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Govere SM, Kalinda C, Chimbari MJ. The impact of same-day antiretroviral therapy initiation on retention in care and clinical outcomes at four eThekwini clinics, KwaZulu-Natal, South Africa. BMC Health Serv Res 2023; 23:838. [PMID: 37553685 PMCID: PMC10408100 DOI: 10.1186/s12913-023-09801-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 07/11/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Same-day initiation (SDI) of antiretroviral therapy (ART) increases ART uptake, however retention in care after ART initiation remains a challenge. Public health behaviours, such as retention in HIV care and adherence to antiretroviral therapy (ART) pose major challenges to reducing new Human Immunodeficiency Virus (HIV) transmission and improving health outcomes among HIV patients. METHODS We evaluated 6-month retention in care, and clinical outcomes of an ART cohort comprising of SDI and delayed ART initiators. We conducted a 6 months' observational prospective cohort study of 403 patients who had been initiated on ART. A structured questionnaire was used to abstract data from patient record review which comprised the medical charts, laboratory databases, and Three Interlinked Electronic Registers.Net (TIER.Net). Treatment adherence was ascertained by patient visit constancy for the clinic scheduled visit dates. Retention in care was determined by status at 6 months after ART initiation. RESULTS Among the 403 participants enrolled in the study and followed up, 286 (70.97%) and 267 (66.25%) complied with scheduled clinics visits at 3 months and 6 months, respectively. One hundred and thirteen (28.04%) had been loss to follow-up. 17/403 (4.22%) had died and had been out of care after 6 months. 6 (1.49%) had been transferred to other health facilities and 113 (28.04%) had been loss to follow-up. Among those that had been lost to follow-up, 30 (33.63%) deferred SDI while 75 (66.37%) initiated ART under SDI. One hundred and eighty-nine (70.79%) participants who had remained in care were SDI patients while 78 (29.21%) were SDI deferred patients. In the bivariate analysis; gender (OR: 1.672; 95% CI: 1.002-2.791), number of sexual partners (OR: 2.092; 95% CI: 1.07-4.061), age (OR: 0.941; 95% CI: 0.734-2.791), ART start date (OR: 0.078; 95% CI: 0.042-0.141), partner HIV status (OR: 0.621; 95% CI: 0.387-0.995) and the number of hospitalizations after HIV diagnosis (OR: 0.173; 95% CI: 0.092-0.326). were significantly associated with viral load detection. Furthermore, SDI patients who defaulted treatment were 2.4 (95% CI: 1.165-4.928) times more likely to have increased viral load than those who had been returned in care. CONCLUSION Viral suppression under SDI proved higher but with poor retention in care. However, the results also emphasise a vital need, to not only streamline processes to increase immediate ART uptake further, but also to ensure retention in care.
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Affiliation(s)
- Sabina M Govere
- School of Nursing and Public Health, Discipline of Public Health Medicine, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa.
| | - Chester Kalinda
- School of Nursing and Public Health, Discipline of Public Health Medicine, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
- Bill and Joyce Cummings Institute of Global Health and Institute of Global Health Equity Research (IGHER), University of Global Health Equity Kigali Heights, Kigali, Rwanda
| | - Moses J Chimbari
- School of Nursing and Public Health, Discipline of Public Health Medicine, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
- Department of Public Health, Great Zimbabwe University, P.O Box 1235, Masvingo, Zimbabwe
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Fauk NK, Ziersch A, Gesesew H, Ward PR, Mwanri L. Strategies to improve access to mental health services: Perspectives of African migrants and service providers in South Australia. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2021.100058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Siraj M, Gedamu S, Tegegne B. Predictors of Survival Time Among HIV-Infected Adults After Initiating Anti-Retroviral Therapy in Kombolcha Town: A 5-Year Retrospective Cohort Study. HIV AIDS (Auckl) 2022; 14:181-194. [PMID: 35464618 PMCID: PMC9020508 DOI: 10.2147/hiv.s359495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Antiretroviral therapy (ART) enhances the survival of HIV-infected patients by reducing viral load and increasing CD4. As CD4 count increases, patients are more protected against opportunistic infections. In developing countries including Ethiopia, there were limited studies about the survival benefit of ART particularly no study in Kombolcha Town. Thus, this study was aimed to address the gap. Methods A hospital-based retrospective cohort study was employed in Kombolcha town among 510 patients’ records from January 2015 to December 2019. A systematic random sampling technique was used to select patient records. The collected data were checked, coded, and entered into Epidata version 4.6 and exported to Statistical Package for Social Sciences version 26 for data cleaning and analysis. Kaplan–Meier was used to estimate the probability of category of each predictor and a log rank test was used to compare survival curves. Bivariate and multivariate Cox-regression were employed using a 95% CI and variables with p-value <0.05 were declared as predictors of poor survival time. Results In this cohort, out of 510 HIV-infected patients, 39 (7.65%) were died, and 471 (92.35%) were censored. Fair drug adherence (AHR=6.88, 95% CI: 4.31–24.04), Poor drug adherence (AHR=9.58, 95% CI: 8.72–30.97), CD4 count <50 cell/µL (AHR=9.38, 95% CI: 1.48–59.31), CD4 count 50–99 cell/µL (AHR=9.67, 95% CI: 1.80–51.73), bedridden (AHR=9.5, 95% CI: 4.49–18.66), opportunistic infections (AHR=4.58, 95% CI: 1.20–5.65), weight <60kg (AHR=2.48, 95% CI:1.59, 10.38), WHO stage III (AHR=3.56, 95% CI: 1.71–17.89), WHO stage IV (AHR=4.42, 95% CI:1.75–25.93) were predictors of poor survival time. Conclusion The Kaplan–Meier result showed that the estimated median survival time of patients after ART initiation in Kombolcha town was higher (32 months) as compared to other studies. Poor drug adherence, WHO stage III & IV, Lower baseline CD4 count, presence of opportunistic infections, weight <60kg, and being bedridden were predictors of poor survival time. Thus, early initiation of ART ought to be encouraged among HIV-infected patients and good patient counseling on the level of adherence should be strengthened.
