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Campbell LS, Knight L, Masquillier C, Wouters E. Including the Household: Individual, Community and Household Factors Affecting Antiretroviral Therapy Adherence After ART Initiation in Cape Town, South Africa. AIDS Behav 2024:10.1007/s10461-024-04447-3. [PMID: 39090458 DOI: 10.1007/s10461-024-04447-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2024] [Indexed: 08/04/2024]
Abstract
Antiretroviral therapy (ART) adherence is crucial for health outcomes of people living with HIV (PLHIV), influenced by a complex interplay of individual, community, and household factors. This article focuses on the influence of household factors, as well as individual and community factors, on ART adherence among PLHIV in Cape Town who have recently initiated ART. Baseline data for a cluster-randomized controlled trial were collected from 316 PLHIV in 12 districts in Cape Town between 6th May 2021 and 22nd May 2022. Zero-inflated Poisson models, with cluster-adjusted standard errors, were used to analyse the association between individual, household, and community factors and ART adherence measures. At the household-level, household support was associated with both better self-rated adherence (exp(β) = 0.81, z = - 4.68, p < 0.001) and fewer days when pills were missed (exp(β) = 0.65, z = - 2.92, p = 0.003). Psychological violence (exp(β) = 1.37, z = 1.97, p = 0.05) and higher household asset scores (exp(β) = 1.29, z = - 2.83, p = 0.05) were weakly associated with poorer ART adherence. At the individual-level, male gender (exp(β) = 1.37, z = 3.95, p < 0.001) and reinitiating ART (exp(β) = 1.35, z = 3.64, p < 0.001) were associated with worse self-rated ART adherence; higher education levels (exp(β) = 0.30 times, z = - 3.75, p < 0.001) and better HIV knowledge (exp(β) = 0.28, z = - 2.83, p = 0.005) were associated with fewer days where pills were missed. At the community-level, community stigma was associated with worse self-rated ART adherence (exp(β) = 1.24, z = 3.01, p = 0.003). When designing interventions to improve ART adherence, household, individual and community factors should all be considered, particularly in addressing gender-based disparities, reducing stigma, tackling violence, and enhancing household support.Clinical Trial Number: Pan African Clinical Trial Registry, PACTR201906476052236. Registered on 24 June 2019.
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Affiliation(s)
- Linda S Campbell
- Faculty of Social Sciences, Centre for Population, Family and Health, University of Antwerp, Prinsstraat 13, 2000, Antwerp, Belgium.
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Lucia Knight
- Division of Social and Behavioural Sciences, Faculty of Health Sciences, School of Public Health, University of Cape Town, Cape Town, South Africa
- School of Public Health, Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Caroline Masquillier
- Faculty of Social Sciences, Centre for Population, Family and Health, University of Antwerp, Prinsstraat 13, 2000, Antwerp, Belgium
- Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Edwin Wouters
- Faculty of Social Sciences, Centre for Population, Family and Health, University of Antwerp, Prinsstraat 13, 2000, Antwerp, Belgium
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
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Rosen JG, Nakyanjo N, Ddaaki WG, Zhao T, Van Vo A, Nakubulwa R, Ssekyewa C, Isabirye D, Katono RL, Nabakka P, Ssemwanga RJ, Kigozi G, Odiya S, Nakigozi G, Nalugoda F, Kigozi G, Kagaayi J, Grabowski MK, Kennedy CE. Identifying longitudinal patterns of HIV treatment (dis)engagement and re-engagement from oral histories of virologically unsuppressed persons in Uganda: A thematic trajectory analysis. Soc Sci Med 2023; 339:116386. [PMID: 37984182 PMCID: PMC10841599 DOI: 10.1016/j.socscimed.2023.116386] [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: 04/06/2023] [Revised: 10/01/2023] [Accepted: 10/28/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND There is limited study of persons deemed "harder to reach" by HIV treatment services, including those discontinuing or never initiating antiretroviral therapy (ART). We conducted narrative research in southern Uganda with virologically unsuppressed persons identified through population-based sampling to discern longitudinal patterns in HIV service engagement and identify factors shaping treatment persistence. METHODS In mid-2022, we sampled adult participants with high-level HIV viremia (≥1000 RNA copies/mL) from the prospective, population-based Rakai Community Cohort Study. Using life history