1
|
Gondwe A, Amberbir A, Singogo E, Berman J, Singano V, Theu J, Gaven S, Mwapasa V, Hosseinipour MC, Paul M, Chiwaula L, van Oosterhout JJ. Prisoners' access to HIV services in southern Malawi: a cross-sectional mixed methods study. BMC Public Health 2021; 21:813. [PMID: 33910547 PMCID: PMC8080321 DOI: 10.1186/s12889-021-10870-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The prevalence of Human Immunodeficiency Virus (HIV) among prisoners remains high in many countries, especially in Africa, despite a global decrease in HIV incidence. Programs to reach incarcerated populations with HIV services have been implemented in Malawi, but the success of these initiatives is uncertain. We explored which challenges prisoners face in receiving essential HIV services and whether HIV risk behavior is prevalent in prisons. METHODS We conducted a mixed-methods (qualitative and quantitative), cross-sectional study in 2018 in six prisons in Southern Malawi, two large central prisons with on-site, non-governmental organization (NGO) supported clinics and 4 smaller rural prisons. Four hundred twelve prisoners were randomly selected and completed a structured questionnaire. We conducted in-depth interviews with 39 prisoners living with HIV, which we recorded, transcribed and translated. We used descriptive statistics and logistic regression to analyze quantitative data and content analysis for qualitative data. RESULTS The majority of prisoners (93.2%) were male, 61.4% were married and 63.1% were incarcerated for 1-5 years. Comprehensive services were reported to be available in the two large, urban prisons. Female prisoners reported having less access to general medical services than males. HIV risk behavior was reported infrequently and was associated with incarceration in urban prisons (adjusted odds ratio [aOR] 18.43; 95% confidence interval [95%-CI] 7.59-44.74; p = < 0.001) and not being married (aOR 17.71; 95%-CI 6.95-45.13; p = < 0.001). In-depth interviews revealed that prisoners living with HIV experienced delays in referrals for more severe illnesses. Prisoners emphasized the detrimental impact of poor living conditions on their personal health and their ability to adhere to antiretroviral therapy (ART). CONCLUSIONS Malawian prisoners reported adequate knowledge about HIV services albeit with gaps in specific areas. Prisoners from smaller, rural prisons had suboptimal access to comprehensive HIV services and female prisoners reported having less access to health care than males. Prisoners have great concern about their poor living conditions affecting general health and adherence to ART. These findings provide guidance for improvement of HIV services and general health care in Malawian institutionalized populations such as prisoners.
Collapse
Affiliation(s)
- Austrida Gondwe
- Dignitas International, P. O Box 1071, C/O Box 333, Zomba, Malawi.
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | | | - Emmanuel Singogo
- Dignitas International, P. O Box 1071, C/O Box 333, Zomba, Malawi
| | - Joshua Berman
- Dignitas International, P. O Box 1071, C/O Box 333, Zomba, Malawi
| | - Victor Singano
- Dignitas International, P. O Box 1071, C/O Box 333, Zomba, Malawi
| | - Joe Theu
- Dignitas International, P. O Box 1071, C/O Box 333, Zomba, Malawi
| | - Steven Gaven
- Dignitas International, P. O Box 1071, C/O Box 333, Zomba, Malawi
| | - Victor Mwapasa
- College of Medicine, P/Bag 360, Chichiri, Blantyre, Malawi
| | - Mina C Hosseinipour
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- University of North Carolina-Malawi Project, Tidziwe Centre, P/Bag A-104, Lilongwe, Malawi
| | - Magren Paul
- Chichiri Prison, P/Bag 30117, Blantyre 3, Blantyre, Malawi
| | | | - Joep J van Oosterhout
- Dignitas International, P. O Box 1071, C/O Box 333, Zomba, Malawi
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| |
Collapse
|
2
|
Wali A, Khan D, Safdar N, Shawani Z, Fatima R, Yaqoob A, Qadir A, Ahmed S, Rashid H, Ahmed B, Khan S. Prevalence of tuberculosis, HIV/AIDS, and hepatitis; in a prison of Balochistan: a cross-sectional survey. BMC Public Health 2019; 19:1631. [PMID: 31801496 PMCID: PMC6894348 DOI: 10.1186/s12889-019-8011-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/27/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV), Hepatitis, and Tuberculosis (TB) are three primary communicable infections have the likely potential to cause severe morbidity in prison settings. The prison has the most favorable environment for the transmission of infections. We conducted this survey to determine the prevalence and feasibility of rapid diagnostic tests in an active screening of these infectious diseases in prison. METHODS This cross-sectional survey conducted in central Jail Gaddani, one of the largest prisons in the Balochistan province of Pakistan. All prisoners, jail staffs, and staff's family members participated. Informed consent obtained from each participant before the screening. Van equipped with digital X-ray linked with Computer-Aided Detection for TB (CAD4TB) software used for testing. Sputum samples tested on Xpert for MTB/RIF assay and blood specimens collected for HIV and hepatitis serology. Diagnosed TB patients enrolled for treatment at Basic Management Unit (BMU), reactive on hepatitis Rapid Diagnostic Tools (RDTs) were referred for further testing and management, while HIV reactive referred to Anti Retro Viral (ARV) center for Anti Retro Viral Treatment (ART). RESULTS A total of 567 participants offered screening, 63% (356) prisoners, 23% (129) staff's family members, and 14% (82) jail staffs. Among tested 10.3% (58/562) were hepatitis seropositive (Hepatitis-C 41 [7.29%] Hepatitis-B, 16 [2.84%] Hepatitis B&C both, 01 [0.17%]). In reactive participants, 49 were prisoners, 08 were jail staffs, and 01 was the staff's family member. HIV seropositive was 4% (24/566), and all were prisoners. Almost 99% (565/567) screened by digital X-ray, 172 (30%) were with abnormal CAD4TB suggestion (score > 50), out of them sputum of 26% (148) tested on Xpert, and 2% (03) found Mycobacterium tuberculosis Positive (MTB+). A total of five TB patients were detected; out of two were diagnosed clinically. Co-morbidities observed in 15 patients, (01 TB/HIV co-infected, 12 HIV/HCV, 01 HIV/HBV, and 01 HBV/HCV). CONCLUSION The high frequency of infectious diseases in prison is alarming. For limiting the transmission of infections among prison and community, immediate steps are needed to be taken for improvement of prisons condition by application of recommended screening protocols at the time of the first entry of prisoners in prisons.