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Affiliation(s)
- Muhammed Siraj
- Department of Nursing, Tropical College of Medicine, Dessie, Ethiopia
| | - Sisay Gedamu
- Department of Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Belachew Tegegne
- Department of Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- Correspondence: Belachew Tegegne, Department of Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia, Email
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Gesesew H, Ward P, Karnon J, Woodman R, Mwanri L. Peer-led HIV care and the UNAIDS 90-90-90 treatment targets in Tigrai, Ethiopia: a cluster randomised trial and economic evaluation of teach-test-link-trace model (TTLT) trial protocol. BMJ Open 2021; 11:e043943. [PMID: 34083328 PMCID: PMC8174492 DOI: 10.1136/bmjopen-2020-043943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION This study will evaluate the acceptability and effectiveness of a new intervention programme called teach-test-link-trace (TTLT) model in Tigrai, Ethiopia, where peer educators counsel about HIV (teach), perform house-to-house HIV testing (test) through pinprick HIV testing (H2H) or OraQuick HIV self-testing (HIVST), link HIV-positive patients to HIV care (link) and trace lost patients house-to-house (trace). METHODS AND ANALYSIS The four-arm cluster randomised trial will be conducted in five phases: Phase 1 will assess the acceptability of the TTLT model using a cross-sectional survey among adults aged 18 years irrespective of HIV status in 6909 households from 40 villages (kebeles). Phase 2 will assess effectiveness of the TTLT model through comparing intervention and control groups among HIV negative or unknown HIV status. The intervention groups will receive one of the three home-based interventions provided by peer educators: (1) demonstrate and distribute OraQuick HIV self-testing kits (HIVST), (2) perform pinprick HIV testing (H2H) and (3) offer a choice to either receive HIVST or H2H. The control group will receive the standard care in which nurses counsel and refer eligible household members to nearby health facilities to access existing HIV testing services. The primary outcomes of the interventions are proportion of individuals who know of their HIV status (first 90), link to HIV care and treatment (second 90) and meet virological suppression (third 90). We will perform process evaluation through qualitative interviews in phase 3, economic evaluation for cost-effectiveness analysis in phase 4 and a sustainability exit strategy using nominal group technique in phase 5. We will apply descriptive and inferential statistics for quantitative studies, and thematic framework analysis for qualitative studies. ETHICS AND DISSEMINATION Ethics approval was obtained from the Southern Adelaide Clinical Health Research Ethics Committee (SAC HREC), South Australia, and findings will be disseminated through publications, conference presentations, media release and policy briefs. TRIAL REGISTRATION NUMBER ACTRN12620000570987p.
