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Hoffmann CJ, Herce ME, Chimoyi L, Smith HJ, Tlali M, Olivier CJ, Topp SM, Muyoyeta M, Reid SE, Hausler H, Charalambous S, Fielding K. Reaching for 90:90:90 in Correctional Facilities in South Africa and Zambia: Virtual Cross-Section of Coverage of HIV Testing and Antiretroviral Therapy During Universal Test and Treat Implementation. J Acquir Immune Defic Syndr 2024; 96:465-471. [PMID: 38985444 DOI: 10.1097/qai.0000000000003456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/11/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND People in correctional settings are a key population for HIV epidemic control. We sought to demonstrate scale-up of universal test and treat in correctional facilities in South Africa and Zambia through a virtual cross-sectional analysis. METHODS We used routine data on 2 dates: At the start of universal test and treat implementation (time 1, T1) and 1 year later (time 2, T2). We obtained correctional facility census lists for the selected dates and matched HIV testing and treatment data to generate virtual cross-sections of HIV care continuum indicators. RESULTS In the South African site, there were 4193 and 3868 people in the facility at times T1 and T2; 43% and 36% were matched with HIV testing or treatment data, respectively. At T1 and T2, respectively, 1803 (43%) and 1386 (36%) had known HIV status, 804 (19%) and 845 (21%) were known to be living with HIV, and 60% and 56% of those with known HIV were receiving antiretroviral therapy (ART). In the Zambian site, there were 1467 and 1366 people in the facility at times T1 and T2; 58% and 92% were matched with HIV testing or treatment data, respectively. At T1 and T2, respectively, 857 (59%) and 1263 (92%) had known HIV status, 277 (19%) and 647 (47%) were known to be living with HIV, and 68% and 68% of those with known HIV were receiving ART. CONCLUSIONS This virtual cross-sectional analysis identified gaps in HIV testing coverage, and ART initiation that was not clearly demonstrated by prior cohort-based studies.
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Affiliation(s)
- Christopher J Hoffmann
- Department of Medicine, Johns Hopkins University, Baltimore, MD
- The Aurum Institute, Johannesburg, South Africa
| | - Michael E Herce
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC
| | | | - Helene J Smith
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Mpho Tlali
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Stephanie M Topp
- College of Public Health Medicine and Veterinary Sciences, James Cook University, Townsville, Australia
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Stewart E Reid
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Department of Family Medicine, School of Medicine, University of Pretoria, Pretoria, South Africa; and
| | - Harry Hausler
- TB HIV Care, Cape Town, South Africa
- Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Katherine Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Annor F, Nartey YA, Abbew ET, Cudjoe O, Ayisi-Addo S, Ashinyo A, Obiri-Yeboah D. Human immunodeficiency virus care and management in incarcerated populations in Sub-Saharan Africa between 2010 and 2022: A narrative review. Int J STD AIDS 2024; 35:80-95. [PMID: 37793133 DOI: 10.1177/09564624231205335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Different countries in sub-Saharan Africa (SSA) have established guidelines to reduce HIV transmission and improve its management in prisons. This narrative review aimed to examine established literature on HIV care and management among incarcerated persons in SSA to identify successful interventions that could inform improved guidelines, policies, and practices related to the clinical care of this population. METHODS We searched PubMed, Scopus, Web of Science, Embase, and TRIP Medical Databases in August 2022 for articles published between 1st January 2010 and 30th June 2022. We identified 27 eligible articles based on the Population/Concept/Context framework. RESULTS HIV screening primarily involved mass campaigns rather than formal prison programmes, with limited implementation of universal testing and treatment. Although a few studies reported on access to antiretrovirals (ARVs), prisoners in urban areas and females had disproportionate access. Barriers identified include poor living conditions, high levels of stigma, and resource constraints. Inter-prison transfers, release from prison, and lack of established programmes hindered follow-up and linkage to care. CONCLUSIONS The implementation of strategies such as universal testing and treatment, human resource strengthening, financing plans for testing, ARV care, and frequent assessment of risk could improve HIV care and management in prisons in SSA.
