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Njuguna N, Akolo C, Anzala O, Baeten JM, Heffron R, Mugo NR, Bateganya M. Differentiated Service Delivery Models for Maintaining HIV Treatment and Prevention Services During Crisis and Disease Outbreaks: Lessons from the COVID-19 Pandemic. Curr HIV/AIDS Rep 2024:10.1007/s11904-024-00703-2. [PMID: 39052142 DOI: 10.1007/s11904-024-00703-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE OF REVIEW This review summarizes differentiated service delivery (DSD) models for HIV treatment and prevention that have been adapted for maintaining continuity of services during the COVID-19 pandemic and proposes strategies for sustaining their benefits now and during future disruptions. RECENT FINDINGS The COVID-19 pandemic resulted in an overburdened and disrupted health system, forcing countries to adopt and/or scale up DSD models for HIV services. While initially implemented as emergency measures, these models evolved and were refined over time to fit recipient needs ensuring continued HIV treatment and prevention services with minimal health system impact. Successful models employed task shifting, community-based delivery models, multimonth scripting and dispensing, and telehealth for remote consultation. DSD models enabled HIV services globally to be maintained during the COVID-19 pandemic. Though these models and adaptations were critical in addressing health gaps and disruptions caused by the pandemic, they were beneficial in improving efficiency and access to client-centered services and should be sustained.
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Affiliation(s)
- Njambi Njuguna
- FHI 360, Nairobi, Kenya.
- University of Nairobi, Nairobi, Kenya.
| | | | | | | | | | - Nelly R Mugo
- Kenya Medical Research Institute, Nairobi, Kenya
- University of Washington, Seattle, WA, USA
| | - Moses Bateganya
- United States Agency for International Development, Dar es Salaam, Tanzania
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Sukmaningrum E, Levy J, Negara MD, Devika D, Wardhani BDK, Wulandari LPL, Januraga PP. Lived experience, social support, and challenges to health service use during the COVID-19 pandemic among HIV key populations in Indonesia. BMC Health Serv Res 2024; 24:774. [PMID: 38956516 PMCID: PMC11218143 DOI: 10.1186/s12913-024-11227-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 06/20/2024] [Indexed: 07/04/2024] Open
Abstract
The COVID-19 pandemic has greatly affected the lives, health, and social well-being of people globally including presenting special challenges in low to middle income countries for people living with HIV. This study investigates the pandemic experiences of the four key HIV-positive populations in Indonesia: men who have sex with men, transgender women, female sex workers, and people who use drugs. In-depth interviews were conducted with a convenience sample of 22 key population members recruited through 9 nongovernment HIV agencies in Jakarta and Bali, Indonesia. Indonesia's Large-scale Social Restrictions Policy mandating physical distancing and stay-at-home orders had been in effect for 7-10 months at the time of the interviews. The interviews were audio-recorded, transcribed, and coded using NVivo™ (R1.7) software. A grounded theory approach identified key concepts along with similarities, differences, and reoccurring patterns of COVID-19 lived experience among participants. Participants recounted the impact of both the pandemic and the Restriction Policy on their interpersonal, financial, medical, and psychosocial well-being. When in need, they turned to formal and informal sources of financial and social support plus their own resourcefulness. Along with other factors, HIV medication shortages, HIV and COVID-19 related stigma, and fear of acquiring COVID-19 negatively impacted their antiretroviral adherence and the use of health services. The results point to the latent consequences of government attempts to curb a pandemic through public health lockdowns and enforced policies of physical separation. Its findings reveal the importance of ensuring that public safety nets for HIV key populations are available to supplement more informal personal sources of needed support.
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Affiliation(s)
- Evi Sukmaningrum
- Faculty of Psychology, Atma Jaya Catholic University of Indonesia, Jakarta, 12930, Indonesia.
