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Carpenter D, Hast M, Buono N, Hrapcak S, Sato K, Mrina R, Cox MH, Agaba PA, Vrazo AC, Wolf H, Rivadeneira ED, Shang JD, Mayer MM, Prao AH, Longuma HO, Kabwe C, Lwana PN, Tilahun T, Ts’oeu M, Mutisya I, Omoto LN, Cowan JG, de Deus MIJT, Fagbamigbe OJ, Ene U, Ikpeazu A, Ndlovu MB, Matiko E, Schaad N, Bisimba J, Lema E, Musokotwane K, Maphosa T, Buthelezi B, Olarinoye A, Lawal I, Mukungunugwa S, Mwambona JT, Wondimu T, Kathure IA, Igboelina OD, Nzima VN, Bissai RG, Lenka M, Shasha W, Olivier NK, Matsinhe M, Wate A, Godfrey L, Alexander H, Alemnji G, Lecher S. Pediatric and adolescent HIV viral load coverage and suppression rates in the context of the COVID-19 pandemic in 12 PEPFAR-supported sub-Saharan African countries in 2019 and 2020. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003513. [PMID: 39088480 PMCID: PMC11293699 DOI: 10.1371/journal.pgph.0003513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/28/2024] [Indexed: 08/03/2024]
Abstract
The early period of the COVID-19 pandemic limited access to HIV services for children and adolescents living with HIV (C/ALHIV). To determine progress in providing care and treatment services, we describe viral load coverage (VLC) and suppression (VLS) (<1000 copies/ mL) rates during the COVID-19 pandemic in 12 United States President's Emergency Plan for AIDS Relief (PEPFAR)-supported countries. Data for children (0-9 years) and adolescents (10-19 years) on VLC and VLS were analyzed for 12 sub-Saharan African (SSA) countries between 2019 (pre-COVID-19) and 2020 (during COVID-19). We report the number of viral load (VL) tests, and percent change in VLC and VLS for patients on ART. For 12 countries, 181,192 children had a VL test during the pre-COVID-19 period compared with 177,683 December 2020 during COVID-19. VLC decreased from 68.8% to 68.3% overall. However, 9 countries experienced an increase ranging from a 0.7%-point increase for Tanzania and Zimbabwe to a 15.3%-point increase for Nigeria. VLS increased for all countries from 71.2% to 77.7%. For adolescents the number with a VL test increased from 377,342 to 402,792. VLC decreased from 77.4% to 77.1%. However, 7 countries experienced an increase ranging from 1.8% for Mozambique to 13.8% for Cameroon. VLS increased for all countries from 76.8% to 83.8%. This analysis shows variation in HIV VLC across 12 SSA countries. VLS consistently improved across all countries demonstrating resilience of countries during 2020. Countries should continue to improve clinical outcomes from C/ALHIV despite service disruptions that may occur during pandemic response.
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Affiliation(s)
- Deborah Carpenter
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marisa Hast
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole Buono
- United States Agency for International Development, Washington, District of Columbia, United States of America
| | - Susan Hrapcak
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kimi Sato
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rosemary Mrina
- Walter Reed Army Institute of Research, United States Military HIV Research Program, Silver Spring, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Mackenzie Hurlston Cox
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patricia Aladi Agaba
- Walter Reed Army Institute of Research, United States Military HIV Research Program, Silver Spring, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Alexandra C. Vrazo
- United States Agency for International Development, Washington, District of Columbia, United States of America
| | - Hilary Wolf
- US Department of State, Office of the United States Global AIDS Coordinator, Washington, District of Columbia, United States of America
| | - Emilia D. Rivadeneira
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Judith D. Shang
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Yaounde, Cameroon
| | - Magdalene Mange Mayer
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Yaounde, Cameroon
| | - Aka Herve Prao
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Abidjan, Côte d’Ivoire
| | - Henri Onema Longuma
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | - Constantin Kabwe
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | - Patricia Nyembo Lwana
- Ministry of Health, National AIDS Control Committee, Kinshasa, Democratic Republic of Congo
| | - Tsegaye Tilahun
- United States Agency for International Development, Addis Ababa, Ethiopia
| | - Mamorapeli Ts’oeu
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Maseru, Lesotho
| | - Immaculate Mutisya
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Lennah Nyabiage Omoto
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Jessica Greenberg Cowan
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Maria Ines Jorge Tomo de Deus
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Omodele Johnson Fagbamigbe
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Nigeria
| | - Uzoma Ene
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Nigeria
| | | | - Mduduzi B. Ndlovu
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Eva Matiko
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Nicolas Schaad
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Jema Bisimba
- United States Agency for International Development, Dar es Salaam, Tanzania
| | - Elizabeth Lema
- United States Agency for International Development, Dar es Salaam, Tanzania
| | - Kebby Musokotwane
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Talent Maphosa
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Buyile Buthelezi