calendars, we conducted initial and follow-up in-depth interviews to elicit oral histories of participants' journeys in HIV care, from diagnosis to the present. We then used thematic trajectory analysis to identify discrete archetypes of HIV treatment engagement by "re-storying" participant narratives and visualizing HIV treatment timelines derived from interviews and abstracted clinical data. RESULTS Thirty-eight participants (median age: 34 years, 68% men) completed 75 interviews. We identified six HIV care engagement archetypes from narrative timelines: (1) delayed ART initiation, (2) early treatment discontinuation, (3) treatment cycling, (4) prolonged treatment interruption, (5) transfer-related care disruption, and (6) episodic viremia. Patterns of service (dis)engagement were highly gendered, occurred in the presence and absence of optimal ART adherence, and were shaped by various factors emerging at different time points, including: denial of HIV serostatus and disclosure concerns; worsening HIV-related symptoms; psychological distress and depression; social support; intimate partner violence; ART side effects; accessibility constraints during periods of mobility; incarceration; and inflexible ART dispensing regulations. CONCLUSIONS Identified trajectories uncovered heterogeneities in both the timing and drivers of ART (re-)initiation and (dis)continuity, demonstrating the distinct characteristics and needs of people with different patterns of HIV treatment engagement throughout the life course. Enhanced mental health service provision, expanded eligibility for differentiated service delivery models, and streamlined facility switching processes may facilitate timely (re-)engagement in HIV services.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | | | | | - Tongying Zhao
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anh Van Vo
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | | | | | - Silas Odiya
- Rakai Health Sciences Program, Entebbe, Uganda
| | | | | | | | | | - M Kate Grabowski
- Rakai Health Sciences Program, Entebbe, Uganda; Division of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Caitlin E Kennedy
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Rakai Health Sciences Program, Entebbe, Uganda
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Tao Y, Xiao X, Zhang C, Xie Y, Wang H. Prevalence of delayed antiretroviral therapy initiation among people living with HIV: A systematic review and meta-analysis. PLoS One 2023; 18:e0286476. [PMID: 37874794 PMCID: PMC10597480 DOI: 10.1371/journal.pone.0286476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 05/16/2023] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVE HIV continues to be a global challenge. Key recommendations for HIV prevention and treatment are presented on rapid antiretroviral therapy (ART) initiation. However, several studies showed a high prevalence of delayed ART initiation. The aim of this systematic review and meta-analysis was to assess the prevalence of delayed ART initiation among HIV-infected patients globally. METHODS This review summarised eligible studies conducted between January 2015 and August 2022 on the prevalence of delayed ART initiation in HIV-infected adults (age ≥ 15). Relevant studies were systematic searched through PubMed/Medline, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang, and Chongqing VIP databases. Random-effects models were used to calculate pooled prevalence estimates. The heterogeneity was evaluated using Cochran's Q test and I2 statistics. Moreover, potential sources of heterogeneity were explored using univariate subgroup analysis. RESULTS Data on the prevalence of delayed ART initiation was pooled across 29 studies involving 34,937 participants from 15 countries. The overall pooled prevalence of delayed ART initiation was 36.1% [95% confidence interval (CI), 29.7-42.5%]. In subgroup analysis, the estimated pooled prevalence decreased with age. By sex, the prevalence was higher among male patients (39.3%, 95% CI: 32.2-46.4%) than female (36.5%, 95% CI: 26.9-50.7%). Patients with high CD4 cell count were more likely to delay ART initiation than those with low CD4 cell count (>500cells/mm3: 40.3%; 201-500cells/mm3: 33.4%; and ≤200cells/mm3: 25.3%). CONCLUSIONS Our systematic review and meta-analysis identified a high prevalence of delayed ART initiation. The prolonged time interval between diagnosis and treatment is a prevalent and unaddressed problem that should spur initiatives from countries globally. Further research is urgently needed to identify effective strategies for promoting the early ART initiation.