- AIDS Research Centre Health Policy and Social Innovation, University Centre of Excellence, Atma Jaya Catholic University of Indonesia, Jakarta, 12930, Indonesia.
| | - Judith Levy
- University of Illinois at Chicago, Illinois, 60302, USA
| | - Made Diah Negara
- AIDS Research Centre Health Policy and Social Innovation, University Centre of Excellence, Atma Jaya Catholic University of Indonesia, Jakarta, 12930, Indonesia
| | - Devika Devika
- AIDS Research Centre Health Policy and Social Innovation, University Centre of Excellence, Atma Jaya Catholic University of Indonesia, Jakarta, 12930, Indonesia
| | - Brigitta Dhyah K Wardhani
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, 80113, Indonesia
| | | | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, 80113, Indonesia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, 80113, Indonesia
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Ntinga X, Musiello F, Pita T, Mabaso N, Celum C, Szpiro A, van Rooyen H, Barnabas R, van Heerden A. People living with HIV's perspectives of acceptability of fee for home delivery of ART: a qualitative study. BMC Health Serv Res 2024; 24:88. [PMID: 38233824 PMCID: PMC10792944 DOI: 10.1186/s12913-023-10533-4] [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: 08/18/2023] [Accepted: 12/27/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Significant progress has been made in the HIV response in South Africa; however, gaps remain in ensuring engagement in care to support life-long medication adherence and viral suppression. The National Department of Health (NDoH) has introduced community-based and clinic-based HIV differentiated service delivery (DSD) models to tackle suboptimal adherence and retention in care. Nevertheless, differentiated care models require adaptation to better serve clients who struggle with adherence. There is limited research on the acceptability of fee for home delivery of ART in resource-constrained settings. The current study investigates the acceptability of fee for home delivery of ART among people living with HIV in South Africa. METHODS Two mixed-gender focus group discussions (FGDs) took place between June and November 2019, consisting of 10 participants in each group. A purposive sampling strategy was employed to identify and select 10 people living with HIV who were ART-eligible but not in care, and 10 people living with HIV who were currently taking ART and in care. Participants were grouped according to their treatment status. A coding framework, informed by a priori categories and derived from topics in the interview guide, was developed and utilized to facilitate analysis. RESULTS Participants expressed enthusiasm for having ART home-delivered, as it would save the time spent waiting in long queues at the clinic. However, some participants raised concerns about potential payment difficulties due to high unemployment rates in the community. Some participants believed this would be acceptable, as patients already incur costs for travel and food when visiting the clinic. Participants in both FGDs expressed strong concerns about home delivery of their ART based on fear of accidental disclosure, especially for those who have not disclosed to their immediate families and partners. CONCLUSION Our study suggests that charging a fee for home delivery is an acceptable and innovative approach to supporting PLHIV in maintaining adherence to their medication and remaining in care.
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Affiliation(s)
- Xolani Ntinga
- Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, Sweetwaters, Pietermaritzburg, KZN, 3201, South Africa.
| | - Franco Musiello
- Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, Sweetwaters, Pietermaritzburg, KZN, 3201, South Africa
| | - Thembelihle Pita
- Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, Sweetwaters, Pietermaritzburg, KZN, 3201, South Africa
| | - Nomagugu Mabaso
- Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, Sweetwaters, Pietermaritzburg, KZN, 3201, South Africa
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, WA, USA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Adam Szpiro
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Heidi van Rooyen
- Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, Sweetwaters, Pietermaritzburg, KZN, 3201, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ruanne Barnabas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Alastair van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, Sweetwaters, Pietermaritzburg, KZN, 3201, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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Mude W, Mwenyango H, Preston R, O'Mullan C, Vaughan G, Jones G. HIV Testing Disruptions and Service Adaptations During the COVID-19 Pandemic: A Systematic Literature Review. AIDS Behav 2024; 28:186-200. [PMID: 37548796 PMCID: PMC10803448 DOI: 10.1007/s10461-023-04139-4] [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] [Accepted: 07/12/2023] [Indexed: 08/08/2023]
Abstract
Access to treatment and care in safe clinical settings improves people's lives with HIV. The COVID-19 pandemic disrupted vital HIV programs and services, increasing the risk of adverse health outcomes for people with HIV and HIV transmission rates in the community. This systematic literature review provides a meta-analysis of HIV testing disruptions and a synthesis of HIV/AIDS services adapted during COVID-19. We searched scholarly databases from 01 January 2020 to 30 June 2022 using key terms on HIV testing rates and services during the COVID-19 pandemic. The process of how the included articles were identified, selected, appraised, and synthesised was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included 17 articles that reported changes in HIV testing during the COVID-19 pandemic and 22 that reported adaptations in HIV/AIDS services. We found that HIV testing decreased by 37% during the search period because of the COVID-19 pandemic. Service providers adopted novel strategies to support remote service delivery by expanding community antiretroviral therapy dispensing, setting up primary care outreach points, and instituting multi-month dispensing services to sustain client care. Therefore, service providers and policymakers should explore alternative strategies to increase HIV testing rates impacted by COVID-19 and leverage funding to continue providing the identified adapted services.
