC Public Health 2023; 23:1553. [PMID: 37582746 PMCID: PMC10428543 DOI: 10.1186/s12889-023-16262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/07/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) through universal test and treat (UTT) and HIV pre-exposure prophylaxis (PrEP) substantially reduces HIV-related mortality and incidence. Effective ART based prevention has not translated into population-level impact in southern Africa due to sub-optimal coverage among youth. We aim to investigate the effectiveness, implementation and cost effectiveness of peer-led social mobilisation into decentralised integrated HIV and sexual reproductive health (SRH) services amongst adolescents and young adults in KwaZulu-Natal (KZN). METHODS We are conducting a type 1a hybrid effectiveness/implementation study, with a cluster randomized stepped-wedge trial (SWT) to assess effectiveness and a realist process evaluation to assess implementation outcomes. The SWT will be conducted in 40 clusters in rural KZN over 45 months. Clusters will be randomly allocated to receive the intervention in period 1 (early) or period 2 (delayed). 1) Intervention arm: Resident peer navigators in each cluster will approach young men and women aged 15-30 years living in their cluster to conduct health, social and educational needs assessment and tailor psychosocial support and health promotion, peer mentorship, and facilitate referrals into nurse led mobile clinics that visit each cluster regularly to deliver integrated SRH and differentiated HIV prevention (HIV testing, UTT for those positive, and PrEP for those eligible and negative). Standard of Care is UTT and PrEP delivered to 15-30 year olds from control clusters through primary health clinics. There are 3 co-primary outcomes measured amongst cross sectional surveys of 15-30 year olds: 1) effectiveness of the intervention in reducing the prevalence of sexually transmissible HIV; 2) uptake of universal risk informed HIV prevention intervention; 3) cost of transmissible HIV infection averted. We will use a realist process evaluation to interrogate the extent to which the intervention components support demand, uptake, and retention in risk-differentiated biomedical HIV prevention. DISCUSSION The findings of this trial will be used by policy makers to optimize delivery of universal differentiated HIV prevention, including HIV pre-exposure prophylaxis through peer-led mobilisation into community-based integrated adolescent and youth friendly HIV and sexual and reproductive health care. TRIAL REGISTRATION ClinicalTrials.gov Identifier-NCT05405582. Registered: 6th June 2022.
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Affiliation(s)
- Jacob Busang
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Thembelihle Zuma
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
- University of KwaZulu-Natal, Durban, South Africa
| | - Carina Herbst
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Nonhlanhla Okesola
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Natsayi Chimbindi
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
- University of KwaZulu-Natal, Durban, South Africa
| | - Jaco Dreyer
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Nelisiwe Mtshali
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Theresa Smit
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | | | | | - Dumsani Gumede
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Ashley Jalazi
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | | | - Kristien Bird
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Sithembile Msane
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Priscilla Danisa
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Willem Hanekom
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
| | - Limakatso Lebina
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
- University of the Witwatersrand, Johannesburg, South Africa
| | - Ngundu Behuhuma
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Cheryl Hendrickson
- University of the Witwatersrand, Johannesburg, South Africa
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Johannesburg, South Africa
- Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jacqui Miot
- University of the Witwatersrand, Johannesburg, South Africa
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Johannesburg, South Africa
| | - Janet Seeley
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, South Africa
- London School of Hygiene & Tropical Medicine, London, UK
| | - Guy Harling
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
- University of KwaZulu-Natal, Durban, South Africa
- University of the Witwatersrand, Johannesburg, South Africa
- Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Kathy Baisley
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
- London School of Hygiene & Tropical Medicine, London, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa.
- Institute for Global Health, University College London, London, UK.
- University of KwaZulu-Natal, Durban, South Africa.
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Al Mohajer M. Designing a Local Policy to Reduce HIV in Mexico City. Avicenna J Med 2023; 13:187-191. [PMID: 37799182 PMCID: PMC10550362 DOI: 10.1055/s-0043-1773791] [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: 10/07/2023] Open
Abstract
The Joint United Nations Program on human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (Joint United Nations Program on HIV/AIDS, UNAIDS) has recommended 90-90-90 goals to increase the number of patients who are aware of their status, on antiretroviral therapy, and have undetectable viral loads. Mexico City has made several achievements to aid in prevention, early diagnosis, and treatment; however, the incidence of HIV has not decreased over the past decade. This article reviews global initiatives that were successful in achieving some or all these metrics and provide a road map for Mexico to reach the desired goals.
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Affiliation(s)
- Mayar Al Mohajer
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, United States
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Dovel KL, Hariprasad S, Hubbard J, Cornell M, Phiri K, Choko A, Abbott R, Hoffman R, Nichols B, Gupta S, Long L. Strategies to improve antiretroviral therapy (ART) initiation and early engagement among men in sub-Saharan Africa: A scoping review of interventions in the era of universal treatment. Trop Med Int Health 2023; 28:454-465. [PMID: 37132119 PMCID: PMC10354296 DOI: 10.1111/tmi.13880] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVES Men in sub-Saharan Africa (SSA) have lower rates of antiretroviral therapy (ART) initiation and higher rates of early default than women. Little is known about effective interventions to improve men's outcomes. We conducted a scoping review of interventions aimed to increase ART initiation and/or early retention among men in SSA since universal treatment policies were implemented. METHODS Three databases, HIV conference databases and grey literature were searched for studies published between January 2016 to May 2021 that reported on initiation and/or early retention among men. Eligibility criteria included: participants in SSA, data collected after universal treatment policies were implemented (2016-2021), quantitative data on ART initiation and/or early retention for males, general male population (not exclusively focused on key populations), intervention study (report outcomes for at least one non-standard service delivery strategy), and written in English. RESULTS Of the 4351 sources retrieved, 15 (reporting on 16 interventions) met inclusion criteria. Of the 16 interventions, only two (2/16, 13%) exclusively focused on men. Five (5/16, 31%) were randomised control trials (RCT), one (1/16, 6%) was a retrospective cohort study, and 10 (10/16, 63%) did not have comparison groups. Thirteen (13/16, 81%) interventions measured ART initiation and six (6/16, 37%) measured early retention. Outcome definitions and time frames varied greatly, with seven (7/16, 44%) not specifying time frames at all. Five types of interventions were represented: optimising ART services at health facilities, community-based ART services, outreach support (such as reminders and facility escort), counselling and/or peer support, and conditional incentives. Across all intervention types, ART initiation rates ranged from 27% to 97% and early retention from 47% to 95%. CONCLUSIONS Despite years of data of men's suboptimal ART outcomes, there is little high-quality evidence on interventions to increase men's ART initiation or early retention in SSA. Additional randomised or quasi-experimental studies are urgently needed.
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Affiliation(s)
- Kathryn L Dovel
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
- Partners in Hope Medical Center, Lilongwe, Malawi
| | - Santhi Hariprasad
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Julie Hubbard
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
- Partners in Hope Medical Center, Lilongwe, Malawi
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Khumbo Phiri
- Partners in Hope Medical Center, Lilongwe, Malawi
| | | | - Rachel Abbott
- Division of HIV, Infections Diseases & Global Medicine, University of California San Francisco, San Francisco, California, USA
| | - Risa Hoffman
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Brooke Nichols
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Sundeep Gupta
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Lawrence Long
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Meng X, Yin H, Ma W, Gu J, Lu Z, Fitzpatrick T, Zou H. Peer-Led Community-Based Support Services and HIV Treatment Outcomes Among People Living With HIV in Wuxi, China: Propensity Score-Matched Analysis of Surveillance Data From 2006 to 2021. JMIR Public Health Surveill 2023; 9:e43635. [PMID: 36961492 PMCID: PMC10131765 DOI: 10.2196/43635] [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: 10/19/2022] [Revised: 01/02/2023] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Community-based organizations deliver peer-led support services to people living with HIV. Systematic reviews have found that peer-led community-based support services can improve HIV treatment outcomes; however, few studies have been implemented to evaluate its impact on mortality using long-term follow-up data. OBJECTIVE We aimed to evaluate the associations between the receipt of peer-led community-based support services and HIV treatment outcomes and survival among people living with HIV in Wuxi, China. METHODS We performed a propensity score-matched retrospective cohort study using data collected from the Chinese National HIV/AIDS Comprehensive Information Management System for people living with HIV in Wuxi, China, between 2006 and 2021. People living with HIV who received adjunctive peer-led community-based support for at least 6 months from a local community-based organization (exposure group) were matched to people living with HIV who only received routine clinic-based HIV care (control group). We compared the differences in HIV treatment outcomes and survival between these 2 groups using Kaplan-Meier curves. We used competing risk and Cox proportional hazards models to assess correlates of AIDS-related mortality (ARM) and all-cause mortality. We reported adjusted subdistribution hazard ratio and adjusted hazard ratio with 95% CIs. RESULTS A total of 860 people living with HIV were included (430 in the exposure group and 430 in the control group). The exposure group was more likely to adhere to antiretroviral therapy (ART; 396/430, 92.1% vs 360/430, 83.7%; P<.001), remain retained in care 12 months after ART initiation (402/430, 93.5% vs 327/430, 76.1%; P<.001), and achieve viral suppression 9 to 24 months after ART initiation (357/381, 93.7% vs 217/243, 89.3%; P=.048) than the control group. The exposure group had significantly lower ARM (1.8 vs 7.0 per 1000 person-years; P=.01) and all-cause mortality (2.3 vs 9.3 per 1000 person-years; P=.002) and significantly higher cumulative survival rates (P=.003). The exposure group had a 72% reduction in ARM (adjusted subdistribution hazard ratio 0.28, 95% CI 0.09-0.95) and a 70% reduction in all-cause mortality (adjusted hazard ratio 0.30, 95% CI 0.11-0.82). The nonrandomized retrospective nature of our analysis prevents us from determining whether peer-led community-based support caused the observed differences in HIV treatment outcomes and survival between the exposure and control groups. CONCLUSIONS The receipt of peer-led community-based support services correlated with significantly improved HIV treatment outcomes and survival among people living with HIV in a middle-income country in Asia. The 15-year follow-up period in this study allowed us to identify associations with survival not previously reported in the literature. Future interventional trials are needed to confirm these findings.
