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Chapuma CIJ, Sakala D, Nyang'wa MN, Hosseinipour MC, Mbeye N, Matoga M, Kumwenda MK, Chikweza A, Nyondo‐Mipando AL, Mwapasa V. Examining barriers to antiretroviral therapy initiation in infants living with HIV in sub-Saharan Africa despite the availability of point-of-care diagnostic testing: a narrative systematic review. J Int AIDS Soc 2024; 27 Suppl 1:e26284. [PMID: 38965987 PMCID: PMC11224580 DOI: 10.1002/jia2.26284] [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: 09/05/2023] [Accepted: 05/13/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Antiretroviral therapy (ART) initiation in infants living with HIV before 12 weeks of age can reduce the risk of mortality by 75%. Point-of-care (POC) diagnostic testing is critical for prompt ART initiation; however, despite its availability, rates of ART initiation are still relatively low before 12 weeks of age. This systematic review describes the barriers to ART initiation in infants before 12 weeks of age, despite the availability of POC. METHODS This systematic review used a narrative synthesis methodology. We searched PubMed and Scopus using search strategies that combined terms of multiple variants of the keywords "early infant initiation on antiretroviral therapy," "barriers" and "sub-Saharan Africa" (initial search 18th January 2023; final search 1st August 2023). We included qualitative, observational and mixed methods studies that reported the influences of early infant initiation on ART. We excluded studies that reported influences on other components of the Prevention of Mother to Child Transmission cascade. Using a deductive approach guided by the updated Consolidated Framework of Implementation Research, we developed descriptive codes and themes around barriers to early infant initiation on ART. We then developed recommendations for interventions for the identified barriers using the action, actor, target and time framework from the codes. RESULTS Of the 266 abstracts reviewed, 52 full-text papers were examined, of which 12 papers were included. South Africa had most papers from a single country (n = 3) and the most reported study design was retrospective (n = 6). Delays in ART initiation beyond 12 weeks in infants 0-12 months were primarily associated with health facility and maternal factors. The most prominent barriers identified were inadequate resources for POC testing (including human resources, laboratory facilities and patient follow-up). Maternal-related factors, such as limited male involvement and maternal perceptions of treatment and care, were also influential. DISCUSSION We identified structural barriers to ART initiation at the health system, social and cultural levels. Improvements in the timely allocation of resources for POC testing operations, coupled with interventions addressing social and behavioural barriers among both mothers and healthcare providers, hold a promise for enhancing timely ART initiation in infants. CONCLUSIONS This paper identifies barriers and proposes strategies for timely ART initiation in infants.
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Affiliation(s)
| | | | | | | | | | - Mitch Matoga
- University of North Carolina ProjectLilongweMalawi
| | - Moses Kelly Kumwenda
- Malawi Liverpool Research ProgrammeBlantyreMalawi
- Kamuzu University of Health SciencesBlantyreMalawi
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Jahun I, Said I, El-Imam I, Ehoche A, Dalhatu I, Yakubu A, Greby S, Bronson M, Brown K, Bamidele M, Boyd AT, Bachanas P, Dirlikov E, Agbakwuru C, Abutu A, Williams-Sherlock M, Onotu D, Odafe S, Williams DB, Bassey O, Ogbanufe O, Onyenuobi C, Adeola A, Meribe C, Efuntoye T, Fagbamigbe OJ, Fagbemi A, Ene U, Nguhemen T, Mgbakor I, Alagi M, Asaolu O, Oladipo A, Amafah J, Nzelu C, Dakum P, Mensah C, Aliyu A, Okonkwo P, Oyeledun B, Oko J, Ikpeazu A, Gambo A, Charurat M, Ellerbrock T, Aliyu S, Swaminathan M. Optimizing community linkage to care and antiretroviral therapy Initiation: Lessons from the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) and their adaptation in Nigeria ART Surge. PLoS One 2021; 16:e0257476. [PMID: 34543306 PMCID: PMC8451986 DOI: 10.1371/journal.pone.0257476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/01/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Ineffective linkage to care (LTC) is a known challenge for community HIV testing. To overcome this challenge, a robust linkage to care strategy was adopted by the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS). The NAIIS linkage to care strategy was further adapted to improve Nigeria's programmatic efforts to achieve the 1st 90 as part of the Nigeria Antiretroviral Therapy (ART) Surge initiative, which also included targeted community testing. In this paper we provide an overview of the NAIIS LTC strategy and describe the impact of this strategy on both the NAIIS and the Surge initiatives. METHODS The NAIIS collaborated with community-based organizations (CBOs) and deployed mobile health (mHealth) technology with real-time dashboards to manage