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Affiliation(s)
- William Mude
- School of Health Medical and Applied Sciences, Central Queensland University, Cairns Campus, 42-52 Abbott Street & Shields Street, Cairns, QLD, 4870, Australia.
| | - Hadijah Mwenyango
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4BN, UK
| | - Robyn Preston
- School of Health Medical and Applied Sciences, Central Queensland University, Townsville Campus, Townsville, Australia
| | - Catherine O'Mullan
- School of Health Medical and Applied Sciences, Central Queensland University, Bundaberg Campus, Bundaberg, Australia
| | - Geraldine Vaughan
- School of Health Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, Australia
| | - Gary Jones
- Cohort Doctoral Studies Program, James Cook University, Cairns, Australia
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Di Ciaccio M, Bourhaba O, Khoury C, Assi A, Abu Zaki S, Lorente N, Castro Avila J, Niyongabo A, Gakima D, Diouh A, Riegel L, Ben Moussa A, Girard G, Karkouri M, Delabre RM, Rojas Castro D. How Community-Based Organizations Responded to the Covid-19 Crisis to Maintain HIV Services Among Vulnerable Populations in Burundi, Mauritania, and Lebanon: Qualitative Results From the Multicountry EPIC Program. J Int Assoc Provid AIDS Care 2024; 23:23259582241263686. [PMID: 39110012 PMCID: PMC11307353 DOI: 10.1177/23259582241263686] [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: 10/06/2023] [Revised: 03/13/2024] [Accepted: 06/03/2024] [Indexed: 08/10/2024] Open
Abstract
Little is known about the adaption of community-based organizations (CBOs) during the COVID-19 crisis. This study aimed to study how HIV CBOs and their community health workers (CHWs) faced the COVID-19 outbreak. Semi-structured interviews (n = 53) were conducted among CHWs in Burundi, Mauritania, and Lebanon in 2021. A thematic content analysis was performed. Results showed that CBOs had succeeded in maintaining HIV services and integrated COVID-19 prevention and awareness in their activities. COVID-19 led to innovation in terms of HIV services (eg, telemedicine and online psychosocial support) and to opportunities to try new modalities of antiretroviral therapy dispensation. Field workers (a specific group among CHWs) were negatively impacted by the COVID-19 crisis and showed resilience in their adaptation to ensure the continuity of their activities. Considering the essential role of field workers during the crisis, their status and the sustainability of their activities should be clearly supported by health policies and programs.
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Affiliation(s)
| | - Othmane Bourhaba
- Association de Lutte Contre le Sida (ALCS), Casablanca, Morocco
- Community-based Research Laboratory, Coalition PLUS, Dakar, Senegal
| | | | - Ayman Assi
- Marsa-Sexual Health Center, Beirut, Lebanon
| | | | - Nicolas Lorente
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Departament de Salut, Generalitat de Catalunya, Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Badalona, España
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | | | - Annabelle Niyongabo
- Community-based Research Laboratory, Coalition PLUS, Dakar, Senegal
- Association Nationale de Soutien aux Séropositifs et malades du sida, Bujumbura, Burundi
| | - Dévote Gakima
- Association Nationale de Soutien aux Séropositifs et malades du sida, Bujumbura, Burundi
| | | | - Lucas Riegel
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | - Amal Ben Moussa
- Association de Lutte Contre le Sida (ALCS), Casablanca, Morocco
| | - Gabriel Girard
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Mehdi Karkouri
- Association de Lutte Contre le Sida (ALCS), Casablanca, Morocco
| | | | - Daniela Rojas Castro
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
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Joves PJM, Matulac MO, Pagcatipunan RS. Barriers to Antiretroviral Medication Adherence in People Living with HIV (PLHIV) at the Time of the COVID-19 Pandemic in the Philippines. Trop Med Infect Dis 2023; 8:461. [PMID: 37888589 PMCID: PMC10610625 DOI: 10.3390/tropicalmed8100461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Background: During the COVID-19 pandemic, the HIV crisis in the Philippines worsened and triggered a chain reaction that disrupted the provision and utilization of HIV services. This study aims to fill in the gap in knowledge by exploring the possible association between sociodemographic characteristics and the barriers to ART adherence for PLHIV in the Philippines at the time of the COVID-19 pandemic. Methods: A cross-sectional study was performed by using a survey questionnaire, which was distributed via online social media (Twitter). Data were analyzed using the Stata software. Results: There is a significant association between the following treatment barriers and sociodemographic characteristics: the location of treatment hubs and respondents who finished college/graduate studies; checkpoints and crossing borders; and (1) respondents from Northern Luzon Region, (2) unemployed respondents and financial assistance-1. respondents 18 to 25 years old; 2. unemployed respondents-(3) respondents who finished elementary/high school and psychosocial support-(1) respondents from the NCR; (2) respondents 26 to 30 years old, stocks of ARVs and other medicines, and employed respondents. Conclusions: The results suggest a necessity for innovative approaches to make HIV care services, particularly ART, more accessible to PLHIV during the COVID-19 pandemic. Future large-scale studies exploring the association between sociodemographic characteristics and barriers to medication adherence of PLHIV during the COVID-19 pandemic are recommended.