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Affiliation(s)
- Xiaojun Meng
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Hanlu Yin
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Wenjuan Ma
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Jing Gu
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Zhen Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Thomas Fitzpatrick
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Kirby Institute, University of New South Wales, Sydney, Australia
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Lippman SA, de Kadt J, Ratlhagana MJ, Agnew E, Gilmore H, Sumitani J, Grignon J, Gutin SA, Shade SB, Gilvydis JM, Tumbo J, Barnhart S, Steward WT. Impact of short message service and peer navigation on linkage to care and antiretroviral therapy initiation in South Africa. AIDS 2023; 37:647-657. [PMID: 36468499 PMCID: PMC9994809 DOI: 10.1097/qad.0000000000003453] [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: 08/03/2022] [Revised: 11/18/2022] [Accepted: 11/25/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE We examine the efficacy of short message service (SMS) and SMS with peer navigation (SMS + PN) in improving linkage to HIV care and initiation of antiretroviral therapy (ART). DESIGN I-Care was a cluster randomized trial conducted in primary care facilities in North West Province, South Africa. The primary study outcome was retention in HIV care; this analysis includes secondary outcomes: linkage to care and ART initiation. METHODS Eighteen primary care clinics were randomized to automated SMS ( n = 7), automated and tailored SMS + PN ( n = 7), or standard of care (SOC; n = 4). Recently HIV diagnosed adults ( n = 752) were recruited from October 2014 to April 2015. Those not previously linked to care ( n = 352) contributed data to this analysis. Data extracted from clinical records were used to assess the days that elapsed between diagnosis and linkage to care and ART initiation. Cox proportional hazards models and generalized estimating equations were employed to compare outcomes between trial arms, overall and stratified by sex and pregnancy status. RESULTS Overall, SMS ( n = 132) and SMS + PN ( n = 133) participants linked at 1.28 [95% confidence interval (CI): 1.01-1.61] and 1.60 (95% CI: 1.29-1.99) times the rate of SOC participants ( n = 87), respectively. SMS + PN significantly improved time to ART initiation among non-pregnant women (hazards ratio: 1.68; 95% CI: 1.25-2.25) and men (hazards ratio: 1.83; 95% CI: 1.03-3.26) as compared with SOC. CONCLUSION Results suggest SMS and peer navigation services significantly reduce time to linkage to HIV care in sub-Saharan Africa and that SMS + PN reduced time to ART initiation among men and non-pregnant women. Both should be considered candidates for integration into national programs. TRIAL REGISTRATION NCT02417233, registered 12 December 2014; closed to accrual 17 April 2015.
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Affiliation(s)
- Sheri A. Lippman
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Julia de Kadt
- International Training and Education Center for Health (I-TECH), Pretoria, Republic of South Africa
| | - Mary J. Ratlhagana
- International Training and Education Center for Health (I-TECH), Pretoria, Republic of South Africa
| | - Emily Agnew
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Hailey Gilmore
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jeri Sumitani
- International Training and Education Center for Health (I-TECH), Pretoria, Republic of South Africa
| | - Jessica Grignon
- International Training and Education Center for Health (I-TECH), Pretoria, Republic of South Africa
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Sarah A. Gutin
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Starley B. Shade
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jennifer M. Gilvydis
- International Training and Education Center for Health (I-TECH), Pretoria, Republic of South Africa
| | - John Tumbo
- Department of Family Medicine and Primary Health Care, Sefako Makgatho Health Sciences University, Pretoria, Republic of South Africa
| | - Scott Barnhart
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Wayne T. Steward
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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20
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Thorp M, Ayieko J, Hoffman RM, Balakasi K, Camlin CS, Dovel K. Mobility and HIV care engagement: a research agenda. J Int AIDS Soc 2023; 26:e26058. [PMID: 36943731 PMCID: PMC10029995 DOI: 10.1002/jia2.26058] [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: 08/03/2022] [Accepted: 01/10/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Mobility is common and an essential livelihood strategy in sub-Saharan Africa (SSA). Mobile people suffer worse outcomes at every stage of the HIV care cascade compared to non-mobile populations. Definitions of mobility vary widely, and research on the role of temporary mobility (as opposed to permanent migration) in HIV treatment outcomes is often lacking. In this article, we review the current landscape of mobility and HIV care research to identify what is already known, gaps in the literature, and recommendations for future research. DISCUSSION Mobility in SSA is closely linked to income generation, though caregiving, climate change and violence also contribute to the need to move. Mobility is likely to increase in the coming decades, both due to permanent migration and increased temporary mobility, which is likely much more common. We outline three central questions regarding mobility and HIV treatment outcomes in SSA. First, it is unclear what aspects of mobility matter most for HIV care outcomes and if high-risk mobility can be identified or predicted, which is necessary to facilitate targeted interventions for mobile populations. Second, it is unclear what groups are most vulnerable to mobility-associated treatment interruption and other adverse outcomes. And third, it is unclear what interventions can improve HIV treatment outcomes for mobile populations. CONCLUSIONS Mobility is essential for people living with HIV in SSA. HIV treatment programmes and broader health systems must understand and adapt to human mobility, both to promote the rights and welfare of mobile people and to end the HIV pandemic.
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Affiliation(s)
- Marguerite Thorp
- Division of Infectious DiseasesDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - James Ayieko
- Center for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Risa M. Hoffman
- Division of Infectious DiseasesDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | | | - Carol S. Camlin
- Department of ObstetricsGynecology & Reproductive SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Center for AIDS Prevention StudiesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Kathryn Dovel
- Division of Infectious DiseasesDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
- Partners in HopeLilongweMalawi
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21
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van Heerden A, Szpiro A, Ntinga X, Celum C, van Rooyen H, Essack Z, Barnabas R. A Sequential Multiple Assignment Randomized Trial of scalable interventions for ART delivery in South Africa: the SMART ART study. Trials 2023; 24:32. [PMID: 36647092 PMCID: PMC9842495 DOI: 10.1186/s13063-022-07025-x] [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: 11/08/2022] [Accepted: 12/15/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Of the 8 million people in South Africa living with HIV, 74% of persons living with HIV are on antiretroviral therapy (ART) and 65% are virally suppressed. Detectable viral load results in HIV-associated morbidity and mortality and HIV transmission. Patient barriers to care, such as missed wages, transport costs, and long wait times for clinic visits and ART refills, are associated with detectable viral load. HIV differentiated service delivery (DSD) has simplified ART delivery for clients who achieve viral suppression and engage in care. However, DSD needs adaptation to serve clients who are not engaged in care. METHODS A Sequential Multiple Assignment Randomized Trial will be undertaken in KwaZulu-Natal, South Africa, to test adaptive ART delivery for persons with detectable viral load and/or who are not engaged in care. The types of differentiated service delivery (DSD) which will be examined in this study are clinic-based incentives, community-based smart lockers, and home delivery. The study plans to enroll up to 900 participants-people living with HIV, eligible for ART, and who are not engaged in care. The study aims to assess the proportion of ART-eligible persons living with HIV who achieve viral suppression at 18 months. The study will also evaluate the preferences of clients and providers for differentiated service delivery and evaluate the cost-effectiveness of adaptive HIV treatment for those who are not engaged in care. DISCUSSION To increase population-level viral suppression, persons with detectable viral load need responsive DSD interventions. A Sequential Multiple Assignment Randomized Trial (SMART) design facilitates the evaluation of a stepped, adaptive approach to achieving viral suppression with "right-sized" interventions for patients most in need of effective and efficient HIV care delivery strategies. TRIAL REGISTRATION ClinicalTrials.gov NCT05090150. Registered on October 22, 2021.
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Affiliation(s)
- Alastair van Heerden
- grid.417715.10000 0001 0071 1142Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa ,grid.11951.3d0000 0004 1937 1135MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Adam Szpiro
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA USA
| | - Xolani Ntinga
- grid.417715.10000 0001 0071 1142Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Connie Celum
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA USA
| | - Heidi van Rooyen
- grid.11951.3d0000 0004 1937 1135MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa ,grid.417715.10000 0001 0071 1142Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Zaynab Essack
- grid.417715.10000 0001 0071 1142Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Ruanne Barnabas
- grid.32224.350000 0004 0386 9924Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
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22
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Suraratdecha C, MacKellar D, Hlophe T, Dlamini M, Ujamaa D, Pals S, Dube L, Williams D, Byrd J, Mndzebele P, Behel S, Pathmanathan I, Mazibuko S, Tilahun E, Ryan C. Evaluation of Community-Based, Mobile HIV-Care, Peer-Delivered Linkage Case Management in Manzini Region, Eswatini. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:38. [PMID: 36612360 PMCID: PMC9820019 DOI: 10.3390/ijerph20010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
The success of antiretroviral therapy (ART) requires continuous engagement in care and optimal levels of adherence to achieve sustained HIV viral suppression. We evaluated HIV-care cascade costs and outcomes of a community-based, mobile HIV-care, peer-delivered linkage case-management program (CommLink) implemented in Manzini region, Eswatini. Abstraction teams visited referral facilities during July 2019-April 2020 to locate, match, and abstract the clinical data of CommLink clients diagnosed between March 2016 and March 2018. An ingredients-based costing approach was used to assess economic costs associated with CommLink. The estimated total CommLink costs were $2 million. Personnel costs were the dominant component, followed by travel, commodities and supplies, and training. Costs per client tested positive were $499. Costs per client initiated on ART within 7, 30, and 90 days of diagnosis were $2114, $1634, and $1480, respectively. Costs per client initiated and retained on ART 6, 12, and 18 months after diagnosis were $2343, $2378, and $2462, respectively. CommLink outcomes and costs can help inform community-based HIV testing, linkage, and retention programs in other settings to strengthen effectiveness and improve efficiency.
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Affiliation(s)
- Chutima Suraratdecha
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Duncan MacKellar
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Thabo Hlophe
- Eswatini Ministry of Health, Mbabane P.O. Box 5, Eswatini
| | | | | | - Sherri Pals
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Lenhle Dube
- Eswatini Ministry of Health, Mbabane P.O. Box 5, Eswatini
| | - Daniel Williams
- U.S. Centers for Disease Control and Prevention, Pretoria P.O. Box 9536, South Africa
| | | | - Phumzile Mndzebele
- U.S. Centers for Disease Control and Prevention, Mbabane P.O. Box D202, Eswatini
| | - Stephanie Behel
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Ishani Pathmanathan
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Sikhathele Mazibuko
- U.S. Centers for Disease Control and Prevention, Mbabane P.O. Box D202, Eswatini
| | - Endale Tilahun
- Population Services International, Mbabane P.O. Box 170, Eswatini
| | - Caroline Ryan
- U.S. Centers for Disease Control and Prevention, Mbabane P.O. Box D202, Eswatini
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23
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Barnabas RV, Szpiro AA, Ntinga X, Mugambi ML, van Rooyen H, Bruce A, Joseph P, Ngubane T, Krows ML, Schaafsma TT, Zhao T, Tanser F, Baeten JM, Celum C, van Heerden A. Fee for home delivery and monitoring of antiretroviral therapy for HIV infection compared with standard clinic-based services in South Africa: a randomised controlled trial. Lancet HIV 2022; 9:e848-e856. [PMID: 36335976 PMCID: PMC9722609 DOI: 10.1016/s2352-3018(22)00254-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 08/24/2022] [Accepted: 09/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Home delivery and monitoring of antiretroviral therapy (ART) is convenient, overcomes logistical barriers, and could increase individual ART adherence and viral suppression. With client payment and sufficient health benefits, this strategy could be scalable. The aim of the Deliver Health Study was to test the acceptability and efficacy of a user fee for home ART monitoring and delivery. METHODS We conducted a randomised trial, the Deliver Health Study, of a fee for home delivery of ART compared with free clinic ART delivery in South Africa. People with HIV who were 18 years or older and clinically stable (including CD4 count >100 cells per μL and WHO HIV stage 1-3) were randomly assigned to: (1) fee for home delivery and monitoring of ART, including community ART initiation if needed; or (2) clinic-based ART (standard of care). The one-time fee for home delivery (ZAR 30, 60, and 90; equivalent to US$2, 4, 6) was tiered on the basis of participant income. The primary outcomes were recorded fee payment and acceptability assessed via questionnaire. The key virological secondary outcome was viral suppression with the difference between study groups assessed through robust Poisson regression including participants with viral load measured at exit (modified intention-to-treat analysis). This trial is registered on ClinicalTrials.gov (NCT04027153) and is complete, with analyses ongoing. FINDINGS From Oct 7, 2019, to Jan 30, 2020, 162 participants were enrolled; 82 were randomly assigned to the fee for home delivery group and 80 to the clinic-based group, with similar characteristics at baseline. Overall, 87 (54%) participants were men, 101 (62%) were on ART, and 98 (60%) were unemployed. In the home delivery group, 40 (49%), 33 (40%), and nine (11%) participants qualified for the ZAR 30, 60, and 90 fee, respectively. Median follow-up was 47 weeks (IQR 43-50) with 96% retention. 80 (98%) participants paid the user fee, with high acceptability and willingness to pay. In the modified intention-to-treat analysis of 155 (96%) participants who completed follow-up, fee for home delivery and monitoring statistically significantly increased viral suppression from 74% to 88% overall (RR 1·21, 95% CI 1·02-1·42); and from 64% to 84% among men (1·31, 1·01-1·71). INTERPRETATION Among South African adults with HIV, a fee for home delivery and monitoring of ART significantly increased viral suppression compared with clinic-based ART. Clients' paying a fee for home delivery and monitoring of ART was highly acceptable in the context of low income and high unemployment, and improved health outcomes as a result. Home ART delivery and monitoring, potentially with a user fee to offset costs, should be evaluated as a differentiated service delivery strategy to increase access to care. FUNDING National Institutes of Mental Health.