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Affiliation(s)
- Hailay Gesesew
- Epidemiology, Mekelle University, Mekelle, Ethiopia
- Public Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Paul Ward
- Public Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jonathan Karnon
- Public Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Richard Woodman
- Public Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Lillian Mwanri
- Public Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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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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Kebede HK, Mwanri L, Ward P, Gesesew HA. Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis. Infect Dis Poverty 2021; 10:33. [PMID: 33743815 PMCID: PMC7981932 DOI: 10.1186/s40249-021-00822-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 03/08/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND It is known that 'drop out' from human immunodeficiency virus (HIV) treatment, the so called lost-to-follow-up (LTFU) occurs to persons enrolled in HIV care services. However, in sub-Saharan Africa (SSA), the risk factors for the LTFU are not well understood. METHODS We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA. A systematic search of literature using identified keywords and index terms was conducted across five databases: MEDLINE, PubMed, CINAHL, Scopus, and Web of Science. We included quantitative studies published in English from 2002 to 2019. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for methodological validity assessment and data extraction. Mantel Haenszel method using Revman-5 software was used for meta-analysis. We demonstrated the meta-analytic measure of association using pooled odds ratio (OR), 95% confidence interval (CI) and heterogeneity using I2 tests. RESULTS Thirty studies met the search criteria and were included in the meta-analysis. Predictors of LTFU were: demographic factors including being: (i) a male (OR = 1.2, 95% CI 1.1-1.3, I2 = 59%), (ii) between 15 and 35 years old (OR = 1.3, 95% CI 1.1-1.3, I2 = 0%), (iii) unmarried (OR = 1.2, 95% CI 1.2-1.3, I2 = 21%), (iv) a rural dweller (OR = 2.01, 95% CI 1.5-2.7, I2 = 40%), (v) unemployed (OR = 1.2, 95% CI 1.04-1.4, I2 = 58%); (vi) diagnosed with behavioral factors including illegal drug use(OR = 13.5, 95% CI 7.2-25.5, I2 = 60%), alcohol drinking (OR = 2.9, 95% CI 1.9-4.4, I2 = 39%), and tobacco smoking (OR = 2.6, 95% CI 1.6-4.3, I2 = 74%); and clinical diagnosis of mental illness (OR = 3.4, 95% CI 2.2-5.2, I2 = 1%), bed ridden or ambulatory functional status (OR = 2.2, 95% CI 1.5-3.1, I2 = 74%), low CD4 count in the last visit (OR = 1.4, 95% CI 1.1-1.9, I2 = 75%), tuberculosis co-infection (OR = 1.2, 95% CI 1.02-1.4, I2 = 66%) and a history of opportunistic infections (OR = 2.5, 95% CI 1.7-2.8, I2 = 75%). CONCLUSIONS The current review identifies demographic, behavioral and clinical factors to be determinants of LTFU. We recommend strengthening of HIV care services in SSA targeting the aforementioned group of patients. Trial registration Protocol: the PROSPERO Registration Number is CRD42018114418.
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Affiliation(s)
- Hafte Kahsay Kebede
- Clinical Pharmacy, College of Health Sciences, Defense University, Debrezeit, Ethiopia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Paul Ward
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Hailay Abrha Gesesew
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Epidemiology Department, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Gesesew HA, Ward P, Woldemichael K, Lyon P, Mwanri L. Policy and practice suggestions to improve performance on the UNAIDS 90-90-90 targets: Results from a nominal group technique with HIV experts in Southwest Ethiopia. Health Expect 2020; 23:1326-1337. [PMID: 32761685 PMCID: PMC7696206 DOI: 10.1111/hex.13115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 07/05/2020] [Accepted: 07/14/2020] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE This paper aims to evaluate the potential solutions to address negative outcomes of HIV care and treatment, that were proposed by HIV care providers, researchers and HIV programme managers in Southwest Ethiopia. METHODS A nominal group technique (NGT) was conducted with 25 experts in December 2017 in Jimma, Southwest Ethiopia. The NGT process included (a) an analysis of the previously qualitative study conducted with various Ethiopian HIV stakeholders who proposed possible solutions for HIV care and treatment; (b) recruitment of a panel of HIV experts in policy and practice to rate the proposed solutions in Ethiopia before a discussion (first round rating); (c) discussion with the panel of experts on the suggested solutions; and (d) conducting a second round of rating of proposed solutions. Content analysis and Wilcoxon signed rank test were applied to analyse the data. RESULTS Eighteen of the 25 invited panel of experts participated in the NGT. The following proposed solutions were rated and discussed as relevant, feasible and acceptable. In order of decreasing importance, the solutions were as follows: filling gaps in legislation, HIV self-testing, the teach-test-link-trace strategy, house-to-house HIV testing, community antiretroviral therapy (ART) groups, providing ART in private clinics and providing ART at health posts. CONCLUSIONS The current study findings suggested that, to address HIV negative outcomes, priority solutions could include mandatory notification of partner's HIV status, HIV self-testing and the involvement of peer educators on the entire HIV care programme.
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Affiliation(s)
- Hailay Abrha Gesesew
- Public HealthFlinders UniversityAdelaideSAAustralia
- EpidemiologyMekelle UniversityMekelleEthiopia
| | - Paul Ward
- Public HealthFlinders UniversityAdelaideSAAustralia
| | | | - Pamela Lyon
- Southgate Institute for Health, Society and EquityFlinders UniversityAdelaideSAAustralia
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