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Affiliation(s)
- Yan Tao
- Xiangya Nursing School, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Xueling Xiao
- Xiangya Nursing School, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Ci Zhang
- Xiangya Nursing School, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Ying Xie
- Xiangya Nursing School, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Honghong Wang
- Xiangya Nursing School, Central South University, Changsha, Hunan Province, People's Republic of China
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Kiyingi M, Nankabirwa JI, Wiltshire CS, Nangendo J, Kiweewa JM, Katahoire AR, Semitala FC. Perspectives of people living with HIV on barriers to timely ART initiation following referral for antiretroviral therapy: A qualitative study at an urban HIV clinic in Kampala, Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001483. [PMID: 37494338 PMCID: PMC10370709 DOI: 10.1371/journal.pgph.0001483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 06/20/2023] [Indexed: 07/28/2023]
Abstract
Early initiation of antiretroviral therapy (ART) after HIV diagnosis prevents HIV transmission, progression of HIV to AIDS and improves quality of life. However, little is known about the barriers to timely ART initiation among patients who test HIV positive in settings different from where they will receive HIV treatment, hence are referred in the routine setting. Therefore, we explored the perspectives of people living with HIV on barriers faced to initiate ART following HIV testing and referral for treatment. In this qualitative study, we purposively sampled and enrolled 17 patients attending the Mulago ISS clinic. We selected patients (≥18 years) who previously were received as referrals for HIV treatment and had delayed ART initiation, as ascertained from their records. We conducted in-depth interviews, which were audio recorded, transcribed and translated. We used Atlas.ti version 9 software for data management. Data analysis followed thematic and framework analysis techniques and we adopted the socio-ecological model to categorize final themes. Key themes were found at organizational level including; negative experiences at the place of HIV diagnosis attributed to inadequate counselling and support, unclear communication of HIV-positive results and ambiguous referral procedures; and, long waiting time when patients reached the HIV clinic. At individual level, the themes identified were; immediate denial with late acceptance of HIV-positive results attributed to severe emotional and psychological distress at receiving results, fear of perceived side effects and long duration on ART. At interpersonal level, we found that anticipated and enacted stigma after HIV diagnosis resulted in non-disclosure, discrimination and lack of social support. We found that challenges at entry (during HIV test) and navigation of the HIV care system in addition to individual and interpersonal factors contributed to delayed ART initiation. Interventions during HIV testing would facilitate early ART initiation among patients referred for HIV care.
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Affiliation(s)
- Micheal Kiyingi
- Department of Medicine, Makerere University, Kampala, Uganda
- Makerere University Joint AIDS Program, Makerere University, Kampala, Uganda
| | - Joaniter I. Nankabirwa
- Department of Medicine, Makerere University, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala Uganda
| | | | - Joan Nangendo
- Infectious Diseases Research Collaboration, Kampala Uganda
| | - John M. Kiweewa
- Education Department, Fairfield University, Fairfield, Connecticut, United States of America
| | - Anne R. Katahoire
- Child Health Development Center, Makerere University, Kampala, Uganda
| | - Fred C. Semitala
- Department of Medicine, Makerere University, Kampala, Uganda
- Makerere University Joint AIDS Program, Makerere University, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala Uganda
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Yang J, Cui Z, Liao X, He X, Wang L, Wei D, Wu S, Chang Y. Effects of a feedback intervention on antibiotic prescription control in primary care institutions based on a Health Information System: a cluster randomized cross-over controlled trial. J Glob Antimicrob Resist 2023; 33:51-60. [PMID: 36828121 DOI: 10.1016/j.jgar.2023.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/16/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVES Overuse and misuse of antibiotics are major factors in the development of antibiotic resistance in primary care institutions of rural China. In this study, the effectiveness of a Health Information System-based, automatic, and confidential antibiotic feedback intervention was evaluated. METHODS A randomized, cross-over, cluster-controlled trial was conducted in primary care institutions. All institutions were randomly divided into two groups and given either a three-month intervention followed by a three-month period without any intervention or vice versa. The intervention consisted of three feedback measures: a real-time pop-up warning message of inappropriate antibiotic prescriptions on the prescribing physician's computer screen, a 10-day antibiotic prescription summary, and distribution of educational manuals. The primary outcome was the 10-day inappropriate antibiotic prescription rate. RESULTS There were no significant differences in inappropriate antibiotic prescription rates (69.1% vs. 72.0%) between two groups at baseline (P = 0.072). After three months (cross-over point), inappropriate antibiotic prescription rates decreased significantly faster in group A (12.3%, P < 0.001) compared to group B (4.4%, P < 0.001). At the end point, the inappropriate antibiotic prescription rates decreased in group B (15.1%, P < 0.001) while the rates increased in group A (7.2%, P < 0.001). The characteristics of physicians did not significantly affect the rate of antibiotic or inappropriate antibiotic prescription rates. CONCLUSION A Health Information System-based, real-time pop-up warnings, a 10-day prescription summary, and the distribution of educational manuals, can effectively reduce the rates of antibiotic and inappropriate antibiotic prescriptions.