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Affiliation(s)
- Francis Annor
- Directorate of Research, Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana
| | - Yvonne Ayerki Nartey
- Department of Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Department of Internal Medicine and Therapeutics, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Elizabeth Tabitha Abbew
- Department of Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerpen, Belgium
| | - Obed Cudjoe
- Department of Medical Laboratory Science, University of Cape Coast, Cape Coast, Ghana
| | - Stephen Ayisi-Addo
- National AIDS/STI Control Program of the Ghana Health Service, Accra, Ghana
| | - Anthony Ashinyo
- National AIDS/STI Control Program of the Ghana Health Service, Accra, Ghana
| | - Dorcas Obiri-Yeboah
- Directorate of Research, Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
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Mabuto T, Woznica DM, Ndini P, Moyo D, Abraham M, Hanrahan C, Charalambous S, Zack B, Baral S, Owczarzak J, Hoffmann CJ. Transitional community adherence support for people leaving incarceration in South Africa: a pragmatic, open-label, randomised controlled trial. Lancet HIV 2024; 11:e11-e19. [PMID: 38071994 PMCID: PMC10894448 DOI: 10.1016/s2352-3018(23)00235-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/15/2023] [Accepted: 09/11/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND People released from correctional facilities face multifactorial barriers to continuing HIV treatment. We hypothesised that barriers faced in the first 6 months of community re-entry would be decreased by a multilevel group-based and peer-led intervention, the Transitional Community Adherence Club (TCAC). METHODS We did a pragmatic, open-label, individually randomised controlled trial in five correctional facilities in Gauteng, South Africa. Participants aged 18 years and older and receiving antiretroviral therapy (ART) in correctional facilities were enrolled before release and randomly assigned (1:2) to either passive referral (usual care) or TCACs. TCACs followed a 12-session curriculum over 6 months and were facilitated by trained peer and social workers. Participants were followed up by telephone and in person to assess the primary outcome: post-release enrolment in HIV treatment services at 6 months from the date of release. We did an intention-to-treat analysis to determine the effectiveness of TCACs compared with usual care. The trial was registered with the South African National Clinical Trials Register (DOH-27-0419-605) and ClinicalTrials.gov (NCT03340428). This study is completed and is listed as such on ClinicalTrials.gov. FINDINGS From March 1, to Dec 13, 2019, we screened 222 individuals and enrolled 176 participants who were randomly assigned 1:2 to the usual care group (n=59) or TCACs (n=117). 175 participants were included in the final analysis. In the usual care group, 21 (36%) of 59 participants had enrolled in HIV treatment services at 6 months, compared with 71 (61%) of 116 in the TCAC group (risk ratio 1·7, 95% CI 1·2-2·5; p=0·0010). No adverse events were reported. INTERPRETATION We found strong evidence that a differentiated service delivery model with curriculum and peer support designed specifically to address the needs of people with HIV returning from incarceration improved the primary outcome of enrolment in HIV treatment services. Our approach is a reasonable model to build further HIV treatment continuity interventions for individuals in the criminal justice system in South Africa and elsewhere. FUNDING National Institute of Mental Health.
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Affiliation(s)
- Tonderai Mabuto
- Department of Implementation Research, The Aurum Institute, Johannesburg, South Africa.
| | | | - Pretty Ndini
- Department of Implementation Research, The Aurum Institute, Johannesburg, South Africa
| | - Derrick Moyo
- Department of Implementation Research, The Aurum Institute, Johannesburg, South Africa
| | - Munazza Abraham
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Colleen Hanrahan
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Salome Charalambous
- Department of Implementation Research, The Aurum Institute, Johannesburg, South Africa; The University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jill Owczarzak
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christopher J Hoffmann
- The University of the Witwatersrand School of Public Health, Johannesburg, South Africa; Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Smith HJ, Herce ME, Mwila C, Chisenga P, Yenga C, Chibwe B, Mai V, Kashela L, Nanyagwe M, Hatwiinda S, Moonga CN, Musheke M, Lungu Y, Sikazwe I, Topp SM. Experiences of Justice-Involved People Transitioning to HIV Care in the Community After Prison Release in Lusaka, Zambia: A Qualitative Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00444. [PMID: 37116925 PMCID: PMC10141426 DOI: 10.9745/ghsp-d-22-00444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/15/2023] [Indexed: 04/30/2023]
Abstract