- United States Agency for International Development, Pretoria, South Africa
| | | | - Ismail Lawal
- US Army Medical Research Directorate-Africa/ Walter Reed Army Institute of Research, Abuja, Nigeria
| | | | | | - Teferi Wondimu
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | | | | | | | - Matjeko Lenka
- United States Agency for International Development, Maseru, Lesotho
| | - Willibrord Shasha
- United States Agency for International Development, Abidjan, Côte d’Ivoire
| | | | - Mѐrcia Matsinhe
- United States Agency for International Development, Maputo, Mozambique
| | - Argentina Wate
- United States Agency for International Development, Maputo, Mozambique
| | - Lingenda Godfrey
- United States Agency for International Development, Lusaka, Zambia
| | - Heather Alexander
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - George Alemnji
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shirley Lecher
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Amutuhaire W, Semitala FC, Kimera ID, Namugenyi C, Mulindwa F, Ssenyonjo R, Katwesigye R, Mugabe F, Mutungi G, Ssinabulya I, Schwartz JI, Katahoire AR, Musoke LS, Yendewa GA, Longenecker CT, Muddu M. Time to blood pressure control and predictors among patients receiving integrated treatment for hypertension and HIV based on an adapted WHO HEARTS implementation strategy at a large urban HIV clinic in Uganda. J Hum Hypertens 2024; 38:452-459. [PMID: 38302611 PMCID: PMC11076202 DOI: 10.1038/s41371-024-00897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 10/01/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024]
Abstract
In this cohort study, we determined time to blood pressure (BP) control and its predictors among hypertensive PLHIV enrolled in integrated hypertension-HIV care based on the World Health Organization (WHO) HEARTS strategy at Mulago Immunosuppression Clinic in Uganda. From August 2019 to March 2020, we enrolled hypertensive PLHIV aged ≥ 18 years and initiated Amlodipine 5 mg mono-therapy for BP (140-159)/(90-99) mmHg or Amlodipine 5 mg/Valsartan 80 mg duo-therapy for BP ≥ 160/90 mmHg. Patients were followed with a treatment escalation plan until BP control, defined as BP < 140/90 mmHg. We used Cox proportional hazards models to identify predictors of time to BP control. Of 877 PLHIV enrolled (mean age 50.4 years, 62.1% female), 30% received mono-therapy and 70% received duo-therapy. In the monotherapy group, 66%, 88% and 96% attained BP control in the first, second and third months, respectively. For patients on duo-therapy, 56%, 83%, 88% and 90% achieved BP control in the first, second, third, and fourth months, respectively. In adjusted Cox proportional hazard analysis, higher systolic BP (aHR 0.995, 95% CI 0.989-0.999) and baseline ART tenofovir/lamivudine/efavirenz (aHR 0.764, 95% CI 0.637-0.917) were associated with longer time to BP control, while being on ART for >10 years was associated with a shorter time to BP control (aHR 1.456, 95% CI 1.126-1.883). The WHO HEARTS strategy was effective at achieving timely BP control among PLHIV. Additionally, monotherapy anti-hypertensive treatment for stage I hypertension is a viable option to achieve BP control and limit pill burden in resource limited HIV care settings.
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Affiliation(s)
- Willington Amutuhaire
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | | | | | | | - Frank Mulindwa
- Makerere University Infectious Diseases Institute, Kampala, Uganda
| | | | | | - Frank Mugabe
- Department of non-communicable diseases, Uganda Ministry of Health, Kampala, Uganda
| | - Gerald Mutungi
- Department of non-communicable diseases, Uganda Ministry of Health, Kampala, Uganda
| | | | - Jeremy I Schwartz
- Yale School of Medicine, Section of General Internal Medicine, Connecticut, CT, USA
| | - Anne R Katahoire
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Lewis S Musoke
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Chris T Longenecker
- Department of Global Health and Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Martin Muddu
- Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
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Neduzhko O, Kiriazova T, Zeziulin O, Legkostup L, Riabokon S, DeHovitz JA, Dumchev K. The Effects of COVID-19 Pandemic on HIV Service Provision in Ukraine. J Int Assoc Provid AIDS Care 2024; 23:23259582241277649. [PMID: 39252523 PMCID: PMC11384520 DOI: 10.1177/23259582241277649] [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: 09/11/2024] Open
Abstract
Ukraine faced significant fluctuations in COVID-19 morbidity and mortality, alongside an escalating HIV epidemic. This mixed-methods study, conducted between February and August 2022, employed a sequential explanatory design combining a quantitative analysis of national data and qualitative interviews to investigate the pandemic's effects on HIV services in Ukraine. The observed trends confirmed that the pandemic significantly disrupted facility-based HIV testing due to logistical challenges, an increased burden on healthcare workers, and supply shortages. Meanwhile, community-based testing showed resilience, largely attributed to programmatic adjustments rather than the pandemic itself. The initiation of antiretroviral therapy declined, especially during initial lockdowns, reflecting diminished treatment capacities. Despite these challenges, telemedicine and home medication delivery innovations supported antiretroviral therapy adherence. Furthermore, improvements in viral load testing and suppression rates showed healthcare resilience. The study highlights the critical need for adaptable, sustainable healthcare strategies in crises, emphasized during the war with Russia.