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Affiliation(s)
- Philip John M. Joves
- Department of Internal Medicine, Adventist Medical Center Manila, Pasay City 1302, Philippines; (M.O.M.)
| | - Melgar O. Matulac
- Department of Internal Medicine, Adventist Medical Center Manila, Pasay City 1302, Philippines; (M.O.M.)
- Department of Internal Medicine, Pasay City General Hospital, Pasay City 1302, Philippines
| | - Rodolfo S. Pagcatipunan
- Department of Internal Medicine, Adventist Medical Center Manila, Pasay City 1302, Philippines; (M.O.M.)
- St. Luke’s Medical Center Global City, Taguig 1634, Philippines
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Fauk NK, Gesesew HA, Seran AL, Ward PR. Barriers to access to antiretroviral therapy by people living with HIV in an indonesian remote district during the COVID-19 pandemic: a qualitative study. BMC Infect Dis 2023; 23:296. [PMID: 37147599 PMCID: PMC10161978 DOI: 10.1186/s12879-023-08221-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/04/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Coronavirus disease (COVID-19) pandemic has a significant influence on the access to healthcare services. This study aimed to understand the views and experiences of people living with HIV (PLHIV) about barriers to their access to antiretroviral therapy (ART) service in Belu district, Indonesia, during the COVID-19 pandemic. METHODS This qualitative inquiry employed in-depth interviews to collect data from 21 participants who were recruited using a snowball sampling technique. Data analysis was guided by a thematic framework analysis. RESULTS The findings showed that fear of contracting COVID-19 was a barrier that impeded participants' access to ART service. Such fear was influenced by their awareness of their vulnerability to the infection, the possibility of unavoidable physical contact in public transport during a travelling to HIV clinic and the widespread COVID-19 infection in healthcare facilities. Lockdowns, COVID-19 restrictions and lack of information about the provision of ART service during the pandemic were also barriers that impeded their access to the service. Other barriers included the mandatory regulation for travellers to provide their COVID-19 vaccine certificate, financial difficulty, and long-distance travel to the HIV clinic. CONCLUSIONS The findings indicate the need for dissemination of information about the provision of ART service during the pandemic and the benefits of COVID-19 vaccination for the health of PLHIV. The findings also indicate the need for new strategies to bring ART service closer to PLHIV during the pandemic such as a community-based delivery system. Future large-scale studies exploring views and experiences of PLHIV about barriers to their access to ART service during the COVID-19 pandemic and new intervention strategies are recommended.
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Affiliation(s)
- Nelsensius Klau Fauk
- Research Centre on Public Health, Equity and Human Flourishing (PHEHF), Torrens University, 88 Wakefield Street, 5000, Adelaide, South Australia, Australia
- Institute of Resource Governance and Social Change, 85227, Kupang, Indonesia
| | - Hailay Abrha Gesesew
- Research Centre on Public Health, Equity and Human Flourishing (PHEHF), Torrens University, 88 Wakefield Street, 5000, Adelaide, South Australia, Australia.