INTRODUCTION In sub-Saharan Africa (SSA), incarcerated people experience a higher HIV burden than the general population. While access to HIV care and treatment for incarcerated people living with HIV (PLHIV) in SSA has improved in some cases, little is known about their transition to and post-release experience with care in the community. To address this gap, we conducted a qualitative study to describe factors that may influence post-release HIV care continuity in Zambia. METHODS In March-December 2018, we recruited study participants from a larger prospective cohort study following incarcerated and newly released PLHIV at 5 correctional facilities in 2 provinces in Zambia. We interviewed 50 participants immediately before release; 27 (54%) participated in a second interview approximately 6 months post-release. Demographic and psychosocial data were collected through a structured survey. RESULTS The pre-release setting was strongly influenced by the highly structured prison environment and assumptions about life post-release. Participants reported accessible HIV services, a destigmatizing environment, and strong informal social supports built through comradery among people facing the same trying detention conditions. Contrary to their pre-release expectations, during the immediate post-release period, participants struggled to negotiate the health system while dealing with unexpected stressors. Long-term engagement in HIV care was possible for participants with strong family support and a high level of self-efficacy. CONCLUSION Our study highlights that recently released PLHIV in Zambia face acute challenges in meeting their basic subsistence needs, as well as social isolation, which can derail linkage to and retention in community HIV care. Releasees are unprepared to face these challenges due to a lack of community support services. To improve HIV care continuity in this population, new transitional care models are needed that develop client self-efficacy, facilitate health system navigation, and pragmatically address structural and psychosocial barriers like poverty, gender inequality, and substance use.
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Affiliation(s)
- Helene J Smith
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Michael E Herce
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Chilambwe Mwila
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Peter Chisenga
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Chisenga Yenga
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Besa Chibwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Vivien Mai
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Lillian Kashela
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Mirriam Nanyagwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sisa Hatwiinda
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Clement N Moonga
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Maurice Musheke
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Yotam Lungu
- Zambia Correctional Service, Government of the Republic of Zambia, Lusaka, Zambia
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
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Lindsay B, Nyirongo N, Mwango L, Toeque MG, Masumba C, Litongola JP, Sikanyika J, Kabombo H, Moyo M, Siachibila S, Mudenda J, Tembo K, Olowski P, Olufunso A, Muchinda E, Musonda B, Okuku J, Mwila A, Moonga CN, Herce ME, Claassen CW. Initial implementation of HIV pre-exposure prophylaxis for people who are incarcerated in Zambia: a cross-sectional observational study. Lancet HIV 2023; 10:e24-e32. [PMID: 36243018 DOI: 10.1016/s2352-3018(22)00220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND There are over 23 000 incarcerated people in Zambia, a population which has higher HIV prevalence than the general population yet has no access to HIV prevention. To evaluate the feasibility of HIV pre-exposure prophylaxis (PrEP) implementation in Zambian criminal justice facilities, we offered PrEP services to incarcerated people and aimed to describe early implementation outcomes. METHODS In this cross-sectional observational study, we implemented a PrEP programme between Oct 1, 2020, and March 31, 2021, supporting 16 criminal justice facilities in four Zambian provinces. Before implementation, we held stakeholder engagement meetings with Zambia Correctional Service officials to discuss PrEP benefits, and trained Zambia Correctional Service health-care workers in PrEP management using the national PrEP training package. People who were incarcerated and screened positive for substantial HIV risk by use of a standardised HIV risk assessment tool were offered voluntary HIV testing and counselling. Those who tested positive were linked to antiretroviral therapy, and those who tested negative and met national HIV prevention eligibility criteria were offered PrEP. We assessed PrEP uptake and used descriptive statistics to characterise programme beneficiaries and the cascade of PrEP services. FINDINGS During the study period, we reached 12 367 people older than 15 years with HIV risk assessment and counselling, including 11 794 (95·4%) men and 573 (4·6%) women. Of these, 2610 people received HIV testing, with 357 (13·7%) testing HIV positive; positivity was significantly higher in women (20·6%) than men (13·2%, p=0·011). 1276 people were identified as HIV negative and PrEP eligible. Of these, 1190 (93·3%) initiated PrEP. The age group with the highest proportion reached and initiated on PrEP was those aged 25-29 years, representing 19·2% (2377 of 12 367) of all people reached and 24·1% (287 of 1190) of those who initiated PrEP. INTERPRETATION Delivery of PrEP to people who are incarcerated is feasible with adequate resourcing and support to the criminal justice health system, and can result in high uptake among eligible individuals. Further assessment is needed of PrEP persistence and adherence, and the perceptions of people who are incarcerated regarding their HIV risk and preferences for combination HIV prevention services. FUNDING US President's Emergency Plan for AIDS Relief through the US Centers for Disease Control and Prevention.