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Affiliation(s)
| | | | | | - Liudmyla Legkostup
- Public Health Center of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Serhii Riabokon
- Public Health Center of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Jack A DeHovitz
- Department of Medicine, SUNY Downstate Health Sciences University, New York, USA
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Mude W, Mwenyango H, Preston R, O'Mullan C, Vaughan G, Jones G. HIV Testing Disruptions and Service Adaptations During the COVID-19 Pandemic: A Systematic Literature Review. AIDS Behav 2024; 28:186-200. [PMID: 37548796 PMCID: PMC10803448 DOI: 10.1007/s10461-023-04139-4] [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: 07/12/2023] [Indexed: 08/08/2023]
Abstract
Access to treatment and care in safe clinical settings improves people's lives with HIV. The COVID-19 pandemic disrupted vital HIV programs and services, increasing the risk of adverse health outcomes for people with HIV and HIV transmission rates in the community. This systematic literature review provides a meta-analysis of HIV testing disruptions and a synthesis of HIV/AIDS services adapted during COVID-19. We searched scholarly databases from 01 January 2020 to 30 June 2022 using key terms on HIV testing rates and services during the COVID-19 pandemic. The process of how the included articles were identified, selected, appraised, and synthesised was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included 17 articles that reported changes in HIV testing during the COVID-19 pandemic and 22 that reported adaptations in HIV/AIDS services. We found that HIV testing decreased by 37% during the search period because of the COVID-19 pandemic. Service providers adopted novel strategies to support remote service delivery by expanding community antiretroviral therapy dispensing, setting up primary care outreach points, and instituting multi-month dispensing services to sustain client care. Therefore, service providers and policymakers should explore alternative strategies to increase HIV testing rates impacted by COVID-19 and leverage funding to continue providing the identified adapted services.
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Affiliation(s)
- William Mude
- School of Health Medical and Applied Sciences, Central Queensland University, Cairns Campus, 42-52 Abbott Street & Shields Street, Cairns, QLD, 4870, Australia.
| | - Hadijah Mwenyango
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4BN, UK
| | - Robyn Preston
- School of Health Medical and Applied Sciences, Central Queensland University, Townsville Campus, Townsville, Australia
| | - Catherine O'Mullan
- School of Health Medical and Applied Sciences, Central Queensland University, Bundaberg Campus, Bundaberg, Australia
| | - Geraldine Vaughan
- School of Health Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, Australia
| | - Gary Jones
- Cohort Doctoral Studies Program, James Cook University, Cairns, Australia
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5
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Williams V, Haumba S, Ngwenya-Ngcamphalala F, Mafukidze A, Musarapasi N, Byarugaba H, Chiripashi S, Dlamini M, Maseko T, Dlamini NA, Nyapokoto C, Kibwana S, Bongomin P, Mazibuko S, Bhembe F, Ojoo S, Okello V, Bazira D. Implementation of the Automated Medication Dispensing System-Early Lessons From Eswatini. Int J Public Health 2023; 68:1606185. [PMID: 37901592 PMCID: PMC10600347 DOI: 10.3389/ijph.2023.1606185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives: This article describes the implementation of an automated medication dispensing system (AMDS) in Eswatini to increase medication access and presents the early lessons from this implementation. Methods: The AMDS was installed at four health facilities across two regions through collaborative stakeholder engagement. Healthcare workers were trained, and clients who met the inclusion criteria accessed their medications from the system. Each step of the implementation was documented and summarised in this article. Results: Early lessons suggest that implementation of the AMDS is acceptable and feasible to clients and healthcare workers and that phased introduction of medication classes, commencing with antiretroviral therapy (ART) and incorporating other medications in later phases is feasible. Additionally, improved client-centred messaging and communication, consistent power supply and internet network connectivity, and scheduling medication pickup with other services increase AMDS system utilisation. Conclusion: Eswatini has many clients living with HIV and non-communicable diseases (NCDs). Easy, convenient, quick, non-stigmatising and client-centred access to ART and medication for NCDs is critical in addressing retention in care and achieving optimal treatment outcomes.