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Affiliation(s)
- Junli Yang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Zhezhe Cui
- Guangxi Key Laboratory of Major Infectious Disease Prevention and Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Xingjiang Liao
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, China; Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Xun He
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, China; Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou Province, China.
| | - Lei Wang
- Primary Health Department of Guizhou Provincial Health Commission, Guiyang, China
| | - Du Wei
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, China; Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Shengyan Wu
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, China; Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Yue Chang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, China; Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou Province, China.
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Bayisa L, Bayisa D, Turi E, Mulisa D, Tolossa T, Akuma AO, Bokora MC, Rundasa DT. Same-Day ART Initiation and Associated Factors Among People Living with HIV on Lifelong Therapy at Nekemte Specialized Hospital, Western Ethiopia. HIV AIDS (Auckl) 2023; 15:11-22. [PMID: 36718213 PMCID: PMC9884049 DOI: 10.2147/hiv.s395238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/13/2023] [Indexed: 01/26/2023] Open
Abstract
Background The test-and-treat approach recommends early ART initiation (same day). Early ART start has double the benefits as treatment and as prevention. However, there is limited information regarding same-day ART initiation in Ethiopia. Hence, this study aimed to assess the magnitude and factors of same-day ART initiation among people living with HIV (PLHIV) on ART at Nekemte specialized hospital, in Western Ethiopia. Methods A cross-sectional study was conducted among 483 PLHIV from January 10 to February 15, 2021. Data were collected using an investigator-administered questionnaire. Epi Data 3.1 and STATA 14.0 were used for data entry and analysis, respectively. Variables with P-value <0.25 from bivariable analysis were included in the multivariable analysis. AOR with 95% CI and P-value <0.05 were used to declare statistical significance. Results A total of 483 study subjects participated and gave a 100% response rate. Two thirds (65%) of them started ART on the same day with a 95% CI [60.2-68.8]. Urban dwellers (AOR = 3.93 (95% 1.96-7.87)), with no OIs (AOR = 4.02 (95% CI: 1.54-10.47)), not screened for TB (AOR = 6.02 (95% CI: 1.71-21.15)), tested via VCT (AOR = 2.32 (95% CI: 1.37-3.26)), who have not used CPT (AOR = 1.88 (95% CI: 1.10-3.23)), who have not used IPT (AOR = 2.36 (95% CI: 1.0-5.57)), who were tested in 2019/20 (AOR = 2.37 (95% CI: 1.08-5.518)), and with BMI ≥25 kg/m2 (AOR = 2.18 (95% CI: 1.05-4.52)) were significantly associated with same-day ART initiation. Conclusion Two thirds of study subjects initiated ART on the same day as HIV diagnosis. Voluntary testing and immediate referral to HIV care, advocating test-and-treat, and intensive counseling should be strengthened and reinforced for newly diagnosed HIV-positive people. Given that, high attention should be paid to individuals from urban residence, not screened for TB, who have not used CPT and IPT prophylaxis.
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Affiliation(s)
- Lami Bayisa
- Department of Nursing, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia,Correspondence: Lami Bayisa, Department of Nursing, School of Nursing and Midwifery, Wollega University, P.O.Box: 395, Nekemte, Ethiopia, Tel +251 924318135, Email
| | - Diriba Bayisa
- Department of Midwifery, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia
| | - Ebisa Turi
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Diriba Mulisa
- Department of Nursing, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Adugna Olani Akuma
- Department of Nursing, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia
| | - Merga Chala Bokora
- Department of Midwifery, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia
| | - Dawit Tesfaye Rundasa
- Department of Nursing, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia