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Affiliation(s)
- Brianna Lindsay
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia; Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Nasho Nyirongo
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | | | - Mona Gekanju Toeque
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia; Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | | | | | - Kalima Tembo
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | - Pawel Olowski
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | | | | | - Bupe Musonda
- Department of Public Health, Ministry of Health, Lusaka, Zambia
| | - Jackson Okuku
- US Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Annie Mwila
- US Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Clement N Moonga
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Michael E Herce
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia; Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Cassidy W Claassen
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia; Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
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Chimoyi L, Charalambous S. The case for pre-exposure prophylaxis in prison settings. Lancet HIV 2023; 10:e3-e4. [PMID: 36243017 DOI: 10.1016/s2352-3018(22)00258-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/06/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Lucy Chimoyi
- The Aurum Institute, Parktown, Johannesburg, South Africa 2193; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Salome Charalambous
- The Aurum Institute, Parktown, Johannesburg, South Africa 2193; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Yale School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA.
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7
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Tuberculosis control at a South African correctional centre: Diagnosis, treatment and strain characterisation. PLoS One 2022; 17:e0277459. [DOI: 10.1371/journal.pone.0277459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Correctional centres provide ideal conditions for tuberculosis (TB) transmission and disease progression. Despite the high TB incidence and incarceration rate in South Africa, data from South African correctional centres are scarce. Thus, the study evaluated TB diagnosis, treatment initiation and completion, and identified prevalent Mycobacterium tuberculosis strains among detainees entering a South African correctional centre.
Methods
This study was a prospective observational study that enrolled participants between February and September 2017 from a correctional centre located in the Western Cape, South Africa. All adult male detainees who tested positive for TB during admission screening were eligible to participate in the study. Sputum samples from enrolled participants underwent smear microscopy and culture. Strain typing was performed on culture-positive samples. The time between specimen collection and diagnosis, the time between diagnosis and treatment initiation, and the proportion of detainees completing TB treatment at the correctional centre were calculated.
Results
During the study period, 130 TB cases were detected through routine admission screening (126 male, 2 female, 2 juvenile). Out of the 126 eligible male detainees, 102 were enrolled in the study (81%, 102/126). All TB cases were detected within 30 hrs of admission screening. The majority (78%, 80/102) of participants started treatment within 48 hrs of TB diagnosis. However, only 8% (9/102) of participants completed treatment at the correction centre. Sputa from 90 of the 102 participants were available for smear and culture. There was a high smear positivity, with 49% (44/90) of isolates being smear positive. The Beijing family was the most frequent lineage (55.2%) in the study.
Conclusion
The strengths of the current TB control efforts at the correctional centre include rapid detection of cases through admission screening and prompt treatment initiation. However, a high number of detainees exiting before treatment completion highlights the need to strengthen links between correctional TB services and community TB services to ensure detainees complete TB treatment after release and prevent TB transmission.
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Mukora R, Smith HJ, Herce ME, Chimoyi L, Hausler H, Fielding KL, Charalambous S, Hoffmann CJ. Costs of implementing universal test and treat in three correctional facilities in South Africa and Zambia. PLoS One 2022; 17:e0272595. [PMID: 36006967 PMCID: PMC9409581 DOI: 10.1371/journal.pone.0272595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 07/21/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Universal test and treat (UTT) is a population-based strategy that aims to ensure widespread HIV testing and rapid antiretroviral therapy (ART) for all who have tested positive regardless of CD4 count to decrease HIV incidence and improve health outcomes. Little is known about the specific resources required to implement UTT in correctional facilities for incarcerated people. The primary aim of this study was to describe the resources used to implement UTT and to provide detailed costing to inform UTT scale-up in similar settings.
Methods
The costing study was a cross-sectional descriptive study conducted in three correctional complexes, Johannesburg Correctional Facility in Johannesburg (>4000 inmates) South Africa, and Brandvlei (~3000 inmates), South Africa and Lusaka Central (~1400 inmates), Zambia. Costing was determined through a survey conducted between September and December 2017 that identified materials and labour used for three separate components of UTT: HIV testing services (HTS), ART initiation, and ART maintenance. Our study participants were staff working in the correctional facilities involved in any activity related to UTT implementation. Unit costs were reported as cost per client served while total costs were reported for all clients seen over a 12-month period.