Collapse
Affiliation(s)
- Ahmad Wali
- Provincial Tuberculosis Control Program, Health Department Government of Balochistan, Building Western Bypass Link Brewery Road, Quetta, Balochistan, Pakistan. .,National Tuberculosis Control Program, Ministry of NHSR&C, Islamabad, Pakistan.
| | - Dawood Khan
- Provincial AIDS Control Program, Quetta, Balochistan, Pakistan
| | - Nauman Safdar
- Social and Health Inequalities Network Pakistan, Quetta, Pakistan.,University of Bergen, Bergen, Norway
| | - Zeenat Shawani
- Provincial Tuberculosis Control Program, Health Department Government of Balochistan, Building Western Bypass Link Brewery Road, Quetta, Balochistan, Pakistan
| | - Razia Fatima
- National Tuberculosis Control Program, Ministry of NHSR&C, Islamabad, Pakistan
| | - Aashifa Yaqoob
- National Tuberculosis Control Program, Ministry of NHSR&C, Islamabad, Pakistan
| | - Aurangzeb Qadir
- National Tuberculosis Control Program, Ministry of NHSR&C, Islamabad, Pakistan
| | - Sultan Ahmed
- Provincial Tuberculosis Control Program, Health Department Government of Balochistan, Building Western Bypass Link Brewery Road, Quetta, Balochistan, Pakistan
| | | | - Bashir Ahmed
- Provincial Tuberculosis Control Program, Health Department Government of Balochistan, Building Western Bypass Link Brewery Road, Quetta, Balochistan, Pakistan
| | - Shereen Khan
- Faculty of Bolan Medical University, Quetta, Pakistan
| |
Collapse
|
3
|
Epidemiology of hepatitis B, C and D in Malawi: systematic review. BMC Infect Dis 2018; 18:516. [PMID: 30314448 PMCID: PMC6186098 DOI: 10.1186/s12879-018-3428-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/01/2018] [Indexed: 12/20/2022] Open
Abstract
Background Viral hepatitis is an important public health issue in sub-Saharan Africa. Due to rising mortality from cirrhosis and hepatocellular carcinoma and limited implementation of screening and treatment programmes, it has been characterised as a neglected tropical disease. Synthesis of the existing evidence on the epidemiology of viral hepatitis B, C and D in Malawi is required to inform policy and identify research gaps. Methods We searched Pubmed, EMBASE and Scopus for studies reporting the epidemiology of viral hepatitis B, C and D in Malawi from 1990 to 2018. Articles reporting prevalence estimates were included provided they described details of participant selection, inclusion criteria and laboratory methods (detection of HBsAg, anti-HCV or anti-HDV antibody, HCV antigen or HCV RNA or HDV RNA). We assessed study quality using a prevalence assessment tool. Where appropriate, a pooled prevalence was calculated using a DerSimonian Laird random effects model. Results Searches identified 199 studies, 95 full text articles were reviewed and 19 articles were included. Hepatitis B surface antigen (HBsAg) seroprevalence was assessed in 14 general population cohorts. The pooled prevalence among adults was 8.1% (95% CI 6.1, 10.3). In 3 studies where HBsAg was stratified by HIV status, no effect of HIV on HBsAg prevalence was observed (OR 1.2 (95% CI: 0.8, 1.6, p = 0.80)). In a single study of HIV/HBV infected individuals, anti-hepatitis D antibody (anti-HDV) prevalence was low (1.5%). HCV antibody prevalence (anti-HCV) ranged from 0.7 to 18.0% among 12 cohorts in general populations. Among three studies which used PCR to confirm current infection, the pooled rate of HCV RNA confirmation among anti-HCV positive individuals was only 7.3% (95% CI: 0.0, 24.3). Conclusions Hepatitis B is highly prevalent in Malawi. There is a paucity of epidemiological data from rural areas where 85% of the population reside, and the Northern region. Priority research needs include large-scale representative community studies of HBV, HDV and HCV seroprevalence, assessment of children following introduction of the HBV vaccine in 2002, prevalence estimates of viral hepatitis among individuals with cirrhosis and HCC and data on HCV prevalence using PCR confirmation, to support a viral hepatitis strategy for Malawi. Electronic supplementary material The online version of this article (10.1186/s12879-018-3428-7) contains supplementary material, which is available to authorized users.