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Kiyingi M, Nankabirwa JI, Sekaggya-Wiltshire C, Nangendo J, Kiweewa JM, Katahoire AR, Semitala FC. Predictors of delayed Anti-Retroviral Therapy initiation among adults referred for HIV treatment in Uganda: a cross-sectional study. BMC Health Serv Res 2023; 23:40. [PMID: 36647104 PMCID: PMC9843953 DOI: 10.1186/s12913-023-09052-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Uganda's current guidelines recommend immediate initiation of Anti-Retroviral Therapy (ART) for persons living with HIV in order to reduce HIV/AIDS related morbidity and mortality. However, not all eligible PLHIV initiate ART within the recommended time following HIV diagnosis. We assessed the prevalence and factors associated with delayed ART initiation among PLHIV referred for ART initiation, five years since rolling out the test and treat guidelines. METHODS In this cross-sectional study, we enrolled adult patients referred to Mulago Immune Suppressive Syndrome (Mulago ISS) clinic for ART initiation from January 2017 to May 2021. We collected data on socio-demographics, HIV diagnosis and referral circumstances, and time to ART initiation using a questionnaire. The outcome of interest was proportion of patients that delayed ART, defined as spending more than 30 days from HIV diagnosis to ART initiation. We performed multivariable logistic regression and identified significant factors. RESULTS A total of 312 patients were enrolled of which 62.2% were female. The median (inter-quartile range [IQR]) age and baseline CD4 count of the patients were 35 (28-42) years and 315 (118.8-580.5) cells/μL respectively. Forty-eight (15.4%) patients delayed ART initiation and had a median (IQR) time to ART of 92 (49.0-273.5) days. The factors associated with delayed ART initiation were; 1) having had the HIV diagnosis made from a private health facility versus public, (adjusted odds ratio [aOR] = 2.4 (95% confidence interval [CI] 1.1-5.5); 2) initial denial of positive HIV test results, aOR = 5.4 (95% CI: 2.0-15.0); and, 3) having not received a follow up phone call from the place of HIV diagnosis, aOR = 2.8 (95% CI: 1.2-6.8). CONCLUSION There was significant delay of ART initiation among referred PLHIV within 5 years after the rollout of test and treat guidelines in Uganda. Health system challenges in the continuity of HIV care services negatively affects timely ART initiation among referred PLHIV in Uganda.
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Affiliation(s)
- Micheal Kiyingi
- Department of Medicine, Makerere University College of Health Sciences, Makerere University, Box 7062, Kampala, Uganda
- Makerere University Joint AIDS Program, Makerere University, Kampala, Uganda
| | - Joaniter I. Nankabirwa
- Department of Medicine, Makerere University College of Health Sciences, Makerere University, Box 7062, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Joan Nangendo
- Department of Medicine, Makerere University College of Health Sciences, Makerere University, Box 7062, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - John M. Kiweewa
- Education Department, Fairfield University, Fairfield, CT USA
| | - Anne R. Katahoire
- Child Health and Development Center, Makerere University, Kampala, Uganda
| | - Fred C. Semitala
- Department of Medicine, Makerere University College of Health Sciences, Makerere University, Box 7062, Kampala, Uganda
- Makerere University Joint AIDS Program, Makerere University, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
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Ulvund I, Dadi GB, Gutteberg A. 'I am struggling to survive' - limited living conditions increase the burden of HIV: A qualitative study. Glob Public Health 2023; 18:2280049. [PMID: 37967520 DOI: 10.1080/17441692.2023.2280049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/01/2023] [Indexed: 11/17/2023]
Abstract
The human immunodeficiency virus (HIV) continues to have life-limiting health consequences for many individuals and remains a significant threat to global public health. This qualitative study explores the experiences of people living with HIV in Sidama, Ethiopia. Interviews with 19 adults recruited from an HIV outpatient clinic were conducted using a semi-structured interview guide. The analysis method used was systematic text condensation. The results reveal that an HIV diagnosis triggered strong emotions. Economic concerns, stigma, and discrimination also increased the burden of a diagnosis, which could lead to a loss of income or housing. Consequently, informants' ability to maintain a regular life and receive social and psychological support was reduced. Religious faith provided strength to informants, though they stated that some religious leaders do not support antiretroviral therapy. Understanding the everyday challenges of people living with HIV is crucial for health professionals and health programme developers working to promote health and enable people to follow their recommended course of treatment. Person-centred care is recommended. In particular, the poorest should receive attention. It is also crucial to reduce stigma and discriminatory attitudes towards people living with HIV and to motivate faith leaders to prevent HIV stigma and support antiretroviral therapy.