and optimize community LTC for people living with HIV (PLHIV) diagnosed during the survey. In NAIIS, CBOs' role was to facilitate linkage of identified PLHIV in community to facility of their choice. For the ART Surge, we modified the NAIIS LTC strategy by empowering both CBOs and mobile community teams as responsible for not only active LTC but also for community testing, ART initiation, and retention in care. RESULTS Of the 2,739 PLHIV 15 years and above identified in NAIIS, 1,975 (72.1%) were either unaware of their HIV-positive status (N = 1890) or were aware of their HIV-positive status but not receiving treatment (N = 85). Of these, 1,342 (67.9%) were linked to care, of which 952 (70.9%) were initiated on ART. Among 1,890 newly diagnosed PLHIV, 1,278 (67.6%) were linked to care, 33.7% self-linked and 66.3% were linked by CBOs. Among 85 known PLHIV not on treatment, 64 (75.3%) were linked; 32.8% self-linked and 67.2% were linked by a CBO. In the ART Surge, LTC and treatment initiation rates were 98% and 100%, respectively. Three-month retention for monthly treatment initiation cohorts improved from 76% to 90% over 6 months. CONCLUSIONS Active LTC strategies by local CBOs and mobile community teams improved LTC and ART initiation in the ART Surge initiative. The use of mHealth technology resulted in timely and accurate documentation of results in NAIIS. By deploying mHealth in addition to active LTC, CBOs and mobile community teams could effectively scale up ART with real-time documentation of client-level outcomes.
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Affiliation(s)
- Ibrahim Jahun
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Ishaq Said
- Maryland Global Initiatives (affiliate of the University of Maryland, Baltimore), Abuja, Federal Capital Territory, Nigeria
| | - Ibrahim El-Imam
- Maryland Global Initiatives (affiliate of the University of Maryland, Baltimore), Abuja, Federal Capital Territory, Nigeria
| | - Akipu Ehoche
- Maryland Global Initiatives (affiliate of the University of Maryland, Baltimore), Abuja, Federal Capital Territory, Nigeria
| | - Ibrahim Dalhatu
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Aminu Yakubu
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Stacie Greby
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Megan Bronson
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kristin Brown
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Moyosola Bamidele
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Andrew T. Boyd
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Pamela Bachanas
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Emilio Dirlikov
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Chinedu Agbakwuru
- Maryland Global Initiatives (affiliate of the University of Maryland, Baltimore), Abuja, Federal Capital Territory, Nigeria
| | - Andrew Abutu
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | | | - Denis Onotu
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Solomon Odafe
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Daniel B. Williams
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Orji Bassey
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Obinna Ogbanufe
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Chibuzor Onyenuobi
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Ayo Adeola
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Chidozie Meribe
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Timothy Efuntoye
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Omodele J. Fagbamigbe
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Ayodele Fagbemi
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Uzoma Ene
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Tingir Nguhemen
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Ifunanya Mgbakor
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Matthias Alagi
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Olugbenga Asaolu
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Ademola Oladipo
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | - Joy Amafah
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
| | | | - Patrick Dakum
- Institute of Human Virology (IHVN), Abuja, Federal Capital Territory, Nigeria
| | - Charles Mensah
- Institute of Human Virology (IHVN), Abuja, Federal Capital Territory, Nigeria
| | - Ahmad Aliyu
- Institute of Human Virology (IHVN), Abuja, Federal Capital Territory, Nigeria
| | - Prosper Okonkwo
- AIDS Prevention Initiative Nigeria (APIN), Abuja, Federal Capital Territory, Nigeria
| | - Bolanle Oyeledun
- Center for Integrated Health Program (CIHP), Abuja, Federal Capital Territory, Nigeria
| | - John Oko
- Catholic Caritas Foundation Nigeria (CCFN), Abuja, Federal Capital Territory, Nigeria
| | | | - Aliyu Gambo
- National Agency for the Control of AIDS, Abuja, Federal Capital Territory, Nigeria
| | - Manhattan Charurat
- Maryland Global Initiatives (affiliate of the University of Maryland, Baltimore), Abuja, Federal Capital Territory, Nigeria
| | - Tedd Ellerbrock