- College of Health Sciences, Mekelle University, P.O. Box 231, Mekelle, Tigray, Ethiopia.
| | - Alfonsa Liquory Seran
- Health Department of Belu District, Atapupu Public Health Centre, 85752, Atambua, Belu, Indonesia
| | - Paul Russell Ward
- Research Centre on Public Health, Equity and Human Flourishing (PHEHF), Torrens University, 88 Wakefield Street, 5000, Adelaide, South Australia, Australia
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Venturas JP. HIV and COVID-19 Disease. Semin Respir Crit Care Med 2023; 44:35-49. [PMID: 36646084 DOI: 10.1055/s-0042-1758852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Despite effective antiretroviral therapy (ART), HIV infected individuals throughout the world remain at significant risk of respiratory infections and non-communicable disease. Severe disease from SARS-CoV-2 is associated with a hyperinflammatory phenotype which manifests in the lungs as pneumonia and in some cases can lead to acute respiratory failure. Progression to severe COVID-19 is associated with comorbid disease such as obesity, diabetes mellitus and cardiovascular disease, however data concerning the associated risks of HIV coinfection are still conflicting, with large population studies demonstrating poorer outcomes, whilst smaller, case-controlled studies showing better outcomes. Furthermore, underlying immunopathological processes within the lungs and elsewhere, including interactions with other opportunistic infections (OI), remain largely undefined. Nonetheless, new and repurposed anti-viral therapies and vaccines which have been developed are safe to use in this population, and anti-inflammatory agents are recommended with the caveat that the coexistence of opportunistic infections is considered and excluded. Finally, HIV infected patients remain reliant on good ART adherence practices to maintain HIV viral suppression, and some of these practices were disrupted during the COVID-19 pandemic, putting these patients at further risk for acute and long-term adverse outcomes.
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Affiliation(s)
- Jacqui P Venturas
- Department of Internal Medicine and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital and Universtity of the Witwatersrand, Johannesburg, South Africa
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Nwaokoro P, Sanwo O, Toyo O, Akpan U, Nwanja E, Elechi I, Ukpong KA, Idiong H, Gana B, Badru T, Idemudia A, Ogbechie MD, Imohi P, Achanya A, Oqua D, Kakanfo K, Olatunbosun K, Umoh A, Essiet P, Usanga I, Ezeanolue E, Obiora-Okafo C, James E, Iyortim I, Chiegil R, Khamofu H, Pandey SR, Bateganya M. Achieving HIV epidemic control through integrated community and facility-based strategies: Lessons learnt from ART-surge implementation in Akwa Ibom, Nigeria. PLoS One 2022; 17:e0278946. [PMID: 36542606 PMCID: PMC9770335 DOI: 10.1371/journal.pone.0278946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
This study examines the lessons learnt from the implementation of a surge program in Akwa Ibom State, Nigeria as part of the Strengthening Integrated Delivery of HIV/AIDS Services (SIDHAS) Project. In this analysis, we included all clients who received HIV counseling and testing services, tested HIV positive, and initiated ART in SIDHAS-supported local government areas (LGAs) from April 2017 to March 2021. We employed descriptive and inferential statistics to analyze our results. A total of 2,018,082 persons were tested for HIV. Out of those tested, 102,165 (5.1%) tested HIV-positive. Comparing the pre-surge and post-surge periods, we observed an increase in HIV testing from 490,450 to 2,018,082 (p≤0.031) and in HIV-positive individuals identified from 21,234 to 102,165 (p≤0.001) respectively. Of those newly identified positives during the surge, 98.26% (100,393/102,165) were linked to antiretroviral therapy compared to 99.24% (21,073/21,234) pre-surge. Retention improved from 83.3% to 92.3% (p<0.001), and viral suppression improved from 73.5% to 96.2% (p<0.001). A combination of community and facility-based interventions implemented during the surge was associated with the rapid increase in case finding, retention, and viral suppression; propelling the State towards HIV epidemic control. HIV programs should consider a combination of community and facility-based interventions in their programming.