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Affiliation(s)
- Ruanne V Barnabas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Global Health, University of Washington, Seattle, WA, USA; Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA.
| | - Adam A Szpiro
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Xolani Ntinga
- Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa
| | | | - Heidi van Rooyen
- Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa; MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, South Africa
| | - Andrew Bruce
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Philip Joseph
- Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa
| | - Thulani Ngubane
- Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa
| | - Meighan L Krows
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Torin T Schaafsma
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Theodore Zhao
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | - Frank Tanser
- Africa Health Research Institute, Somkhele, South Africa
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA; Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Gilead Sciences, Foster City, CA, USA
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, WA, USA; Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Alastair van Heerden
- Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa; MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, South Africa
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24
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Øgård-Repål A, Berg RC, Skogen V, Fossum M. "They make a difference": a qualitative study of providers' experiences of peer support in outpatient clinics for people living with HIV. BMC Health Serv Res 2022; 22:1380. [PMID: 36411443 PMCID: PMC9676711 DOI: 10.1186/s12913-022-08810-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although the life expectancy of people living with HIV has increased, they are still often disconnected from society through stigma and discrimination. Peer support has been found to increase social support. Given the limited research on peer support from the providers' perspective, this study explored how peer supporters experience their roles and contributions in outpatient clinics (OPCs). Additionally, healthcare professionals' perceptions of working with peer supporters in OPCs were examined. METHODS: This qualitative study included purposively selected peer supporters (n = 10) and healthcare professionals (n = 5) from five OPCs in Norway in 2020. In-depth interviews and focus group discussions were conducted in Norwegian or English, using interview guides. Interview transcripts were analysed in NVivo 12 using reflexive and collaborative thematic analysis. RESULTS The results show that peer supporters experience mutual support through emotional and honest interactions. Further, the peer supporters found it essential to negotiate with the service users about their preconception of HIV, confront their views through dialogue, and replicate positive experiences by being credible role models. The participants expressed that integrating peer support in the OPCs' usual care processes increased the prospect of equitable services. Quality of peer support and role clarity were identified as critical components. The results demonstrate that emotional and honest conversations promote support between peers and that peer supporters identify a need for a reframed understanding of HIV by modelling plausible alternative interpretations and coping experiences. CONCLUSIONS This study contributes to knowledge on how peer support can meet the needs of people living with HIV. Incorporating people living with HIV in the co-production and distribution of healthcare services may improve the knowledge and perspectives in healthcare services. However, the skill standards of peer supporters should be addressed when implementing peer support in usual care.
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Affiliation(s)
- Anita Øgård-Repål
- grid.23048.3d0000 0004 0417 6230Centre for Caring Research, Department of Health and Nursing Science, University of Agder, Southern Norway, Grimstad, Aust-Agder, Norway
| | - Rigmor C. Berg
- grid.418193.60000 0001 1541 4204Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway ,grid.10919.300000000122595234Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Vegard Skogen
- grid.10919.300000000122595234Institute for Clinical Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540Department of Infectious Diseases, Medical Clinic, University Hospital of North Norway, Tromsø, Norway
| | - Mariann Fossum
- grid.23048.3d0000 0004 0417 6230Centre for Caring Research, Department of Health and Nursing Science, University of Agder, Southern Norway, Grimstad, Aust-Agder, Norway
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25
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Achieving the UNAIDS goals by 2030 in people living with HIV: A simulation model to support the prioritization of health care interventions. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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26
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Psychological Factors and Sexual Risk Behaviors: A Multidimensional Model Based on the Chilean Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159293. [PMID: 35954656 PMCID: PMC9367853 DOI: 10.3390/ijerph19159293] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/18/2022] [Accepted: 07/23/2022] [Indexed: 12/10/2022]
Abstract
Human immunodeficiency virus (HIV) is a global health problem, with sexual risk behaviors (SRB) being the main routes of spreading the virus. Evidence indicates that different psychological factors influence SRB (e.g., attitude towards condoms, sexual self-concept, sexual sensation seeking, knowledge of sexual risk behaviors, risk perception). This study proposes an explanatory model of sexual risk behaviors in young people and adults. The sample consisted of 992 young people and adults aged between 18 and 35 years. The model presented good levels of fit (X2 = 3311.433, df = 1471, CFI = 0.964, TLI = 0.959, RMSEA = 0.036), explaining 56% of the variance of sexual activity with multiple partners, 77% of the inadequate use of protective barriers, and 58.8% of sexual activity under the influence of alcohol or drugs from a set of psychological factors in self-report measures. The details of the results offer novel contextual evidence for the prioritization of prevention-oriented psychosocial interventions.
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Mthiyane N, Baisley K, Chimbindi N, Zuma T, Okesola N, Dreyer J, Herbst C, Smit T, Danaviah S, McGrath N, Harling G, Sherr L, Seeley J, Floyd S, Birdthistle I, Shahmanesh M. The association of exposure to DREAMS on sexually acquiring or transmitting HIV amongst adolescent girls and young women living in rural South Africa. AIDS 2022; 36:S39-S49. [PMID: 35766574 PMCID: PMC10700028 DOI: 10.1097/qad.0000000000003156] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE We investigate how risk of sexually acquiring or transmitting HIV in adolescent girls and young women (AGYW) changed following the real-world implementation of DREAMS (Determined, Resilient, Empowered, AIDS free, Mentored and Safe) HIV prevention programme. DESIGN A representative population-based prospective cohort study of AGYW living in rural KwaZulu-Natal. METHODS Between 2017 and 2019, we interviewed a random sample of AGYW aged 13-22 years annually. We measured exposure to DREAMS as self-reported receipt of an invitation to participate and/or participation in DREAMS activities that were provided by DREAMS implementing organizations. HIV and herpes simplex virus type 2 (HSV-2) statuses were ascertained through blood tests on Dried Blood Spot (DBS). We used multivariable regression analysis to assess the association between exposure to DREAMS and risk of acquiring HIV: measured as incident HSV-2 (a proxy of sexual risk) and incident HIV;and the risk of sexually transmitting HIV: measured as being HIV positive with a detectable HIV viral load (≥50 copie/ml) on the last available DBS. We adjusted for sociodemographic, sexual relationship, and migration. RESULTS Two thousand one hundred and eighty-four (86.4%) of those eligible agreed to participate and 2016 (92.3%) provided data for at least one follow-up time-point. One thousand and thirty (54%) were exposed to DREAMS;HIV and HSV-2 incidence were 2.2/100 person-years [95% confidence interval (CI) 1.66-2.86] and 17.3/100 person-years (95% CI 15.5-19.4), respectively. There was no evidence that HSV-2 and HIV incidence were lower in those exposed to DREAMS: adjusted rate ratio (aRR) 0.96 (95% CI 0.76-1.23 and 0.83 (95% CI 0.46-1.52), respectively. HIV viral load was detectable for 169 (8.9%) respondents;there was no evidence this was lower in those exposed to DREAMS with an adjusted risk difference, compared with those not exposed to DREAMS, of 0.99% (95% CI-1.52 to 3.82]. Participants who lived in peri-urban/ urban setting were more likely to have incident HIV and transmissible HIV. Both HSV-2 incidence and the transmissible HIV were associated with older age and ever having sex. Findings did not differ substantively by respondent age group. CONCLUSION DREAMS exposure was not associated with measurable reductions in risk of sexually acquiring or transmitting HIV amongst a representative cohort of AGYW in rural South Africa.
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Affiliation(s)
| | - Kathy Baisley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
| | - Natsayi Chimbindi
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
| | - Thembelihle Zuma
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
- University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | | | - Jaco Dreyer
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Carina Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Theresa Smit
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Siva Danaviah
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Nuala McGrath
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, KwaZulu-Natal, South Africa
- University of Southampton, Southampton, UK
| | - Guy Harling
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Gauteng, South Africa
- Department of Epidemiology & Harvard Centre for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sian Floyd
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Maryam Shahmanesh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
- University of KwaZulu-Natal, KwaZulu-Natal, South Africa
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28
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Global Health Facility-Based Interventions to Achieve UNAIDS 90-90-90: A Systematic Review and Narrative Analysis. AIDS Behav 2022; 26:1489-1503. [PMID: 34694526 DOI: 10.1007/s10461-021-03503-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
To evaluate whether health facility-based HIV interventions align with UNAIDS 90-90-90 targets, we performed a systematic review through the lens of UNAIDS targets. We searched 11 databases, retrieving 5201 citations with 26 eligible studies classified by country income and UNAIDS target. We analyzed whether reporting of study outcome metrics was in line with UNAIDS targets using a standardized extraction form and results were summarized in a narrative synthesis given data heterogeneity. We also assessed the quality of randomized trials with the Cochrane Risk of Bias Tool and observational studies with the Newcastle-Ottawa Scale. Stratification of interventions by country income level revealed themes in successful interventions that provide insight for scale-up in similar resource contexts. Few studies reported outcomes using metrics according to UNAIDS targets. Standardization of reporting according to the UNAIDS framework could facilitate comparability of interventions and inform country-level progress on an international scale.
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Øgård-Repål A, Berg RC, Skogen V, Fossum M. Peer support in an outpatient clinic for people living with human immunodeficiency virus: a qualitative study of service users' experiences. BMC Health Serv Res 2022; 22:549. [PMID: 35468797 PMCID: PMC9036816 DOI: 10.1186/s12913-022-07958-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although human immunodeficiency virus (HIV) has become a manageable condition with increasing life expectancy, people living with HIV (PLHIV) are still often isolated from society due to stigma and discrimination. Peer support provides one avenue for increased social support. Given the limited research on peer support from the perspective of PLHIV, this study explored their experiences of peer support organised by healthcare professionals in an outpatient clinical setting. METHODS The study used a qualitative, descriptive research design for an in-depth understanding of peer support provided to PLHIV in the context of outpatient clinics. Healthcare professionals contributed to the recruitment of 16 participants. We conducted in-depth interviews about participants' experiences of peer support, and performed a directed content analysis of the data. Further, we sorted the data into pre-determined categories. RESULTS The pre-determined categories constituted attachment, social integration, an opportunity for nurturance, reassurance of worth, reliable alliance, and guidance. The identified themes were: gained emotional support, disclosure behaviour allowed garnering of emotional support, non-disclosure promoted the need to meet a peer, experienced a sense of belonging, activated an opportunity for mutual support, means to re-establish belief in one's own worth, perceived a positive affirmation of disease management, facilitated dialogue about disease management, the outpatient clinic as a safe place, and a setting for flexible, individualised support. CONCLUSIONS This study highlights the peer support experiences of PLHIV in the context of outpatient clinics. The participants' experiences align with previous findings, showing that peer support contributes to mutual emotional support between peers. This is particularly important in cultures of non-disclosure where PLHIV experience intersectional stigma. Additionally, our results show outpatient clinics to be supportive surroundings for facilitating peer support, ensuring confidentiality in peer support outreach. Therefore, peer support contributes positively to individualising outpatient clinic services to meet the changing needs of PLHIV.