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sani Aliyu
- National Agency for the Control of AIDS, Abuja, Federal Capital Territory, Nigeria
| | - Mahesh Swaminathan
- Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria
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Schatz E, Knight L, Mukumbang FC, Teti M, Myroniuk TW. 'You Have to Withstand That Because You Have Come for What You Have Come for': Barriers and facilitators to antiretroviral treatment access among older South Africans living with HIV. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:624-641. [PMID: 33682928 DOI: 10.1111/1467-9566.13243] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
Nationwide rollout of antiretroviral treatment (ART) is increasing the number of older persons living with HIV (OPLWH) in South Africa. Yet, little is known about how the sociological aspects of ageing - stigma, finances and family dynamics - impact access to ART. Qualitative interviews with 23 persons aged 50-plus living near Cape Town highlight the barriers and facilitators to the acceptability, affordability and availability of ART access among OPLWH. Key age-related barriers included perceived shame of sexuality and disclosing HIV status to others, perceived disrespect by clinical staff, affording transportation to clinics and pre-existing co-morbidities. Key age-related facilitators included family moral and financial support, particularly from children and grandchildren, and access to social grants. Importantly, many barriers and facilitators had feedback loops, for example social grants reduced transportation barriers to clinics when ageing and poor health limited mobility. As the population living with HIV ages, it is critical to assess the ways ageing, as a social process, impacts ART access and to address these to improve older persons' HIV care.
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Affiliation(s)
- Enid Schatz
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit(Agincourt, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia Knight
- Division of Social and Behavioural Sciences, Faculty of Health Sciences, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Ferdinand C Mukumbang
- Department of Global Health, The Global Center for Integrated Health of Women, Adolescents, and Children (Global WACh, University of Washington, Seattle, WA, USA
| | - Michelle Teti
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO, USA
| | - Tyler W Myroniuk
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO, USA
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Nearly one in every six HIV-infected children lost from ART follow-up at Debre Markos Referral Hospital, Northwest Ethiopia: A 14-year retrospective follow-up study. PLoS One 2020; 15:e0239013. [PMID: 32931502 PMCID: PMC7491726 DOI: 10.1371/journal.pone.0239013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022] Open
Abstract
Background Although antiretroviral therapy (ART) significantly improves the survival status and quality of life among human immunodeficiency virus (HIV)-infected children, loss to follow-up (LTFU) from HIV-care profoundly affecting the treatment outcomes of this vulnerable population. For better interventions, up-to-date information concerning LTFU among HIV-infected children on ART is vital. However, only a few studies have been conducted in Ethiopia to address this concern. Thus, this study aims to identify the predictors of LTFU among HIV-infected children receiving ART at Debre Markos Referral Hospital. Methods An institution-based retrospective follow-up study was done among 408 HIV-infected children receiving ART at Debre Markos Referral Hospital between 2005 and March 15, 2019. Data were abstracted from the medical records of HIV-infected children using a standardized data abstracted checklist. We used Epi-Data Version 3.1 for data entry and Stata Version 14 for statistical analysis. The Kaplan-Meier survival curve was used to estimate the survival time. A generalized log-rank test was used to compare the survival curves of different categorical variables. Finally, both bi-variable and multivariable Cox proportional hazard regression models were used to identify the predictors of LTFU. Results Of 408 HIV-infected children included in the final analysis, 70 (17.1%) children were LTFU at the end of the study. The overall incidence rate of LTFU among HIV-infected children was found to be 4.5 (95%CI: 3.5–5.7) per 100-child years of observation. HIV-infected children living in rural areas (AHR: 3.2, 95%CI: 2.0–5.3), having fair or poor ART drug adherence (AHR: 2.3, 95%CI: 1.4–3.7), children started ART through test and treat approach (AHR: 2.7, 95%CI: 1.4–5.5), and children started protease inhibiter (PI)-based ART regimens (AHR: 2.2, 95%CI: 1.1–4.4) were at higher risk of LTFU. Conclusion This study found that one in every six HIV-infected children lost form ART follow-up. HIV-infected children living in rural areas, having fair or poor ART drug adherence, started ART based on test and treat approach, and taking PI-based ART regimens were at higher risk of LTFU.