Collapse
|
4
|
Demir M, Phiri S, Kaiser R, Chaweza T, Neuhann F, Tweya H, Fätkenheuer G, Steffen HM. HIV/Hepatitis C Virus Co-infection among Adults Beginning Antiretroviral Therapy, Malawi. Emerg Infect Dis 2018; 22:2018-2020. [PMID: 27767917 PMCID: PMC5088011 DOI: 10.3201/eid2211.160892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
5
|
Mugomeri E, Senauoane MB, Ruhanya V, Chin'ombe N, Nyandoro G. Occurrence of HBV/HIV coinfection by laboratory values in Roma, Lesotho. Germs 2015; 5:8-11. [PMID: 25763362 DOI: 10.11599/germs.2015.1065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 12/07/2014] [Accepted: 12/28/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study was an assessment of the coinfection status of patients with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) in Lesotho, and this has been rarely reported. METHODS This was a retrospective study, in a laboratory setting, on HBV/HIV coinfection among 304 HIV-positive patients who were screened for HBsAg in St Joseph's Hospital records between March 2011 and December 2013. Demographic characteristics, HIV status, indications for HBsAg screening, HBsAg results and liver function test results including alanine transaminase (ALT), aspartate transaminase (AST) and alkaline phosphatase were reviewed from the patient and laboratory registers. RESULTS In this study 10.5% of 304 HIV-positive patients had HBV/HIV coinfection. With respect to gender, males had a significantly higher (p=0.048) rate of HBV/HIV coinfection in this study. Increased levels of ALT (p=0.013) and AST (p=0.014) were significantly associated with HBV/HIV coinfection status. CONCLUSION Gender and liver function tests are important predictors for HBV/HIV coinfection. Screening for HBV coinfection in HIV-positive patients is recommended.
Collapse
Affiliation(s)
- Eltony Mugomeri
- MTech, Department of Pharmacy, National University of Lesotho, Maseru, Lesotho
| | | | - Vurayai Ruhanya
- MSc, Department of Medical Microbiology, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - Nyasha Chin'ombe
- PhD, Department of Medical Microbiology, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - George Nyandoro
- MSc, Department of Medical Microbiology, University of Zimbabwe, Avondale, Harare, Zimbabwe
| |
Collapse
|
6
|
Fox JM, Newton R, Bedaj M, Keding A, Molyneux E, Carpenter LM, Martin F, Mutalima N. Prevalence of hepatitis C virus in mothers and their children in Malawi. Trop Med Int Health 2015; 20:638-642. [PMID: 25611121 PMCID: PMC4418396 DOI: 10.1111/tmi.12465] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objectives Hepatitis C virus (HCV) prevalence is poorly mapped in the East African region; with the advent of novel HCV therapies, better epidemiological data are required to target the infection. We sought to estimate HCV prevalence in healthy Malawian mothers and assess mother-to-child transmission (MTCT); context is provided by reviewing previously published HCV prevalence data from the region. Methods Using ELISA screening and confirmatory blot, serological testing of 418 healthy Malawian mothers for HCV was performed. To examine MTCT, the children of any positive women were also tested for HCV; all children had malignant disease unrelated to hepatocellular carcinoma. We compared our results to published literature on HCV prevalence in Malawi and its neighbouring countries. Results Three of 418 women were HCV reactive by ELISA; two were confirmed positive by immunoblot (0.5%). One child of an HCV-infected mother was HCV seropositive. The literature review revealed HCV prevalence ranging from 0 to 7.2% in the region, being highest in Tanzania and specifically for cohorts of inpatients and HIV-co-infected people. The overall estimated prevalence of HCV in Malawi was 1.0% (95%CI 0.7–1.4) when all studies were included (including this one), but lower in healthy cohorts alone at 0.3% (95%CI 0.1–1.2). Conclusions This is the first study using confirmatory tests to examine HCV prevalence in healthy Malawian mothers; the prevalence was low. Future studies need to address the source of infection in healthy women.
Collapse
Affiliation(s)
- James M Fox
- Centre for Immunology and Infection, University of York, York, UK
| | - Robert Newton
- Epidemiology and Cancer Statistics Group, University of York, York, UK.,MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Marija Bedaj
- Centre for Immunology and Infection, University of York, York, UK
| | - Ada Keding
- York Trials Unit, University of York, York, UK
| | | | | | - Fabiola Martin
- Centre for Immunology and Infection, University of York, York, UK
| | - Nora Mutalima
- Epidemiology and Cancer Statistics Group, University of York, York, UK
| |
Collapse
|