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Affiliation(s)
- Anita Øgård-Repål
- Centre for Caring Research- Southern Norway, Department of Health and Nursing Science, University of Agder, Grimstad, Aust-Agder, Norway.
| | - Rigmor C Berg
- Divison of Health Services, Norwegian Institute of Public Health, Oslo, Norway.,Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Vegard Skogen
- Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Infectious Diseases, Medical Clinic, University Hospital of North Norway, Tromsø, Norway
| | - Mariann Fossum
- Centre for Caring Research- Southern Norway, Department of Health and Nursing Science, University of Agder, Grimstad, Aust-Agder, Norway
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Chidumwa G, Chimbindi N, Herbst C, Okeselo N, Dreyer J, Zuma T, Smith T, Molina JM, Khoza T, McGrath N, Seeley J, Pillay D, Tanser F, Harling G, Sherr L, Copas A, Baisley K, Shahmanesh M. Isisekelo Sempilo study protocol for the effectiveness of HIV prevention embedded in sexual health with or without peer navigator support (Thetha Nami) to reduce prevalence of transmissible HIV amongst adolescents and young adults in rural KwaZulu-Natal: a 2 × 2 factorial randomised controlled trial. BMC Public Health 2022; 22:454. [PMID: 35255859 PMCID: PMC8900304 DOI: 10.1186/s12889-022-12796-8] [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: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background Antiretroviral therapy (ART) through universal test and treat (UTT) and HIV pre-exposure prophylaxis (PrEP) substantially reduces HIV-related mortality, morbidity and incidence. Effective individual-level prevention modalities have not translated into population-level impact in southern Africa due to sub-optimal coverage among adolescents and youth who are hard to engage. We aim to investigate the feasibility, acceptability, and preliminary population level effectiveness of HIV prevention services with or without peer support to reduce prevalence of transmissible HIV amongst adolescents and young adults in KwaZulu-Natal. Methods We are conducting a 2 × 2 factorial trial among young men and women aged 16–29 years, randomly selected from the Africa Health Research Institute demographic surveillance area. Participants are randomly allocated to one of four intervention combinations: 1) Standard of Care (SOC): nurse-led services for HIV testing plus ART if positive or PrEP for those eligible and negative; 2) Sexual and Reproductive Health (SRH): Baseline self-collected vaginal and urine samples with study-organized clinic appointments for results, treatment and delivery of HIV testing, ART and PrEP integrated with SRH services; 3) Peer-support: Study referral of participants to a peer navigator to assess their health, social and educational needs and provide risk-informed HIV prevention, including facilitating clinic attendance; or 4) SRH + peer-support. The primary outcomes for effectiveness are: (1) the proportion of individuals with infectious HIV at 12 months and (2) uptake of risk-informed comprehensive HIV prevention services within 60 days of enrolment. At 12 months, all participants will be contacted at home and the study team will collect a dried blood spot for HIV ELISA and HIV viral load testing. Discussion This trial will enable us to understand the relative importance of SRH and peer support in creating demand for effective and risk informed biomedical HIV prevention and preliminary data on their effectiveness on reducing the prevalence of transmissible HIV amongst all adolescents and youth. Trial registration Trial Registry: clincialtrials.gov. ClinicalTrials.gov Identifier NCT04532307. Registered: March 2020.
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Affiliation(s)
- Glory Chidumwa
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Natsayi Chimbindi
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa.,UCL Institute for Global Health, 3rd Floor Mortimer Market Centre, Capper Street, London, WC1E 6JP, UK.,University of KwaZulu-Natal, Durban, South Africa
| | - Carina Herbst
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Nonhlanhla Okeselo
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Jaco Dreyer
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Thembelihle Zuma
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa.,UCL Institute for Global Health, 3rd Floor Mortimer Market Centre, Capper Street, London, WC1E 6JP, UK.,University of KwaZulu-Natal, Durban, South Africa
| | - Theresa Smith
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Jean-Michel Molina
- Department of Infectious Diseases, Hospitals Saint-Louis and Lariboisière, Paris, France
| | - Thandeka Khoza
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Nuala McGrath
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa.,University of Southampton, Southampton, UK
| | - Janet Seeley
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa.,London School of Hygiene & Tropical Medicine, London, UK
| | - Deenan Pillay
- UCL Institute for Global Health, 3rd Floor Mortimer Market Centre, Capper Street, London, WC1E 6JP, UK
| | - Frank Tanser
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa.,Lincoln University, London,, UK
| | - Guy Harling
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa.,UCL Institute for Global Health, 3rd Floor Mortimer Market Centre, Capper Street, London, WC1E 6JP, UK.,University of KwaZulu-Natal, Durban, South Africa.,University of the Witwatersrand, Johannesburg, South Africa.,Harvard T.H. Chan School of Public Health, Boston, USA
| | - Lorraine Sherr
- UCL Institute for Global Health, 3rd Floor Mortimer Market Centre, Capper Street, London, WC1E 6JP, UK
| | - Andrew Copas
- UCL Institute for Global Health, 3rd Floor Mortimer Market Centre, Capper Street, London, WC1E 6JP, UK
| | - Kathy Baisley
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa.,London School of Hygiene & Tropical Medicine, London, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa. .,UCL Institute for Global Health, 3rd Floor Mortimer Market Centre, Capper Street, London, WC1E 6JP, UK. .,University of KwaZulu-Natal, Durban, South Africa.
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Chimoyi L, Chikovore J, Musenge E, Mabuto T, Chetty-Makkan CM, Munyai R, Nchachi T, Charalambous S, Setswe G. Understanding factors influencing utilization of HIV prevention and treatment services among patients and providers in a heterogeneous setting: A qualitative study from South Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000132. [PMID: 36962320 PMCID: PMC10021737 DOI: 10.1371/journal.pgph.0000132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/29/2021] [Indexed: 12/16/2022]
Abstract
Despite advances made in HIV prevention and treatment interventions in South Africa, barriers to their utilization continue to exist. Understanding perspectives from patients and providers of healthcare can shed light on the necessary strategies to enhance uptake of HIV services. A cross-sectional qualitative study was conducted in July 2020 in Ekurhuleni District. Based on HIV prevalence estimates from a national survey, male condom use coverage and antiretroviral treatment (ART) initiation rates from routinely collected clinical data for 2012, we selected facilities from geographical areas with varying HIV prevalence and uptake of HIV services. In-depth interviews were conducted with adult (≥18 years) patients and healthcare workers in selected primary healthcare facilities. Thematic analysis was performed following a framework built around the social cognitive theory to describe behavioural, personal, and social/environmental factors influencing utilization of HIV services. Behavioural factors facilitating uptake of HIV services included awareness of the protective value of condoms, and the benefits of ART in suppressing viral load and preventing mother-to-child HIV transmission which was evident across geographical areas. Barriers in high prevalence areas included suboptimal condom use, fears of a positive HIV result, and anticipated HIV-related stigma while seeking healthcare services. Across the geographical areas, personal factors included ability to correctly use available services enhanced by knowledge acquired during counselling sessions and community-based health promotion activities. Further, social support from family reinforced engagement in care. Compared to low uptake areas, clinics in high uptake areas used care-facilitators, outreach teams and decanting programs to address the environmental barriers including staff shortages and long queues. Barriers at multiple levels prevent optimal utilization of HIV services, calling for strategies that target and address the different levels and tailored to needs of specific settings. Overall, improved delivery of HIV prevention or treatment interventions can be achieved through strengthening training of healthcare providers in facilities and communities and addressing negative sequelae from utilising services in low uptake areas.
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Affiliation(s)
- Lucy Chimoyi
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeremiah Chikovore
- Human and Social Capabilities Research Division, Human Sciences Research Council, Durban, South Africa
| | - Eustasius Musenge
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Tonderai Mabuto
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Candice M Chetty-Makkan
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Faculty of Health Sciences, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Reuben Munyai
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Tshegang Nchachi
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Salome Charalambous
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Geoffrey Setswe
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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Moucheraud C, Hoffman RM, Balakasi K, Wong V, Sanena M, Gupta S, Dovel K. Screening Adults for HIV Testing in the Outpatient Department: An Assessment of Tool Performance in Malawi. AIDS Behav 2022; 26:478-486. [PMID: 34379273 PMCID: PMC8813838 DOI: 10.1007/s10461-021-03404-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 02/03/2023]
Abstract
Little is known about screening tools for adults in high HIV burden contexts. We use exit survey data collected at outpatient departments in Malawi (n = 1038) to estimate the sensitivity, specificity, negative and positive predictive values of screening tools that include questions about sexual behavior and use of health services. We compare a full tool (seven relevant questions) to a reduced tool (five questions, excluding sexual behavior measures) and to standard of care (two questions, never tested for HIV or tested > 12 months ago, or seeking care for suspected STI). Suspect STI and ≥ 3 sexual partners were associated with HIV positivity, but had weak sensitivity and specificity. The full tool (using the optimal cutoff score of ≥ 3) would achieve 55.6% sensitivity and 84.9% specificity for HIV positivity; the reduced tool (optimal cutoff score ≥ 2) would achieve 59.3% sensitivity and 68.5% specificity; and standard of care 77.8% sensitivity and 47.8% specificity. Screening tools for HIV testing in outpatient departments do not offer clear advantages over standard of care.
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Affiliation(s)
- Corrina Moucheraud
- Department of Health Policy and Management, Fielding School of Public Health, University of California, 650 Charles E. Young Dr. S., 31-235A, Los Angeles, CA 90095 USA
| | - Risa M. Hoffman
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA USA
| | | | | | | | - Sundeep Gupta
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA USA
| | - Kathryn Dovel
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA USA ,Partners in Hope, Lilongwe, Malawi
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Øgård-Repål A, Berg RC, Fossum M. A Scoping Review of the Empirical Literature on Peer Support for People Living with HIV. J Int Assoc Provid AIDS Care 2021; 20:23259582211066401. [PMID: 34919006 PMCID: PMC8725019 DOI: 10.1177/23259582211066401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
People living with HIV receiving antiretroviral therapy need support related to linkage to care and self-management in everyday life. Peer support has been found to provide varied support according to the unique needs of the group. This scoping review aims to provide an overview of research on peer support provided to people living with HIV. A search was conducted in eight databases until May 2021, and two reviewers independently screened all identified studies. We sorted the included studies into categories and conducted descriptive analyses. For this communication, we included 34 studies representing three study categories: the experiences of peer support (n = 23), program descriptions (n = 6), and training of peer supporters (n = 5). The studies were published between 2000 and 2021 and included 4275 participants from 10 countries. The flexibility of peer support complements healthcare services, but there is a need to clarify and adjust the ongoing support when living with HIV.