Results
The cost of HIV testing services (HTS) per client was $ 92.12 at Brandvlei, $ 73.82 at Johannesburg, and $ 65.15 at Lusaka. The largest cost driver for HIV testing at Brandvlei were staff costs at 55.6% of the total cost, while at Johannesburg (56.5%) and Lusaka (86.6%) supplies were the largest contributor. The cost per client initiated on ART was $917 for Brandvlei, $421.8 for Johannesburg, and $252.1 for Lusaka. The activity cost drivers were adherence counselling at Brandvlei (59%), and at Johannesburg and Lusaka it was the actual ART initiation at 75.6% and 75.8%, respectively. The annual unit cost for ART maintenance was $2,640.6 for Brandvlei, $710 for Johannesburg, and $385.5 for Lusaka. The activity cost drivers for all three facilities were side effect monitoring, and initiation of isoniazid preventive treatment (IPT), cotrimoxazole, and fluconazole, with this comprising 44.7% of the total cost at Brandvlei, 88.9% at Johannesburg, and 50.5% at Lusaka.
Conclusion
Given the needs of this population, the opportunity to reach inmates at high risk for HIV, and overall national and global 95-95-95 goals, the UTT policies for incarcerated individuals are of vital importance. Our findings provide comparator costing data and highlight key drivers of UTT cost by facility.
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Affiliation(s)
- Rachel Mukora
- The Aurum Institute, Aurum House, The Ridge, Johannesburg, South Africa
- * E-mail:
| | - Helene J. Smith
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | - Michael E. Herce
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Lucy Chimoyi
- The Aurum Institute, Aurum House, The Ridge, Johannesburg, South Africa
| | | | - Katherine L. Fielding
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Salome Charalambous
- The Aurum Institute, Aurum House, The Ridge, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Christopher J. Hoffmann
- The Aurum Institute, Aurum House, The Ridge, Johannesburg, South Africa
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Ostermann J, Yelverton V, Smith HJ, Nanyangwe M, Kashela L, Chisenga P, Mai V, Mwila C, Herce ME. Preferences for transitional HIV care among people living with HIV recently released from prison in Zambia: a discrete choice experiment. J Int AIDS Soc 2021; 24:e25805. [PMID: 34648690 PMCID: PMC8516367 DOI: 10.1002/jia2.25805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction No studies from sub‐Saharan Africa have attempted to assess HIV service delivery preferences among incarcerated people living with HIV as they transition from prisons to the community (“releasees”). We conducted a discrete choice experiment (DCE) to characterize releasee preferences for transitional HIV care services in Zambia to inform the development of a differentiated service delivery model to promote HIV care continuity for releasees. Methods Between January and October 2019, we enrolled a consecutive sample of 101 releasees from a larger cohort prospectively following 296 releasees from five prisons in Zambia. We administered a DCE eliciting preferences for 12 systematically designed choice scenarios, each presenting three hypothetical transitional care options. Options combined six attributes: (1) clinic type for post‐release HIV care; (2) client focus of healthcare workers; (3) transitional care model type; (4) characteristics of transitional care provider; (5) type of transitional care support; and (6) HIV status disclosure support. We analysed DCE choice data using a mixed logit model, with coefficients describing participants’ average (“mean”) preferences for each option compared to the standard of care and their distributions describing preference variation across participants. Results Most DCE participants were male (n = 84, 83.2%) and had completed primary school (n = 54, 53.5%), with 29 (28.7%) unemployed at follow‐up. Participants had spent an average of 8.2 months in the community prior to the DCE, with 18 (17.8%) reporting an intervening episode of re‐incarceration. While we observed significant preference variation across participants (p < 0.001 for most characteristics), releasees were generally averse to clinics run by community‐based organizations versus government antiretroviral therapy clinics providing post‐release HIV care (mean preference = –0.78, p < 0.001). On average, releasees most preferred livelihood support (mean preference = 1.19, p < 0.001) and HIV care support (mean preference = 1.00, p < 0.001) delivered by support groups involving people living with HIV (mean preference = 1.24, p < 0.001). Conclusions We identified preferred characteristics of transitional HIV care that can form the basis for differentiated service delivery models for prison releasees. Such models should offer client‐centred care in trusted clinics, provide individualized HIV care support delivered by support groups and/or peer navigators, and strengthen linkages to programs providing livelihood support.