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Affiliation(s)
- Victor Williams
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Samson Haumba
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
- Center for Global Health Practice and Impact, Georgetown University, Washington, DC, United States
| | - Fikile Ngwenya-Ngcamphalala
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
- Eswatini National AIDS Program, Mbabane, Eswatini
| | - Arnold Mafukidze
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Normusa Musarapasi
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Hugben Byarugaba
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Simbarashe Chiripashi
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Makhosazana Dlamini
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Thokozani Maseko
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | | | | | - Sharon Kibwana
- Center for Global Health Practice and Impact, Georgetown University, Washington, DC, United States
| | - Pido Bongomin
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Sikhathele Mazibuko
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Mbabane, Eswatini
| | | | - Sylvia Ojoo
- Center for Global Health Practice and Impact, Georgetown University, Washington, DC, United States
| | | | - Deus Bazira
- Center for Global Health Practice and Impact, Georgetown University, Washington, DC, United States
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Rose AL, Ochieng YA, Jack HE, Sangraula A, Ciya N, Jacobs Y, Ndamase S, Regenauer KS, Brown I, Hines AC, Johnson K, Bassett IV, Joska JA, Magidson JF, Myers B. Patient and stakeholder perspectives on impacts of the COVID-19 pandemic on HIV and mental health care delivery in South Africa. Int J STD AIDS 2023; 34:525-531. [PMID: 36943694 PMCID: PMC10031273 DOI: 10.1177/09564624231160581] [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: 10/06/2022] [Accepted: 02/13/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND The COVID-19 pandemic had a global impact on health systems and the delivery of health services, including for chronic conditions such as HIV. In South Africa, impacts on HIV services have widely been quantitatively described. Across different health settings, patients have also qualitatively described numerous negative impacts to their HIV care. However, patient perspectives on COVID-19 impacts to HIV care in South Africa, the largest HIV care system in the world, have been little explored to date. METHODS We conducted 29 semi-structured individual interviews with people living with HIV (n = 24) and providers (n = 5) in Cape Town, South Africa. RESULTS While most patient participants reported continued access to HIV treatment during the pandemic, many described perceiving that the quality of their care declined. Increased structural barriers were described as one contributing factor to this change. Additionally, patients described that reduced privacy in clinical interactions was a key factor negatively influencing their experience of receiving care. CONCLUSION Findings underscore the importance of ensuring patient privacy for HIV services even during the rearrangement of services in emergencies. It is also important to continue developing models to integrate community mental health services within HIV care delivery in South Africa.
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Affiliation(s)
- Alexandra L Rose
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Yvonne A Ochieng
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Helen E Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Anu Sangraula
- Department of Behavioral and Community Health, University of Maryland, College Park, MD, USA
| | - Nonceba Ciya
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa
| | - Yuche Jacobs
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa
| | - Sibabalwe Ndamase
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa
| | | | - Imani Brown
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Abigail C Hines
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa
| | - Ingrid V Bassett
- Division of Infectious Diseases, Medical Practice Evaluation Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - John A Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa
- Curtin EnAble Institute, Curtin University, Perth, Western Australia, Australia
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Nalintya E, Sekar P, Kavuma P, Kigozi J, Ssuna M, Kirumira P, Naluyima R, Namuli T, Musa FT, Skipper CP, Hullsiek KH, Ellis J, Boulware DR, Meya DB, Rajasingham R. Effect of Coronavirus Disease 2019 Lockdowns on Identification of Advanced Human Immunodeficiency Virus Disease in Outpatient Clinics in Uganda. Clin Infect Dis 2023; 76:2014-2017. [PMID: 36799434 PMCID: PMC10249983 DOI: 10.1093/cid/ciad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/31/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
Using data from 67 Ugandan human immunodeficiency virus (HIV) clinics (July 2019-January 2022), we report a 40% (1005/1662) reduction in the number of people with HIV presenting to care after August 2021 compared to prepandemic levels, with a greater proportion presenting with advanced HIV disease (20% vs 16% in the pre-coronavirus disease 2019 period).