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Affiliation(s)
| | - Rigmor C Berg
- 25563Norwegian Institute of Public Health, Oslo, Norway, and University of Tromsø, Tromsø, Norway
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34
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Zepeda KGM, Gaspar RB, Moura COD, Santos KA, Gimbel S, Silva MMD. Meanings and significance attributed by people with HIV/aids to their lives with this virus/disease. Rev Bras Enferm 2021; 75:e20201323. [PMID: 34706046 DOI: 10.1590/0034-7167-2020-1323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/31/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to understand the meanings and significance attributed by people with HIV/aids to the process of living with this virus/disease. METHODS qualitative and exploratory study, carried out in Rio de Janeiro, Brazil. The Grounded Theory and the Symbolic Interactionism were used. Data were collected in a semistructured interview and through non-participant observation, from August 2017 to May 2018. 29 patients participated. RESULTS living with HIV/AIDS is a social phenomenon in which it is not possible to disconnect the process of adapting to the disease from the social relations one (re)constructs during life. It also involves stigmatization, rejection, and isolation. FINAL CONSIDERATIONS understanding the meanings of this process is a positive influence for proactive behavior and resilience, not only in regard to the care concerning the presence of the virus and the uninterrupted need to adhere to medication, but also in the way to deal with the social values that reproduce previous models, which, in turn, can help improve self-knowledge.
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Affiliation(s)
| | | | | | | | - Sarah Gimbel
- University of Washington. Seatle, Estados Unidos da América
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35
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Mashishi BR, Makatini Z, Adu-Gyamfi CG. The evolving HIV epidemic and its impact on the HIV testing algorithm: Is it time to change the HIV testing algorithm in South Africa? J Clin Virol 2021; 144:104990. [PMID: 34610486 DOI: 10.1016/j.jcv.2021.104990] [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] [Received: 05/10/2021] [Revised: 08/28/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022]
Abstract
HIV-1/2 testing is the first step in ensuring HIV-infected individuals are diagnosed and appropriately managed. The impact of suboptimal HIV-1/2 testing algorithms significantly contributes to the increased rates of misdiagnosis of HIV infection. Recently, the World Health Organization (WHO) recommended that high burden countries revise their testing algorithm from a 2 to 3-test testing strategy in the context of an evolving HIV epidemic. Implementation of a new HIV-testing algorithm must be tailor-made within a national framework and must be balanced out with operational feasibility, patient outcomes, and cost-effectiveness. In this review, we provide an overview of the current state of the HIV epidemic and its impact on HIV testing, further we highlight areas of concern in changing from a 2-step to a 3-step test algorithm in the context of South Africa's HIV epidemic and public health program.
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Affiliation(s)
- Bonolo Rankotsane Mashishi
- Department of Virology, National Health Laboratory Service and School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.
| | - Zinhle Makatini
- Department of Virology, National Health Laboratory Service and School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Clement Gascua Adu-Gyamfi
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, South Africa; Brain Function Research Group,School of Physiology,Faculty of Health Sciences,University of the Witwatersrand, South Africa
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Amstutz A, Lejone TI, Khesa L, Kopo M, Kao M, Muhairwe J, Bresser M, Räber F, Klimkait T, Battegay M, Glass TR, Labhardt ND. Offering ART refill through community health workers versus clinic-based follow-up after home-based same-day ART initiation in rural Lesotho: The VIBRA cluster-randomized clinical trial. PLoS Med 2021; 18:e1003839. [PMID: 34673765 PMCID: PMC8568187 DOI: 10.1371/journal.pmed.1003839] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/04/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Community-based antiretroviral therapy (ART) dispensing by lay workers is an important differentiated service delivery model in sub-Sahara Africa. However, patients new in care are generally excluded from such models. Home-based same-day ART initiation is becoming widespread practice, but linkage to the clinic is challenging. The pragmatic VIBRA (Village-Based Refill of ART) trial compared ART refill by existing lay village health workers (VHWs) versus clinic-based refill after home-based same-day ART initiation. METHODS AND FINDINGS The VIBRA trial is a cluster-randomized open-label clinical superiority trial conducted in 249 rural villages in the catchment areas of 20 health facilities in 2 districts (Butha-Buthe and Mokhotlong) in Lesotho. In villages (clusters) randomized to the intervention arm, individuals found to be HIV-positive during a door-to-door HIV testing campaign were offered same-day ART initiation with the option of refill by VHWs. The trained VHWs dispensed drugs and scheduled clinic visits for viral load measurement at 6 and 12 months. In villages randomized to the control arm, participants were offered same-day ART initiation with clinic-based ART refill. The primary outcome was 12-month viral suppression. Secondary endpoints included linkage and 12-month engagement in care. Analyses were intention-to-treat. The trial was registered on ClinicalTrials.gov (NCT03630549). From 16 August 2018 until 28 May 2019, 118 individuals from 108 households in 57 clusters in the intervention arm, and 139 individuals from 130 households in 60 clusters in the control arm, were enrolled (150 [58%] female; median age 36 years [interquartile range 30-48]; 200 [78%] newly diagnosed). In the intervention arm, 48/118 (41%) opted for VHW refill. At 12 months, 46/118 (39%) participants in the intervention arm and 64/139 (46%) in the control arm achieved viral suppression (adjusted risk difference -0.07 [95% CI -0.20 to 0.06]; p = 0.256). Arms were similar in linkage (adjusted risk difference 0.03 [-0.10 to 0.16]; p = 0.630), but engagement in care was non-significantly lower in the intervention arm (adjusted risk difference -0.12 [-0.23 to 0.003]; p = 0.058). Seven and 0 deaths occurred in the intervention and control arm, respectively. Of the intervention participants who did not opt for drug refill from the VHW at enrollment, 41/70 (59%) mentioned trust or conflict issues as the primary reason. Study limitations include a rather small sample size, 9% missing viral load measurements in the primary endpoint window, the low uptake of the VHW refill option in the intervention arm, and substantial migration among the study population. CONCLUSIONS The offer of village-based ART refill after same-day initiation led to similar outcomes as clinic-based refill. The intervention did not amplify the effect of home-based same-day ART initiation alone. The findings raise concerns about acceptance and safety of ART delivered by lay health workers after initiation in the community. TRIAL REGISTRATION Registered with Clinicaltrials.gov (NCT03630549).
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Affiliation(s)
- Alain Amstutz
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | | | | | | | | | | | - Moniek Bresser
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Thomas Klimkait
- University of Basel, Basel, Switzerland
- Molecular Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Manuel Battegay
- University of Basel, Basel, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Tracy Renée Glass
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Niklaus Daniel Labhardt
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- * E-mail:
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McGuire M, de Waal A, Karellis A, Janssen R, Engel N, Sampath R, Carmona S, Zwerling AA, Suarez MF, Pai NP. HIV self-testing with digital supports as the new paradigm: A systematic review of global evidence (2010-2021). EClinicalMedicine 2021; 39:101059. [PMID: 34430835 PMCID: PMC8367787 DOI: 10.1016/j.eclinm.2021.101059] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/06/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND HIV self-testing (HIVST) is recommended by the WHO as an innovative strategy to reach UNAIDS targets to end HIV by 2030. HIVST with digital supports is defined as the use of digital interventions (e.g., website-based, social media, mobile HIVST applications (apps), text messaging (SMS), digital vending machines (digital VMs)) to improve the efficiency and impact of HIVST. HIVST deployment and integration in health services is an emerging priority. We conducted a systematic review aiming to close the gap in evidence that summarizes the impact of digitally supported HIVST and to inform policy recommendations. METHODS We searched PubMed and Embase for articles and abstracts on HIVST with digital supports published during the period February 1st, 2010 to June 15th, 2021, following Cochrane guidelines and PRISMA methodology. We assessed feasibility, acceptability, preference, and impact outcomes across all populations and study designs. Metrics reported were willingness to use HIVST, preferences for HIVST delivery, proportion of first-time testers, HIVST uptake, HIVST kit return rate, and linkage to care. Heterogeneity of the interventions and reported metrics precluded us from conducting a meta-analysis. FINDINGS 46 studies were narratively synthesized, of which 72% were observational and 28% were RCTs. Half of all studies (54%, 25/46) assessed web-based innovations (e.g., study websites, videos, chatbots), followed by social media (26%, 12/46), HIVST-specific apps (7%, 3/46), SMS (9%, 4/46), and digital VMs (4%, 2/46). Web-based innovations were found to be acceptable (77-97%), preferred over in-person and hybrid options by more first-time testers (47-48%), highly feasible (93-95%), and were overall effective in supporting linkage to care (53-100%). Social media and app-based innovations also had high acceptability (87-95%) and linkage to care proportions (80-100%). SMS innovations increased kit return rates (54-94%) and HIVST uptake among hard-to-reach groups. Finally, digital VMs were highly acceptable (54-93%), and HIVST uptake was six times greater when using digital VMs compared to distribution by community workers. INTERPRETATION HIVST with digital supports was deemed feasible, acceptable, preferable, and was shown to increase uptake, engage first-time testers and hard-to-reach populations, and successfully link participants to treatment. Findings pave the way for greater use of HIVST interventions with digital supports globally.
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Affiliation(s)
- Madison McGuire
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal, QC H3A 1A2, Canada
- The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, Canada
| | - Anna de Waal
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal, QC H3A 1A2, Canada
- The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, Canada
| | - Angela Karellis
- The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, Canada
- Department of Medicine, McGill University, 3605 rue de la Montagne, Montréal, QC H3G 2M1, Canada
| | - Ricky Janssen
- Department of Health, Ethics and Society, Maastricht University, Postbus 616 6200 MD, Maastricht, the Netherland
| | - Nora Engel
- Department of Health, Ethics and Society, Maastricht University, Postbus 616 6200 MD, Maastricht, the Netherland
| | - Rangarajan Sampath
- Foundation for Innovative New Diagnostics, Chemin des Mines 9, Geneva 1202, Switzerland
| | - Sergio Carmona
- Foundation for Innovative New Diagnostics, Chemin des Mines 9, Geneva 1202, Switzerland
| | - Alice Anne Zwerling
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z, Canada
| | | | - Nitika Pant Pai
- The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, Canada
- Department of Medicine, McGill University, 3605 rue de la Montagne, Montréal, QC H3G 2M1, Canada
- Corresponding author at: The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, Canada.
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Davoust M, Drainoni ML, Baughman A, Campos Rojo M, Estes T, Rajabiun S, Ross-Davis K, McCann K, Sullivan M, Todd L, Wolfe HL, Sprague Martinez L. "He Gave Me Spirit and Hope": Client Experiences with the Implementation of Community Health Worker Programs in HIV Care. AIDS Patient Care STDS 2021; 35:318-326. [PMID: 34375140 DOI: 10.1089/apc.2021.0085] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Community health workers (CHWs) are members of the frontline health workforce who serve as intermediaries between health services and communities. In the United States, the role of CHWs has begun to expand as they have been shown to improve outcomes and reduce inequities in care for chronic conditions. This study used qualitative methods to explore the experiences of clients in CHW programs to inform their implementation in HIV care. Thirty clients from 6 Ryan White HIV/AIDS Program care settings across the United States participated in individual semistructured interviews to learn more about their experiences working with a CHW. Four key themes arose from the client perspective. First, CHWs embodied key qualities. Some of the qualities clients attributed to CHWs included being caring and supportive, along with capable of fostering personal connections. Second, CHWs met clients where they were. Clients described the CHW approach as more holistic compared with other care team members; they emphasized CHWs were able to focus on whatever was needed in that moment. Third, CHWs occupied a unique role in the HIV care team. Clients noted CHWs had more time to dedicate to their interactions; they also saw CHWs as representing a different level of authority. Finally, CHWs influenced how clients engaged with care and accessed resources. This included empowering clients to access resources independently in the future. Overall, clients' perceptions of CHWs in terms of their qualities, approach, role, and influence on the HIV care experience suggest they are a valuable resource on the care team.