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Affiliation(s)
- Pius Nwaokoro
- Family Health International, Abuja, Nigeria
- * E-mail:
| | | | - Otoyo Toyo
- Achieving Health Nigeria Initiative (AHNi), Abuja, Nigeria
| | - Uduak Akpan
- Achieving Health Nigeria Initiative (AHNi), Abuja, Nigeria
| | - Esther Nwanja
- Achieving Health Nigeria Initiative (AHNi), Abuja, Nigeria
| | | | | | - Helen Idiong
- Achieving Health Nigeria Initiative (AHNi), Abuja, Nigeria
| | - Bala Gana
- Achieving Health Nigeria Initiative (AHNi), Abuja, Nigeria
| | | | | | | | | | | | - Dorothy Oqua
- Howard University Global Initiative, Abuja, Nigeria
| | | | | | | | | | | | - Echezona Ezeanolue
- Center for Translation & Implementation Research College of Medicine, University of Nigeria, Nsukka, Nigeria
| | | | | | | | - Robert Chiegil
- Family Health International, Durham, NC, United States of America
| | | | | | - Moses Bateganya
- Family Health International, Durham, NC, United States of America
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Chanda-Kapata P, Ntoumi F, Kapata N, Lungu P, Mucheleng'anga LA, Chakaya J, Tembo J, Himwaze C, Ansumana R, Asogun D, Mfinanga S, Nyasulu P, Mwaba P, Yeboah-Manu D, Zumla A, Nachega JB. Tuberculosis, HIV/AIDS and Malaria Health Services in sub-Saharan Africa - A Situation Analysis of the Disruptions and Impact of the COVID-19 Pandemic. Int J Infect Dis 2022; 124 Suppl 1:S41-S46. [PMID: 35341998 PMCID: PMC8949686 DOI: 10.1016/j.ijid.2022.03.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The unprecedented and ongoing COVID-19 pandemic has exposed weaknesses in African countries' health systems. The impact of shifted focus on COVID-19 for the past 2 years on routine health services, especially those for the epidemics of Tuberculosis, HIV/AIDS and Malaria, have been dramatic in both quantity and quality. METHODS In this article, we reflect on the COVID-19 related disruptions on the Tuberculosis, HIV/AIDS and Malaria routine health services across Africa. RESULTS The COVID-19 pandemic resulted in disruptions of routine health services and diversion of already limited available resources in sub-Saharan Africa. As a result, disease programs like TB, malaria and HIV have recorded gaps in prevention and treatment with the prospects of reversing gains made towards meeting global targets. The extent of the disruption is yet to be fully quantified at country level as most data available is from modelling estimates before and during the pandemic. CONCLUSIONS Accurate country-level data is required to convince donors and governments to invest more into revamping these health services and help prepare for managing future pandemics without disruption of routine services. Increasing government expenditure on health is a critical part of Africa's economic policy. Strengthening health systems at various levels to overcome the negative impacts of COVID-19, and preparing for future epidemics will require strong visionary political leadership. Innovations in service delivery and technological adaptations are required as countries aim to limit disruptions to routine services.
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Affiliation(s)
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale (FCRM), Brazzaville, Republic of Congo; Institute for Tropical Medicine, University of Tübingen, Germany.
| | - Nathan Kapata
- National Public Health Institute, Ministry of Health, and UNZA-UCLMS Research and Training Program, Lusaka, Zambia.
| | - Patrick Lungu
- University of Zambia, School of Medicine, Department Internal Medicine, Lusaka, Zambia.
| | - Luchenga Adam Mucheleng'anga
- Ministry of Home Affairs, Office of the State Forensic Pathologist, and UNZA-UCLMS Research and Training Program, University Teaching Hospital, Lusaka, Zambia.
| | - Jeremiah Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya.
| | - John Tembo
- HERPEZ and UNZA-UCLMS Research and Training Program, University Teaching Hospital, Lusaka, Zambia.
| | - Cordelia Himwaze
- University Teaching Hospital, Department of Pathology and Microbiology; and UNZA-UCLMS Research and Training Program, University Teaching Hospital, Lusaka, Zambia.
| | - Rashid Ansumana
- Mercy Hospital Research Laboratory, Bo, Freetown, Sierra Leone.
| | - Danny Asogun
- Ambrose Alli University, Ekpoma and Irrua Specialist Teaching Hospital, Nigeria.
| | - Sayoki Mfinanga
- Muhimbili Medical Research Centre National Institute for Medical Research, Dar es Salaam, Tanzania.
| | - Peter Nyasulu
- Division of Epidemiology & Biostatistics, Faculty of Medicine; Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Peter Mwaba
- Lusaka Apex Medical University, Faculty of Medicine, and UNZA-UCLMS Research and Training Project, Lusaka, Zambia.
| | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
| | - Alimuddin Zumla
- Center for Clinical Microbiology, Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, United Kingdom; UNZA-UCLMS Research and Training Program Program, Lusaka, Zambia.