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Affiliation(s)
| | - Preethiya Sekar
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, USA
| | - Paul Kavuma
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Joanita Kigozi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Martin Ssuna
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Paul Kirumira
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Rose Naluyima
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Teopista Namuli
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Fred Turya Musa
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Caleb P Skipper
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, USA
| | - Kathy Huppler Hullsiek
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, USA
| | - Jayne Ellis
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
- Clinical Research Department, London School of Hygiene and Tropical Medicine, United Kingdom
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, USA
| | - David B Meya
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Radha Rajasingham
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, USA
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Chun HM, Dirlikov E, Cox MH, Sherlock MW, Obeng-Aduasare Y, Sato K, Voetsch AC, Ater AD, Romano ER, Tomlinson H, Modi S, Achrekar A, Nkengasong J. Vital Signs: Progress Toward Eliminating HIV as a Global Public Health Threat Through Scale-Up of Antiretroviral Therapy and Health System Strengthening Supported by the U.S. President's Emergency Plan for AIDS Relief - Worldwide, 2004-2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:317-324. [PMID: 36952290 PMCID: PMC10042617 DOI: 10.15585/mmwr.mm7212e1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Introduction In 2004, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), with CDC as a major U.S. government implementing agency, began providing HIV antiretroviral therapy (ART) worldwide. Through suppression of HIV viral load, effective ART reduces morbidity and mortality among persons with HIV infection and prevents vertical and sexual transmission. Methods To describe program impact, data were analyzed from all PEPFAR programs and from six countries that have conducted nationally representative Population-based HIV Impact Assessment (PHIA) surveys, including PEPFAR programmatic data on the number of persons with HIV infection receiving PEPFAR-supported ART (2004-2022), rates of viral load coverage (the proportion of eligible persons with HIV infection who received a viral load test) and viral load suppression (proportion of persons who received a viral load test with <1,000 HIV copies per mL of blood) (2015-2022), and population viral load suppression rates in six countries that had two PHIA surveys conducted during 2015-2021. To assess health system strengthening, data on workforce and laboratory systems were analyzed. Results By September 2022, approximately 20 million persons with HIV infection in 54 countries were receiving PEPFAR-supported ART (62% CDC-supported); this number increased 300-fold from the 66,550 reported in September 2004. During 2015-2022, viral load coverage more than tripled, from 24% to 80%, and viral load suppression increased from 80% to 95%. Despite increases in viral load suppression rates and health system strengthening investments, variability exists in viral load coverage among some subpopulations (children aged <10 years, males, pregnant women, men who have sex with men [MSM], persons in prisons and other closed settings [persons in prisons], and transgender persons) and in viral load suppression among other subpopulations (pregnant and breastfeeding women, persons in prisons, and persons aged <20 years). Conclusions and implications for public health practice Since 2004, PEPFAR has scaled up effective ART to approximately 20 million persons with HIV infection in 54 countries. To eliminate HIV as a global public health threat, achievements must be sustained and expanded to reach all subpopulations. CDC and PEPFAR remain committed to tackling HIV while strengthening public health systems and global health security.
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Walensky RP. Partnerships, Collaborations, and Investments Integral to CDC's International Response to COVID-19. Emerg Infect Dis 2022; 28:S1-S3. [PMID: 36496350 DOI: 10.3201/eid2813.221751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Dokubo EK, Shang JD, N'Dir A, Ndongmo CB, Okpu G, Fadil YM, Takang LE, Angumua C, Lyonga E, Mayer M, Ayukotabe T, Nkwoh TK, Hedje J, Etoundi GA, Njock RL. Building on Capacity Established through US Centers for Disease Control and Prevention Global Health Programs to Respond to COVID-19, Cameroon. Emerg Infect Dis 2022; 28:S181-S190. [PMID: 36502395 DOI: 10.3201/eid2813.221193] [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] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic has highlighted the need for resilient health systems with the capacity to effectively detect and respond to disease outbreaks and ensure continuity of health service delivery. The pandemic has disproportionately affected resource-limited settings with inadequate health capacity, resulting in disruptions in health service delivery and worsened outcomes for key health indicators. As part of the US government's goal of ensuring health security, the US Centers for Disease Control and Prevention has used its scientific and technical expertise to build health capacity and address health threats globally. We describe how capacity developed through global health programs of the US Centers for Disease Control and Prevention in Cameroon was leveraged to respond to coronavirus disease and maintain health service delivery. The health system strengthening efforts in Cameroon can be applied in similar settings to ensure preparedness for future global public health threats and improve health outcomes.
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