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Affiliation(s)
- Melissa Davoust
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Allyson Baughman
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
| | - Maria Campos Rojo
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
| | - Terry Estes
- Southwest Louisiana AIDS Council, Lake Charles, Louisiana, USA
| | - Serena Rajabiun
- Department of Public Health, University of Massachusetts—Lowell, Lowell, Massachusetts, USA
| | - Kelly Ross-Davis
- 1917 Clinic at the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Katherine McCann
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
| | - Marena Sullivan
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
| | - LaWanda Todd
- Division of Infectious Diseases and International Travel Health, Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Hill L. Wolfe
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Linda Sprague Martinez
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
- Macro Department, Boston University School of Social Work, Boston, Massachusetts, USA
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de Lind van Wijngaarden JW, van Griensven F, Sun LP, Wignall S. A scoping review of HIV epidemiologic, sociocultural and programmatic studies related to transgender women and men who have sex with men in Cambodia, 1999-2019. PLoS One 2021; 16:e0254490. [PMID: 34270600 PMCID: PMC8284612 DOI: 10.1371/journal.pone.0254490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 06/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background Cambodia is widely credited for its successful HIV epidemic control. However, in recent years there have been signs of increasing HIV prevalence among men who have sex with men (MSM) and transgender women (TGW). This paper reviews HIV epidemiological, social science and HIV program implementation studies conducted over the past 20 years to explore possible reasons for the rising HIV prevalence among these groups and to formulate recommendations for improved policies, HIV programmatic interventions and further research. Methods For this scoping review, we searched the PubMed and Google Scholar databases for scientific publications related to HIV and MSM and TGW in Cambodia published since 1999. From each of the returned citations we subsequently studied reference lists to find additional data sources. We also searched websites for reports commissioned by national and international governmental and non-governmental organizations. Results Twenty-seven relevant studies and papers were found and reviewed; most were epidemiological in nature. Recent epidemiological studies and reports show an increase in HIV prevalence among Cambodian MSM and TGW. The epidemiology of HIV infection in these groups has been relatively well-described and analyzed. While initially MSM and TGW were grouped together, in more recent years they have been studied in their own right, recognizing their specific HIV and other prevention needs. Few studies were found investigating Cambodian same-sex cultures and social and cultural contexts in which HIV transmission among MSM and TGW occurs. A few evaluation studies were found, but it remains unknown how effective current HIV service implementation modalities are, or how successful strategies to increase access to essential HIV prevention, testing and treatment services have been employed for MSM and TGW in Cambodia. Conclusions Research about Cambodian MSM and TGW in the context of HIV primarily concerns bio-behavioral knowledge generation. Cambodia is unlikely to achieve control of the HIV epidemic among MSM and TGW without doing better in-depth social science research on its multiple sexual- and gender minority cultures, and without understanding what differentiated implementation modalities, strategies and approaches are most effective to address HIV among its increasingly diverse MSM and TGW populations.
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Affiliation(s)
| | - Frits van Griensven
- Institute of Health Research and Innovation, Bangkok, Thailand
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, United States of America
| | - Ly Penh Sun
- National Centre for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
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Shahmanesh M, Okesola N, Chimbindi N, Zuma T, Mdluli S, Mthiyane N, Adeagbo O, Dreyer J, Herbst C, McGrath N, Harling G, Sherr L, Seeley J. Thetha Nami: participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa. BMC Public Health 2021; 21:1393. [PMID: 34256725 PMCID: PMC8278686 DOI: 10.1186/s12889-021-11399-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 06/28/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Despite effective biomedical tools, HIV remains the largest cause of morbidity/mortality in South Africa - especially among adolescents and young people. We used community-based participatory research (CBPR), informed by principles of social justice, to develop a peer-led biosocial intervention for HIV prevention in KwaZulu-Natal (KZN). METHODS Between March 2018 and September 2019 we used CBPR to iteratively co-create and contextually adapt a biosocial peer-led intervention to support HIV prevention. Men and women aged 18-30 years were selected by community leaders of 21 intervention implementation areas (izigodi) and underwent 20 weeks of training as peer-navigators. We synthesised quantitative and qualitative data collected during a 2016-2018 study into 17 vignettes illustrating the local drivers of HIV. During three participatory intervention development workshops and community mapping sessions, the peer-navigators critically engaged with vignettes, brainstormed solutions and mapped the components to their own izigodi. The intervention components were plotted to a Theory of Change which, following a six-month pilot and process evaluation, the peer-navigators refined. The intervention will be evaluated in a randomised controlled trial ( NCT04532307 ). RESULTS Following written and oral assessments, 57 of the 108 initially selected participated in two workshops to discuss the vignettes and co-create the Thetha Nami (`talk to me'). The intervention included peer-led health promotion to improve self-efficacy and demand for HIV prevention, referrals to social and educational resources, and aaccessible youth-friendly clinical services to improve uptake of HIV prevention. During the pilot the peer-navigators approached 6871 young people, of whom 6141 (89%) accepted health promotion and 438 were linked to care. During semi-structured interviews peer-navigators described the appeal of providing sexual health information to peers of a similar age and background but wanted to provide more than just "onward referral". In the third participatory workshop 54 peer-navigators refined the Thetha Nami intervention to add three components: structured assessment tool to tailor health promotion and referrals, safe spaces and community advocacy to create an enabling environment, and peer-mentorship and navigation of resources to improve retention in HIV prevention. CONCLUSION Local youth were able to use evidence to develop a contextually adapted peer-led intervention to deliver biosocial HIV prevention.
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Affiliation(s)
- Maryam Shahmanesh
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa.
- Institute for Global Health, University College London, Capper Street, London, WC1E 6JB, UK.
- University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.
| | | | - Natsayi Chimbindi
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, Capper Street, London, WC1E 6JB, UK
| | - Thembelihle Zuma
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, Capper Street, London, WC1E 6JB, UK
- University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Sakhile Mdluli
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | | | - Oluwafemi Adeagbo
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, Capper Street, London, WC1E 6JB, UK
- University of Johannesburg, Johannesburg, Gauteng, South Africa
| | - Jaco Dreyer
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Carina Herbst
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Nuala McGrath
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- University of Southampton, Southampton, UK
| | - Guy Harling
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, Capper Street, London, WC1E 6JB, UK
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt) University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Department of Epidemiology & Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Lorraine Sherr
- Institute for Global Health, University College London, Capper Street, London, WC1E 6JB, UK
| | - Janet Seeley
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
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Shahmanesh M, Mthiyane TN, Herbsst C, Neuman M, Adeagbo O, Mee P, Chimbindi N, Smit T, Okesola N, Harling G, McGrath N, Sherr L, Seeley J, Subedar H, Johnson C, Hatzold K, Terris-Prestholt F, Cowan FM, Corbett EL. Effect of peer-distributed HIV self-test kits on demand for biomedical HIV prevention in rural KwaZulu-Natal, South Africa: a three-armed cluster-randomised trial comparing social networks versus direct delivery. BMJ Glob Health 2021; 6:e004574. [PMID: 34315730 PMCID: PMC8317107 DOI: 10.1136/bmjgh-2020-004574] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/14/2021] [Indexed: 02/03/2023] Open
Abstract
STUDY OBJECTIVE We investigated two peer distribution models of HIV self-testing (HIVST) in HIV prevention demand creation compared with trained young community members (peer navigators). METHODS We used restricted randomisation to allocate 24 peer navigator pairs (clusters) in KwaZulu-Natal 1:1:1: (1) standard of care (SOC): peer navigators distributed clinic referrals, pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) information to 18-30 year olds. (2) peer navigator direct distribution (PND): Peer navigators distributed HIVST packs (SOC plus two OraQuick HIVST kits) (3) incentivised peer networks (IPN): peer navigators recruited young community members (seeds) to distribute up to five HIVST packs to 18-30 year olds within their social networks. Seeds received 20 Rand (US$1.5) for each recipient who distributed further packs. The primary outcome was PrEP/ART linkage, defined as screening for PrEP/ART eligibility within 90 days of pack distribution per peer navigator month (pnm) of outreach, in women aged 18-24 (a priority for HIV prevention). Investigators and statisticians were blinded to allocation. Analysis was intention to treat. Total and unit costs were collected prospectively. RESULTS Between March and December 2019, 4163 packs (1098 SOC, 1480 PND, 1585 IPN) were distributed across 24 clusters. During 144 pnm, 272 18-30 year olds linked to PrEP/ART (1.9/pnm). Linkage rates for 18-24-year-old women were lower for IPN (n=26, 0.54/pnm) than PND (n=45, 0.80/pnm; SOC n=49, 0.85/pnm). Rate ratios were 0.68 (95% CI 0.28 to 1.66) for IPN versus PND, 0.64 (95% CI 0.26 to 1.62) for IPN versus SOC and 0.95 (95% CI 0.38 to 2.36) for PND versus SOC. In 18-30 year olds, PND had significantly more linkages than IPN (2.11 vs 0.88/pnm, RR 0.42, 95% CI 0.18 to 0.98). Cost per pack distributed was cheapest for IPN (US$36) c.f. SOC (US$64). Cost per person linked to PrEP/ART was cheaper in both peer navigator arms compared with IPN. DISCUSSION HIVST did not increase demand for PrEP/ART. Incentivised social network distribution reached large numbers with HIVST but resulted in fewer linkages compared with PrEP/ART promotion by peer navigators. TRIAL REGISTRATION NUMBER NCT03751826.