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Affiliation(s)
- Jan Ostermann
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, South Carolina, USA.,Center for Health Policy & Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Valerie Yelverton
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Helene J Smith
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.,School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mirriam Nanyangwe
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Lillian Kashela
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Peter Chisenga
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Vivien Mai
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Chilambwe Mwila
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Michael E Herce
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.,Institute for Global Health & Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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10
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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.
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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
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11
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Velen K, Charalambous S. Tuberculosis in prisons: an unintended sentence? LANCET PUBLIC HEALTH 2021; 6:e263-e264. [PMID: 33765454 DOI: 10.1016/s2468-2667(21)00049-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa; School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
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12
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Smith HJ, Topp SM, Hoffmann CJ, Ndlovu T, Charalambous S, Murray L, Kane J, Sikazwe I, Muyoyeta M, Herce ME. Addressing Common Mental Health Disorders Among Incarcerated People Living with HIV: Insights from Implementation Science for Service Integration and Delivery. Curr HIV/AIDS Rep 2021; 17:438-449. [PMID: 32779099 DOI: 10.1007/s11904-020-00518-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Despite evidence of disproportionate burden of HIV and mental health disorders among incarcerated people, scarce services exist to address common mental health disorders, including major depressive and anxiety disorders, post-traumatic stress disorder, and substance use disorders, among incarcerated people living with HIV (PLHIV) in sub-Saharan Africa (SSA). This paper aims to summarize current knowledge on mental health interventions of relevance to incarcerated PLHIV and apply implementation science theory to highlight strategies and approaches to deliver mental health services for PLHIV in correctional settings in SSA. RECENT FINDINGS Scarce evidence-based mental health interventions have been rigorously evaluated among incarcerated PLHIV in SSA. Emerging evidence from low- and middle-income countries and correctional settings outside SSA point to a role for cognitive behavioral therapy-based talking and group interventions implemented using task-shifting strategies involving lay health workers and peer educators. Several mental health interventions and implementation strategies hold promise for addressing common mental health disorders among incarcerated PLHIV in SSA. However, to deliver these approaches, there must first be pragmatic efforts to build corrections health system capacity, address human rights abuses that exacerbate HIV and mental health, and re-conceptualize mental health services as integral to quality HIV service delivery and universal access to primary healthcare for all incarcerated people.
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Affiliation(s)
- Helene J Smith
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | | | - Christopher J Hoffmann
- The Aurum Institute, Johannesburg, South Africa
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa
- University of the Witwatersrand Johannesburg, Johannesburg, South Africa
| | | | | | - Izukanji Sikazwe
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Monde Muyoyeta
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Michael E Herce
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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13
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Herce ME, Hoffmann CJ, Fielding K, Topp SM, Hausler H, Chimoyi L, Smith HJ, Chetty-Makkan CM, Mukora R, Tlali M, Olivier AJ, Muyoyeta M, Reid SE, Charalambous S. Universal test-and-treat in Zambian and South African correctional facilities: a multisite prospective cohort study. Lancet HIV 2020; 7:e807-e816. [PMID: 32763152 DOI: 10.1016/s2352-3018(20)30188-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Despite the global scale-up of antiretroviral therapy (ART), incarcerated people have not benefited equally from test-and-treat recommendations for HIV. To improve access to ART for incarcerated people with HIV, we introduced a universal test-and-treat (UTT) intervention in correctional facilities in South Africa and Zambia, and aimed to assess UTT feasibility and clinical outcomes. METHODS Treatment as Prevention (TasP) was a multisite, mixed methods, implementation research study done at three correctional complexes in South Africa (Johnannesburg and Breede River) and Zambia (Lusaka). Here, we report the clinical outcomes for a prospective cohort of incarcerated individuals who were offered the TasP UTT intervention. Incarcerated individuals were eligible for inclusion if they were aged 18 years or older, with new or previously diagnosed HIV, not yet on ART, and were expected to remain incarcerated for 30 days or longer. To enable the implementation of UTT at the included correctional