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Sharma A, Prinja S, Sharma A, Gupta A, Arora SK. Cost of antiretroviral treatment for HIV patients in two centres of North India. Int J STD AIDS 2019; 30:769-778. [PMID: 31081489 DOI: 10.1177/0956462419839852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is paucity of evidence on cost of antiretroviral therapy (ART) delivered through the public sector in India. Moreover, the Government of India is considering changing the criteria for introduction of ART to HIV patients, which is likely to have significant economic implications. In this paper, we assess the health system cost of ART services at two levels of health care delivery. Bottom-up costing was used to collect data on capital and recurrent resources consumed over a period of one year (April 2014–March 2015). Capital costs were annualized and shared costs apportioned to calculate annual and unit costs of providing ART care. Sensitivity analysis was undertaken to measure the extent of uncertainty in input prices. The annual per capita cost of ART therapy was INR 48,975 (USD738) in the Centre of Excellence (COE) and INR 24,954 (USD376) in the ART centre. Drugs contributed around 70% and 65% of total annual cost, followed by human resource (19% each) and capital cost (7%; 12%) in COE and ART centres, respectively. These provide a comprehensive assessment of the cost of ART care in India. The study estimates could be used for planning of services, as well as undertaking further cost-effectiveness studies.
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Affiliation(s)
- Atul Sharma
- 1 School of Public health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- 1 School of Public health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- 2 Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditi Gupta
- 1 School of Public health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil K Arora
- 3 Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Ayele TA, Worku A, Kebede Y, Alemu K, Kasim A, Shkedy Z. Choice of initial antiretroviral drugs and treatment outcomes among HIV-infected patients in sub-Saharan Africa: systematic review and meta-analysis of observational studies. Syst Rev 2017; 6:173. [PMID: 28841912 PMCID: PMC5574138 DOI: 10.1186/s13643-017-0567-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 08/15/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The effectiveness of antiretroviral therapy (ART) depends on the choice of regimens during initiation. Most evidences from developed countries indicated that there is difference between efavirenz (EFV) and nevirapine (NVP). However, the evidences are limited in resource poor countries particularly in Africa. Thus, this systematic review and meta-analysis was carried out to summarize reported long-term treatment outcomes among people on first line therapy in sub-Saharan Africa. METHODS Observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio to compare risk of treatment failure among HIV/AIDS patients who initiated ART with EFV versus NVP were systematically searched. Searches were conducted using the MEDLINE database within PubMed, Google Scholar, HINARI, and Research Gates between 2007 and 2016. Information was extracted using standardized form. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using random-effect, generic inverse variance method. RESULT A total of 6394 articles were identified, of which, 29 were eligible for review and abstraction in sub-Saharan Africa. Seventeen articles were used for the meta-analysis. Of a total of 121,092 independent study participants, 76,719 (63.36%) were females. Of these, 40,480 (33.43%) initiated with NVP containing regimen. Two studies did not report the median CD4 cell counts at initiation. Patients who have low CD4 cell counts initiated with EFV containing regimen. The pooled effect size indicated that treatment failure was reduced by 15%, 0.85 (95%CI: 0.75-0.98), and non-nucleoside reverse transcriptase inhibitor (NNRTI) switch was reduced by 43%, 0.57 (95%CI: 0.37-0.89). CONCLUSION The risk of treatment failure and NNRTI switch were lower in patients who initiated with EFV than NVP-containing regimen. The review suggests that initiation of patients with EFV-containing regimen will reduce treatment failure and NNRTI switch.
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Affiliation(s)
- Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Alemayehu Worku
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yigzaw Kebede
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Adetayo Kasim
- Wolfson Research Institute, Durham University, Durham, UK
| | - Ziv Shkedy
- I-BioStat, Hasselt University, Diepenbeek, Belgium
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