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Affiliation(s)
- Maryam Shahmanesh
- Institute for Global Health, University College London, London, UK
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | | | - Carina Herbsst
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | - Melissa Neuman
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, London, UK
| | - Oluwafemi Adeagbo
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | - Paul Mee
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, London, UK
| | - Natsayi Chimbindi
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | - Theresa Smit
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | | | - Guy Harling
- Institute for Global Health, University College London, London, UK
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | - Nuala McGrath
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
- Faculty of medicine, University of Southampton, Southampton, Hampshire, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Janet Seeley
- Department of Global Health &Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Hasina Subedar
- South African National Department of Health, Pretoria, South Africa
| | - Cheryl Johnson
- HIV, Hepatitis and STI Department, World Health Organisation, Geneva, Switzerland
| | - Karin Hatzold
- Population Services International, Washington, District of Columbia, USA
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, London, UK
| | - Frances M Cowan
- Centre for Sexual Health HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Elizabeth Lucy Corbett
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- TB-HIV Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
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Krabbenborg N, Spijker R, Żakowicz AM, de Moraes M, Heijman T, de Coul EO. Community-based HIV testing in The Netherlands: experiences of lay providers and end users at a rapid HIV test checkpoint. AIDS Res Ther 2021; 18:34. [PMID: 34162401 PMCID: PMC8220118 DOI: 10.1186/s12981-021-00357-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The AIDS Healthcare Foundation (AHF-Checkpoint) in The Netherlands offers rapid HIV testing for key populations by lay providers. We explored the experiences and needs of lay providers and end users of HIV testing at AHF-Checkpoint, taking into account the WHO 5C-(consent, confidentiality, counselling, correct-results, connection-to-care) criteria for HIV test services. METHODS Qualitative evaluation with 15 semi-structured interviews conducted during 2020 with ten lay providers and five gay or bisexual end users. Recorded interviews were thematically analysed, taking data triangulation into account. RESULTS Four domains were identified: (1) accessibility of HIV testing, (2) quality of test procedures, (3) bridging (transitional care), and (4) future strategies for service delivery. AHF-Checkpoint fills a gap for key populations including LGBTQ and refugees, who experience HIV testing barriers at sexual health centres or general practices. The level of trust between lay providers and end users was highly valued by end users. They appreciated the low threshold to test at no costs, and the absence of waiting lists or triaging. Needs expressed by lay providers included more preparedness for emotionally charged situations, and extra training to improve STI knowledge. End users expressed a need for a full STI test package. Of the 5Cs, consent, counselling, and correct results were realised but confidentiality was sometimes difficult to achieve at pop-up locations, and referral barriers for confirmation testing (connection-to-care) were occasionally experienced by lay providers during weekends. CONCLUSION AHF-Checkpoint was described as a convenient and easily accessible service by end users and lay providers. Of the WHO 5Cs, connection-to-care could be optimised to ensure HIV confirmation and STI testing through a liaison approach with professionals from the regular healthcare sector.
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Berg RC, Page S, Øgård-Repål A. The effectiveness of peer-support for people living with HIV: A systematic review and meta-analysis. PLoS One 2021; 16:e0252623. [PMID: 34138897 PMCID: PMC8211296 DOI: 10.1371/journal.pone.0252623] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/19/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The practice of involving people living with HIV in the development and provision of healthcare has gained increasing traction. Peer-support for people living with HIV is assistance and encouragement by an individual considered equal, in taking an active role in self-management of their chronic health condition. The objective of this systematic review was to assess the effects of peer-support for people living with HIV. METHODS We conducted a systematic review in accordance with international guidelines. Following systematic searches of eight databases until May 2020, two reviewers performed independent screening of studies according to preset inclusion criteria. We conducted risk of bias assessments and meta-analyses of the available evidence in randomised controlled trials (RCTs). The certainty of the evidence for each primary outcome was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS After screening 219 full texts we included 20 RCTs comprising 7605 participants at baseline from nine different countries. The studies generally had low risk of bias. Main outcomes with high certainty of evidence showed modest, but superior retention in care (Risk Ratio [RR] 1.07; Confidence Interval [CI] 95% 1.02-1.12 at 12 months follow-up), antiretroviral therapy (ART) adherence (RR 1.06; CI 95% 1.01-1.10 at 3 months follow-up), and viral suppression (Odds Ratio up to 6.24; CI 95% 1.28-30.5 at 6 months follow-up) for peer-support participants. The results showed that the current state of evidence for most other main outcomes (ART initiation, CD4 cell count, quality of life, mental health) was promising, but too uncertain for firm conclusions. CONCLUSIONS Overall, peer-support with routine medical care is superior to routine clinic follow-up in improving outcomes for people living with HIV. It is a feasible and effective approach for linking and retaining people living with HIV to HIV care, which can help shoulder existing services. TRIAL REGISTRATION CRD42020173433.
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Affiliation(s)
- Rigmor C. Berg
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Community Medicine, University of Tromsø, Tromsø, Norway
| | | | - Anita Øgård-Repål
- Department of Nursing and Health Science, University of Agder, Kristiansand, Norway
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Smith PJ, Davey DJ, Green H, Cornell M, Bekker LG. Reaching underserved South Africans with integrated chronic disease screening and mobile HIV counselling and testing: A retrospective, longitudinal study conducted in Cape Town. PLoS One 2021; 16:e0249600. [PMID: 33945540 PMCID: PMC8096085 DOI: 10.1371/journal.pone.0249600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/20/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Community-based, mobile HIV counselling and testing (HCT) and screening for non-communicable diseases (NCDs) may improve early diagnosis and referral for care in underserved populations. We evaluated HCT/NCD data and described population characteristics of those visiting a mobile clinic in high HIV disease burden settings in Cape Town, South Africa, between 2008 and 2016. METHODS Trained counsellors registered patients ≥12 years old at a mobile clinic, which offered HCT and blood pressure, diabetes (glucose testing) and obesity (body mass index) screening. A nurse referred patients who required HIV treatment or NCD care. Using multivariable logistic regression, we estimated correlates of new HIV diagnoses adjusting for gender, age and year. RESULTS Overall, 43,938 individuals (50% male; 29% <25 years; median age = 31 years) tested for HIV at the mobile clinic, where 27% of patients (66% of males, 34% of females) reported being debut HIV testers. Males not previously tested for HIV had higher rates of HIV positivity (11%) than females (7%). Over half (55%, n = 1,343) of those previously diagnosed HIV-positive had not initiated ART. More than one-quarter (26%) of patients screened positive for hypertension (males 28%, females 24%, p<0.001). Females were more likely overweight (25% vs 20%) or obese (43% vs 9%) and presented with more diabetes symptoms than males (8% vs 4%). Females (3%) reported more symptoms of STIs than males (1%). Reporting symptoms of sexually transmitted infections (aOR = 3.45, 95% CI = 2.84, 4.20), diabetes symptoms (aOR = 1.61, 95% 1.35, 1.92), and TB symptoms (aOR = 4.40, 95% CI = 3.85, 5.01) were associated with higher odds of a new HIV diagnosis after adjusting for covariates. CONCLUSION Findings demonstrate that mobile clinics providing integrated HCT and NCD screening may offer the opportunity of early diagnosis and referral for care for those who delay screening, including men living with HIV not previously tested.
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Affiliation(s)
- Philip John Smith
- Faculty of Health Sciences, The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Dvora Joseph Davey
- Faculty of Health Sciences, The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
- Faculty of Health Sciences, Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Hunter Green
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
| | - Morna Cornell
- Faculty of Health Sciences, Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Linda-Gail Bekker
- Faculty of Health Sciences, The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Kebede HK, Gesesew HA, Mwanri L, Ward P. The Impact of Peer Educators or Community Health Workers on the Progress of the UNAIDS 90-90-90 Targets in Africa: A Systematic Review and Meta-Analysis Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083917. [PMID: 33917917 PMCID: PMC8068227 DOI: 10.3390/ijerph18083917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Africa is far behind from achieving the Joint United Nations Program on HIV and AIDS (UNAIDS) 90-90-90 targets. Evidence shows that the participation of HIV patients as peer educators and other community health workers is substantially improving the entire HIV care continuum and subsequently the UNAIDS targets. This review aims to provide the best available evidence on the impact of peer educators and/or community health workers for the three targets in Africa. METHODS We will include cohort and experimental studies published in English between 2003 and 2020. Studies which reported interventions for HIV diagnosis, initiation of ART, or virological suppression will be included for review. Three steps searching will be conducted: (i) initial search across Google Scholar, (ii) full search strategy across five databases: MEDLINE, PubMed, CINAHL, SCOPUS and Web of Science, and (iii) screening titles and abstracts. Data will be extracted using standardized instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) and analyzed through narrative synthesis, and meta-analyses and regression. Heterogeneity among quantitative studies will be assessed using Cochran Q test and Higgins I2. Ethics: A formal ethical approval will not be required as primary data will not be collected.
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Affiliation(s)
| | - Hailay Abrha Gesesew
- Public Health, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia; (L.M.); (P.W.)
- Epidemiology, School of Health Sciences, Mekelle University, Mekelle 231, Ethiopia
- Correspondence: ; Tel.: +251-924-955-116
| | - Lillian Mwanri
- Public Health, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia; (L.M.); (P.W.)
| | - Paul Ward
- Public Health, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia; (L.M.); (P.W.)
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Arumugam E, David JK, Aridoss S, Jaganathasamy N, Mathiyazhakan M, Balasubramanian G, Natesan M, Padmapriya VM, Kirubakaran BK, Patel S, Kumar P, Rajan S. An Analysis of Levels and Trends in HIV Prevalence Among Pregnant Women Attending Antenatal Clinics in Karnataka, South India, 2003-2019. Int J MCH AIDS 2021; 10:198-209. [PMID: 34804638 PMCID: PMC8590091 DOI: 10.21106/ijma.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Periodic tracking of the trends and the levels of HIV prevalence at regional and district levels helps to strengthen a state's HIV/AIDS response. HIV prevalence among pregnant women is crucial for the HIV prevalence estimation of the general population. Karnataka is one of the high HIV prevalence states in India. Probing regional and district levels and trends of HIV prevalence provides critical insights into district-level epidemic patterns. This paper analyzes the region- and district-wise levels and trends of HIV prevalence among pregnant women attending the antenatal clinics (ANC) from 2003 to 2019 in Karnataka, South India. METHODS HIV prevalence data collected from pregnant women in Karnataka during HIV Sentinel Surveillance (HSS) between 2003 and 2019 was used for trend analysis. The consistent sites were grouped into four zones (Bangalore, Belgaum, Gulbarga and Mysore regions), totaling 60 sites, including 30 urban and 30 rural sites. Regional and district-level HIV prevalence was calculated; trend analysis using Chi-square trend test and spatial analysis using QGIS software was done. For the last three HSS rounds, HIV prevalence based on sociodemographic variables was calculated to understand the factors contributing to HIV positivity in each region. RESULTS In total, 254,563 pregnant women were recruited. HIV prevalence in Karnataka was 0.22 (OR: 0.15 95% CI: 0.16 - 0.28) in 2019. The prevalence was 0.24, 0.32, 0.17 and 0.14 in Bangalore, Belgaum, Gulbarga, and Mysore regions, respectively. HIV prevalence had significantly (P< 0.05) declined in 26 districts. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS HIV prevalence among pregnant women was comparatively higher in Bangalore and Belgaum regions. Analysis of contextual factors associated with the transmission risk and evidence-based targeted interventions will strengthen HIV management in Karnataka. Regionalized, disaggregated, sub-national analyses will help identify emerging pockets of infections, concentrated epidemic zones and contextual factors driving the disease transmission.