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Affiliation(s)
- Ingeborg Ulvund
- Faculty of Health Sciences and Social Care, Molde University College, Specialized University in Logistics, Molde, Norway
| | - Gezahegn Bekele Dadi
- School of Nursing, Hawassa University-College of Medicine & Health Science, Hawassa, Ethiopia
| | - Anne Gutteberg
- Faculty of Health Sciences and Social Care, Molde University College, Specialized University in Logistics, Molde, Norway
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Same‐day
and rapid initiation of antiretroviral therapy in people living with
HIV
in Asia. How far have we come? HIV Med 2022; 23 Suppl 4:3-14. [DOI: 10.1111/hiv.13410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/01/2022] [Indexed: 11/04/2022]
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10
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Ochodo EA, Olwanda EE, Deeks JJ, Mallett S. Point-of-care viral load tests to detect high HIV viral load in people living with HIV/AIDS attending health facilities. Cochrane Database Syst Rev 2022; 3:CD013208. [PMID: 35266555 PMCID: PMC8908762 DOI: 10.1002/14651858.cd013208.pub2] [Citation(s) in RCA: 4] [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] [Indexed: 12/28/2022]
Abstract
BACKGROUND Viral load (VL) testing in people living with HIV (PLHIV) helps to monitor antiretroviral therapy (ART). VL is still largely tested using central laboratory-based platforms, which have long test turnaround times and involve sophisticated equipment. VL tests with point-of-care (POC) platforms capable of being used near the patient are potentially easy to use, give quick results, are cost-effective, and could replace central or reference VL testing platforms. OBJECTIVES To estimate the diagnostic accuracy of POC tests to detect high viral load levels in PLHIV attending healthcare facilities. SEARCH METHODS We searched eight electronic databases using standard, extensive Cochrane search methods, and did not use any language, document type, or publication status limitations. We also searched the reference lists of included studies and relevant systematic reviews, and consulted an expert in the field from the World Health Organization (WHO) HIV Department for potentially relevant studies. The latest search was 23 November 2020. SELECTION CRITERIA We included any primary study that compared the results of a VL test with a POC platform to that of a central laboratory-based reference test to detect high viral load in PLHIV on HIV/AIDS care or follow-up. We included all forms of POC tests for VL as defined by study authors, regardless of the healthcare facility in which the test was conducted. We excluded diagnostic case-control studies with healthy controls and studies that did not provide sufficient data to create the 2 × 2 tables to calculate sensitivity and specificity. We did not limit our study inclusion to age, gender, or geographical setting. DATA COLLECTION AND ANALYSIS Two review authors independently screened the titles, abstracts, and full texts of the search results to identify eligible articles. They also independently extracted data using a standardized data extraction form and conducted risk of bias assessment using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Using participants as the unit of analysis, we fitted simplified univariable models for sensitivity and specificity separately, employing a random-effects model to estimate the summary sensitivity and specificity at the current and commonly reported World Health Organization (WHO) threshold (≥ 1000 copies/mL). The bivariate models did not converge to give a model estimate. MAIN RESULTS We identified 18 studies (24 evaluations, 10,034 participants) defining high viral loads at main thresholds ≥ 1000 copies/mL (n = 20), ≥ 5000 copies/mL (n = 1), and ≥ 40 copies/mL (n = 3). All evaluations were done on samples from PLHIV retrieved from routine HIV/AIDS care centres or health facilities. For clinical applicability, we included 14 studies (20 evaluations, 8659 participants) assessing high viral load at the clinical threshold of ≥ 1000 copies/mL in the meta-analyses. Of these, sub-Saharan Africa, Europe, and Asia contributed 16, three, and one evaluation respectively. All included participants were on ART in only nine evaluations; in the other 11 evaluations the proportion of participants on ART was either partial or not clearly stated. Thirteen evaluations included adults only (n = 13), five mixed populations of adults and children, whilst in the remaining two the age of included populations was not clearly stated. The majority of evaluations included commercially available tests (n = 18). Ten evaluations were POC VL tests conducted near the patient in a peripheral or onsite laboratory, whilst the other 10 were evaluations of POC VL tests in a central or reference laboratory setting. The test types evaluated as POC VL tests included Xpert HIV-1 Viral Load test (n = 8), SAMBA HIV-1 Semi-Q Test (n = 9), Alere Q NAT prototype assay for HIV-1 (n = 2) and m-PIMA HIV-1/2 Viral Load test (n = 1). The majority of evaluations (n = 17) used plasma samples, whilst the rest (n = 3) utilized whole blood samples. Pooled sensitivity (95% confidence interval (CI)) of POC VL at a threshold of ≥ 1000 copies/mL was 96.6% (94.8 to 97.8) (20 evaluations, 2522 participants), and pooled specificity (95% CI) was 95.7% (90.8 to 98.0) (20 evaluations, 6137 participants). Median prevalence for high viral load (≥ 1000 copies/mL) (n = 20) was 33.4% (range 6.9% to 88.5%). Limitations The risk of bias was mostly assessed as unclear across the four domains due to incomplete reporting. AUTHORS' CONCLUSIONS We found POC VL to have high sensitivity and high specificity for the diagnosis of high HIV viral load in PLHIV attending healthcare facilities at a clinical threshold of ≥ 1000 copies/mL.