facilities, we first strengthened on-site HIV service delivery. All participants were offered same-day ART initiation, and had two study-specific follow-up visits scheduled to coincide with routine clinic visits at 6 and 12 months. The main outcomes were ART uptake, time from cohort enrolment to ART initiation, and retention in care and viral suppression at 6 and 12 months. We estimated the association between baseline demographic characteristics and time to ART initiation using Cox proportional hazard models, and, in a post-hoc analysis, we used logistic regression models to assess the association between demographic and clinical variables, including time to ART initiation, and the proportion of participants with a composite poor outcome (defined as viral load >50 copies per mL, or for participants with a missing viral load, lack of retention in care in the on-site ART programme) at 6 months. This study is registered at ClinicalTrials.gov, NCT02946762. FINDINGS Between June 23, 2016, and Dec 31, 2017, we identified 1562 incarcerated people with HIV, of whom 1389 (89%) were screened, 1021 (74%) met eligibility criteria, and 975 (95%) were enrolled and followed up to March 31, 2018. At the end of follow-up, 835 (86%) of 975 participants had started ART. Median time from enrolment to ART initiation was 0 days (IQR 0-8). Of 346 participants who remained incarcerated at 6 months, 327 (95%) were retained in care and 269 (78%) had a documented viral load, of whom 262 (97%) achieved viral suppression (<1000 copies per mL). The mortality rate among the 835 participants who had initiated ART was 1·9 per 100 person-years (95% CI 0·9-3·9). No statistically significant associations were identified between any baseline characteristics and time to ART initiation or composite poor outcome. INTERPRETATION UTT implementation is feasible in correctional settings, and can achieve levels of same-day ART uptake, retention in care, and viral suppression among incarcerated people with HIV that are comparable to those observed in community settings. FUNDING UK Department for International Development, Swedish International Development Cooperation Agency, Norwegian Agency for Development Cooperation.
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Affiliation(s)
- Michael E Herce
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia; Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Christopher J Hoffmann
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA; The Aurum Institute, Johannesburg, South Africa
| | - Katherine Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, QLD, Australia
| | | | | | - Helene J Smith
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Candice M Chetty-Makkan
- The Aurum Institute, Johannesburg, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Mpho Tlali
- The Aurum Institute, Johannesburg, South Africa
| | | | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Stewart E Reid
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia; Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Stevenson KA, Podewils LJ, Zishiri VK, Castro KG, Charalambous S. HIV prevalence and the cascade of care in five South African correctional facilities. PLoS One 2020; 15:e0235178. [PMID: 32614878 PMCID: PMC7332003 DOI: 10.1371/journal.pone.0235178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/09/2020] [Indexed: 01/24/2023] Open
Abstract
Background South Africa is home to the world’s largest HIV epidemic. Throughout the world, incarcerated individuals have a higher prevalence of HIV than the general public, and South Africa has one of the highest rates of incarceration in sub-Saharan Africa. In spite of this, little has been published about the burden of HIV and how care is delivered in South African correctional facilities. Objective To estimate the prevalence of people living with HIV and identify initiation and retention in the HIV cascade of care across five correctional facilities. Methods Cross-sectional retrospective analysis of 30,571 adult inmates who participated in a tuberculosis screening and HIV counseling and testing campaign in South African correctional facilities (January 1, 2014—January 31, 2015). Descriptive statistics were used to estimate the proportion and 95% confidence intervals of HIV. Proportions of persons retained and lost at each step in the HIV cascade of care under this intervention were calculated. Poisson regression with robust variance estimates were used, and clustering by facility was accounted for in all analyses. Results Results of the screening campaign found previously undiagnosed HIV among 13.0% of those consenting to screening, with a total estimated HIV prevalence of 17.7% (n = 3,184, 95% CI: 17.2–18.3%) in the sample. When examining the overall cascade of care, 48.3% of those with HIV initiated care, and overall 45.6% of persons who entered care qualified for ART initiated treatment. A Poisson regression accounting for clustering by facility found HIV high risk groups within the population such as women (aRR = 1.72, 95% CI: 1.57, 1.89), those over 35 years of age (aRR = 2.43, 95% CI: 1.53, 3.85), and people incarcerated less than one year (aRR = 1.41, 95% CI: 1.19, 1.67). Conclusion In this setting, routine screening is recommended, and measures are needed to ensure that persons diagnosed are adequately linked to and retained in care.
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Affiliation(s)
- Kelsey A. Stevenson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Laura J. Podewils
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | | | - Kenneth G. Castro
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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