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Affiliation(s)
| | | | | | | | | | | | | | - V M Padmapriya
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - B K Kirubakaran
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Sanjay Patel
- Karnataka State AIDS Prevention Society, Bangalore, Karnataka, India
| | - Pradeep Kumar
- National AIDS Control Organization, Ministry of Health Family Welfare, Government of India, New Delhi, 110 001, India
| | - Shobini Rajan
- National AIDS Control Organization, Ministry of Health Family Welfare, Government of India, New Delhi, 110 001, India
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Barnabas RV, Szpiro AA, van Rooyen H, Asiimwe S, Pillay D, Ware NC, Schaafsma TT, Krows ML, van Heerden A, Joseph P, Shahmanesh M, Wyatt MA, Sausi K, Turyamureeba B, Sithole N, Morrison S, Shapiro AE, Roberts DA, Thomas KK, Koole O, Bershteyn A, Ehrenkranz P, Baeten JM, Celum C. Community-based antiretroviral therapy versus standard clinic-based services for HIV in South Africa and Uganda (DO ART): a randomised trial. Lancet Glob Health 2020; 8:e1305-e1315. [PMID: 32971053 PMCID: PMC7527697 DOI: 10.1016/s2214-109x(20)30313-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Community-based delivery of antiretroviral therapy (ART) for HIV, including ART initiation, clinical and laboratory monitoring, and refills, could reduce barriers to treatment and improve viral suppression, reducing the gap in access to care for individuals who have detectable HIV viral load, including men who are less likely than women to be virally suppressed. We aimed to test the effect of community-based ART delivery on viral suppression among people living with HIV not on ART. METHODS We did a household-randomised, unblinded trial (DO ART) of delivery of ART in the community compared with the clinic in rural and peri-urban settings in KwaZulu-Natal, South Africa and the Sheema District, Uganda. After community-based HIV testing, people living with HIV were randomly assigned (1:1:1) with mobile phone software to community-based ART initiation with quarterly monitoring and ART refills through mobile vans; ART initiation at the clinic followed by mobile van monitoring and refills (hybrid approach); or standard clinic ART initiation and refills. The primary outcome was HIV viral suppression at 12 months. If the difference in viral suppression was not superior between study groups, an a-priori test for non-inferiority was done to test for a relative risk (RR) of more than 0·95. The cost per person virally suppressed was a co-primary outcome of the study. This study is registered with ClinicalTrials.gov, NCT02929992. FINDINGS Between May 26, 2016, and March 28, 2019, of 2479 assessed for eligibility, 1315 people living with HIV and not on ART with detectable viral load at baseline were randomly assigned; 666 (51%) were men. Retention at the month 12 visit was 95% (n=1253). At 12 months, community-based ART increased viral suppression compared with the clinic group (306 [74%] vs 269 [63%], RR 1·18, 95% CI 1·07-1·29; psuperiority=0·0005) and the hybrid approach was non-inferior (282 [68%] vs 269 [63%], RR 1·08, 0·98-1·19; pnon-inferiority=0·0049). Community-based ART increased viral suppression among men (73%, RR 1·34, 95% CI 1·16-1·55; psuperiority<0·0001) as did the hybrid approach (66%, RR 1·19, 1·02-1·40; psuperiority=0·026), compared with clinic-based ART (54%). Viral suppression was similar for men (n=156 [73%]) and women (n=150 [75%]) in the community-based ART group. With efficient scale-up, community-based ART could cost US$275-452 per person reaching viral suppression. Community-based ART was considered safe, with few adverse events. INTERPRETATION In high and medium HIV prevalence settings in South Africa and Uganda, community-based delivery of ART significantly increased viral suppression compared with clinic-based ART, particularly among men, eliminating disparities in viral suppression by gender. Community-based ART should be implemented and evaluated in different contexts for people with detectable viral load. FUNDING The Bill & Melinda Gates Foundation; the University of Washington and Fred Hutch Center for AIDS Research; the Wellcome Trust; the University of Washington Royalty Research Fund; and the University of Washington King K Holmes Endowed Professorship in STDs and AIDS.
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Affiliation(s)
- Ruanne V Barnabas
- Department of Global Health, University of Washington, Seattle, WA, USA; Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Adam A Szpiro
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Heidi van Rooyen
- Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa; MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Deenan Pillay
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Torin T Schaafsma
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Meighan L Krows
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Alastair van Heerden
- Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa; MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Philip Joseph
- Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa
| | | | | | - Kombi Sausi
- Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa
| | | | - Nsika Sithole
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Susan Morrison
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Adrienne E Shapiro
- Department of Global Health, University of Washington, Seattle, WA, USA; Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - D Allen Roberts
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | - Olivier Koole
- London School of Hygiene & Tropical Medicine, London, UK
| | - Anna Bershteyn
- New York University School of Medicine, New York, NY, USA
| | | | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA; Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, WA, USA; Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
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Lorente N, Sherriff N, Panochenko O, Marcus U, Dutarte M, Kuske M, Aussó S, Huber J, Krone M, Schink SB, Cawley C, Casabona J, Folch C. The Role of Community Health Workers Within the Continuum of Services for HIV, Viral Hepatitis, and Other STIs Amongst Men Who Have Sex with Men in Europe. J Community Health 2020; 46:545-556. [PMID: 32737744 PMCID: PMC7393028 DOI: 10.1007/s10900-020-00900-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Little is known about Community Health Workers (CHWs) who work in non-clinical settings to provide sexual health support around HIV, viral hepatitis, and other sexually transmitted infections (STIs) to men who have sex with men (MSM) in Europe and neighbouring countries. This article describes for the first time, who CHWs are, and how they contribute to the continuum of services for HIV, viral hepatitis, and other STIs amongst MSM. The first European Community Health Worker Online Survey (ECHOES) developed in the framework of the EU-funded ESTICOM project (www.esticom.eu), was available in 16 languages (October 2017-January 2018). Amongst the 1035 persons aged 18 and older reporting CHW activities in the previous 12 months, 28.2% were women, 30.7% were volunteers, 59.2% were men self-defining as gay/homosexual, bisexual or queer (‘peer CHWs’), and most CHWs worked/volunteered in private not-for-profit organisations (86.4%). CHWs involvement in the continuum of services for HIV, viral hepatitis and other STIs was as follows: primary prevention (88.6%), consultation and counselling (58.0%), testing provision (50.6%), linkage to care (49.8%), and treatment and support activities (51.3%). CHWs were also involved in cross-cutting activities such as developing interventions, advocacy, and engaging in research (46.3%). CHWs as a public health workforce contribute to all steps of the continuum of services for HIV, viral hepatitis, and other STIs amongst MSM in Europe. National governments should recognise and support CHWs better in order to make their activities more visible and sustainable, and increase their impact on the continuum of services.
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Affiliation(s)
- Nicolas Lorente
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, 08916, Badalona (Barcelona), Spain.
- Institut Investigació Germans Trias I Pujol (IGTP), 08916, Badalona (Barcelona), Spain.
- Centre D'Estudis Epidemiològics Sobre Les ITS I Sida de Catalunya (CEEISCAT), Fundació Institut D'Investigació en Ciències de La Salut Germans Trias I Pujol (IGTP), Edifici Muntanya, Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Barcelona, Spain.
| | - Nigel Sherriff
- School of Health Sciences, and Centre for Transforming Sexuality & Gender, University of Brighton, Brighton, BN1 9PH, UK
| | | | | | - Maria Dutarte
- European AIDS Treatment Group (EATG), 1000, Brussels, Belgium
- European Patients' Forum (EPF), 1040, Brussels, Belgium
| | | | - Susanna Aussó
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, 08916, Badalona (Barcelona), Spain
- Institut Investigació Germans Trias I Pujol (IGTP), 08916, Badalona (Barcelona), Spain
| | - Jörg Huber
- School of Health Sciences, and Centre for Transforming Sexuality & Gender, University of Brighton, Brighton, BN1 9PH, UK
| | | | | | | | - Jordi Casabona
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, 08916, Badalona (Barcelona), Spain
- Institut Investigació Germans Trias I Pujol (IGTP), 08916, Badalona (Barcelona), Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), 28029, Madrid, Spain
- Departament de Pediatria, Obstetrícia i Ginecologia i de Medicina Preventiva, Universitat Autònoma de Barcelona, 08916, Badalona (Barcelona), Spain
| | - Cinta Folch
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, 08916, Badalona (Barcelona), Spain
- Institut Investigació Germans Trias I Pujol (IGTP), 08916, Badalona (Barcelona), Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), 28029, Madrid, Spain
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Okal J, Lango D, Matheka J, Obare F, Ngunu-Gituathi C, Mugambi M, Sarna A. "It is always better for a man to know his HIV status" - A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya. PLoS One 2020; 15:e0231645. [PMID: 32294124 PMCID: PMC7159816 DOI: 10.1371/journal.pone.0231645] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 03/28/2020] [Indexed: 01/20/2023] Open
Abstract
HIV testing services are an important component of HIV program and provide an entry point for clinical care for persons newly diagnosed with HIV. Although uptake of HIV testing has increased in Kenya, men are still less likely than women to get tested and access services. There is, however, limited understanding of the context, barriers and facilitators of HIV testing among men in the country. Data are from in-depth interviews with 30 men living with HIV and 8 HIV testing counsellors that were conducted to gain insights on motivations and drivers for HIV testing among men in the city of Nairobi. Men were identified retroactively by examining clinical CD4 registers on early and late diagnosis (e.g. CD4 of ≥500 cells/mm, early diagnosis and <500 cells/mm, late diagnosis). Analysis involved identifying broad themes and generating descriptive codes and categories. Timing for early testing is linked with strong social support systems and agency to test, while cost of testing, choice of facility to test and weak social support systems (especially poor inter-partner relations) resulted in late testing. Minimal discussions occurred prior to testing and whenever there was dialogue it happened with partners or other close relatives. Interrelated barriers at individual, health-care system, and interpersonal levels hindered access to testing services. Specifically, barriers to testing included perceived providers attitudes, facility location and set up, wait time/inconvenient clinic times, low perception of risk, limited HIV knowled ge, stigma, discrimination and fear of having a test. High risk perception, severe illness, awareness of partner's status, confidentiality, quality of services and supplies, flexible/extended opening hours, and pre-and post-test counselling were facilitators. Experiences between early and late testers overlapped though there were minor differences. In order to achieve the desired impact nationally and to attain the 90-90-90 targets, multiple interventions addressing both barriers and facilitators to testing are needed to increase uptake of testing and to link the positive to care.
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Affiliation(s)
- Jerry Okal
- Population Council, Nairobi, Kenya
- * E-mail:
| | | | | | | | | | - Mary Mugambi
- National HIV and STI Control Programme (NASCOP), Nairobi, Kenya
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Willems HME, Ahmed SS, Liu J, Xu Z, Peters BM. Vulvovaginal Candidiasis: A Current Understanding and Burning Questions. J Fungi (Basel) 2020; 6:jof6010027. [PMID: 32106438 PMCID: PMC7151053 DOI: 10.3390/jof6010027] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 12/22/2022] Open
Abstract
Candida albicans, along with other closely related Candida species, are the primary causative agents of vulvovaginal candidiasis (VVC)-a multifactorial infectious disease of the lower female reproductive tract resulting in pathologic inflammation. Unlike other forms of candidiasis, VVC is a disease of immunocompetent and otherwise healthy women, most predominant during their child-bearing years. While VVC is non-lethal, its high global incidence and profound negative impact on quality-of-life necessitates further understanding of the host and fungal factors that drive disease pathogenesis. In this review, we cover the current state of our understanding of the epidemiology, host response, fungal pathogenicity mechanisms, impact of the microbiome, and novel approaches to treatment of this most prevalent human candidal infection. We also offer insight into the latest advancements in the VVC field and identify important questions that still remain.
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Affiliation(s)
- Hubertine M. E. Willems
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (H.M.E.W.); (J.L.); (Z.X.)
| | - Salman S. Ahmed
- School of Food Science and Engineering, South China University of Technology, Guangzhou 510641, China;
| | - Junyan Liu
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (H.M.E.W.); (J.L.); (Z.X.)
| | - Zhenbo Xu
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (H.M.E.W.); (J.L.); (Z.X.)
- School of Food Science and Engineering, South China University of Technology, Guangzhou 510641, China;
| | - Brian M. Peters
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (H.M.E.W.); (J.L.); (Z.X.)
- Correspondence:
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