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Affiliation(s)
- Eleanor A Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Centre for Evidence-based Health Care, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Jonathan J Deeks
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Mallett
- UCL Centre for Medical Imaging, Division of Medicine, Faculty of Medical Sciences, University College London, London, UK
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Nicolau V, Cortes R, Lopes M, Virgolino A, Santos O, Martins A, Faria N, Reis AP, Santos C, Maltez F, Pereira ÁA, Antunes F. HIV Infection: Time from Diagnosis to Initiation of Antiretroviral Therapy in Portugal, a Multicentric Study. Healthcare (Basel) 2021; 9:797. [PMID: 34202051 PMCID: PMC8306717 DOI: 10.3390/healthcare9070797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/03/2021] [Accepted: 06/21/2021] [Indexed: 11/17/2022] Open
Abstract
The benefits of antiretroviral therapy (ART) for persons living with HIV (PLWH) are well established. Rapid ART initiation can lead to improved clinical outcomes. Portugal has one of the highest rates of new HIV diagnoses in the European Union, and an average time until ART initiation above the recommendations established by the national guideline according to data from the first two years after its implementation in 2015, with no more recent data available after that. This study aimed to evaluate time from the first hospital appointment until ART initiation among newly diagnosed HIV patients in Portugal between 2017 and 2018, to investigate differences between hospitals, and to understand the experience of patient associations in supporting the navigation of PLWH throughout referral and linkage to the therapeutic process. To answer to these objectives, a twofold design was followed: a quantitative approach, with an analysis of records from five Portuguese hospitals, and a qualitative approach, with individual interviews with three representatives of patient associations. Overall, 847 and 840 PLWH initiated ART in 2017 and in 2018, respectively, 21 days (median of the two years) after the first appointment, with nearly half coming outside the mainstream service for hospital referral, and with observed differences between hospitals. In 2017-2018, only 38.0% of PLWH initiated ART in less than 14 days after the first hospital appointment. From the interviews, barriers of administrative and psychosocial nature were identified that may hinder access to ART. Patient associations work to offer a tailored support to patients' navigation within the health system, which can help to reduce or overcome those potential barriers. Indicators related to time until ART initiation can be used to monitor and improve access to specialized care of PLWH.
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Affiliation(s)
- Vanessa Nicolau
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Rui Cortes
- Lean Health Portugal, Campus da Faculdade de Ciências da Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal; (R.C.); (M.L.)
| | - Maria Lopes
- Lean Health Portugal, Campus da Faculdade de Ciências da Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal; (R.C.); (M.L.)
| | - Ana Virgolino
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal; (A.V.); (O.S.); (F.M.); (Á.A.P.); (F.A.)
- Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Osvaldo Santos
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal; (A.V.); (O.S.); (F.M.); (Á.A.P.); (F.A.)
- Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Unbreakable Idea Research, 2550-426 Painho, Portugal
| | - António Martins
- Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal;
| | - Nancy Faria
- Serviço de Saúde da Região Autónoma da Madeira, Av. Luís de Camões 6180, 9000-177 Funchal, Portugal; (N.F.); (A.P.R.)
| | - Ana Paula Reis
- Serviço de Saúde da Região Autónoma da Madeira, Av. Luís de Camões 6180, 9000-177 Funchal, Portugal; (N.F.); (A.P.R.)
| | - Catarina Santos
- Hospital de Cascais, Av. Brigadeiro Victor Novais Gonçalves, 2755-009 Alcabideche, Portugal;
| | - Fernando Maltez
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal; (A.V.); (O.S.); (F.M.); (Á.A.P.); (F.A.)
- Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Centro Hospitalar de Lisboa Central, Hospital Curry Cabral, Rua da Beneficência, nº 8, 1069-166 Lisboa, Portugal
| | - Álvaro Ayres Pereira
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal; (A.V.); (O.S.); (F.M.); (Á.A.P.); (F.A.)
- Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Av. Professor Egas Moniz, 1649-035 Lisboa, Portugal
| | - Francisco Antunes
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal; (A.V.); (O.S.); (F.M.); (Á.A.P.); (F.A.)
- Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal
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