| | - Jean B Nachega
- Department of Medicine and Division of Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa; Depts of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Depts of Epidemiology, Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
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López LLA, Solis-Soto MT. Response of Care Services for Patients with HIV/AIDS during a Pandemic: Perspectives of Health Staff in Bolivia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13515. [PMID: 36294095 PMCID: PMC9602848 DOI: 10.3390/ijerph192013515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic has caused an unprecedented crisis striking health services, generating risks of setbacks in health care and affecting the most vulnerable populations such as HIV patients. This study aims to explore the impact of the COVID-19 pandemic on the operational management of health services for people living with HIV/AIDS in Cochabamba, Bolivia. We applied a qualitative approach using semi-structured in-depth interviews with ten key health professionals who care for patients with HIV/AIDS in Cochabamba, Bolivia. Interviews were transcribed verbatim and uploaded to Atlas.ti software for analysis. We used an ethnographic approach within the interpretive paradigm to carry out the thematic analysis, considering the "Determinants of health systems resilience framework" of five dimensions developed by the World Health Organization. Even though the provision of services in public care services was not interrupted during the COVID-19 pandemic, health service delivery was severely affected. Digital technology could be used to compensate in urban areas. Regarding the distribution of medications, adaptative strategies to reduce patient complications were implemented. Unfortunately, the complementary tests availability was limited. The COVID-19 pandemic had a significant impact on HIV/AIDS patient care services in Cochabamba, with repercussions for HIV treatment access and virologic suppression.
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Affiliation(s)
- Liseth Lourdes Arias López
- OH TARGET Competence Center, Universidad San Francisco Xavier de Chuquisaca, Estudiantes, 96, Sucre P.O. Box 212, Bolivia
| | - Maria Teresa Solis-Soto
- OH TARGET Competence Center, Universidad San Francisco Xavier de Chuquisaca, Estudiantes, 96, Sucre P.O. Box 212, Bolivia
- Occupational and Environmental Epidemiology & Net Teaching Unit, Institute for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Ziemssenstr. 1, 80336 Munich, Germany
- Center for International Health, University Hospital Munich (LMU), Ziemssenstr. 1, 80336 Munich, Germany
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Roy S, Kennedy S, Hossain S, Warren CE, Sripad P. Examining Roles, Support, and Experiences of Community Health Workers During the COVID-19 Pandemic in Bangladesh: A Mixed Methods Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00761. [PMID: 36041841 PMCID: PMC9426994 DOI: 10.9745/ghsp-d-21-00761] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/20/2022] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Understanding community health workers' (CHWs) experiences of sustaining routine health care promotion and provision activities as well as their challenges in adopting new responsibilities within a dynamic context is critical. This study explored the roles and perspectives of CHWs within the government-led coronavirus disease (COVID-19) community health response in Bangladesh. METHODS We conducted a mixed methods study to explore the government's response to COVID-19 and its association with community health programming through a telephone-based survey of 370 government-employed CHWs. We also conducted 28 in-depth interviews with policy makers, program managers, CHW supervisors, and CHWs. We conducted exploratory and regression analysis of survey data and qualitative analysis of interview data. RESULTS The majority of CHWs reported receiving training related to COVID-19, including community-based prevention strategies from government and nongovernment stakeholders. Access to infection prevention supplies differed significantly by CHW cadre, and perspectives on the provision of adequate supplies varied qualitatively. CHWs reported slight decreases in routine work across all health areas early in the pandemic, and a majority reported added COVID-19-related responsibilities as the pandemic continued, including advising on signs/symptoms in their communities and referring suspected cases of COVID-19 for advanced facility care. Regression analyses showed that government support and integration of CHWs into their response-particularly being trained on COVID-19-predicted CHW capacity to advise communities on symptoms and provide routine services. DISCUSSION Government-employed CHWs in Bangladesh continued to provide health education and routine services in their communities despite pandemic- and response-related challenges. Varied support and differential CHW cadre-specific effects on COVID-19 awareness building in the community, referral, and routine service provision merit attention in Bangladesh's pluralistic community health system. While COVID-19 infection and government-mandated lockdowns restricted CHW mobility, the workers' capacity to continue service provision and education can be leveraged in vaccination and surveillance efforts moving forward.
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Affiliation(s)
| | - Sarah Kennedy
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
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Varshney K, Ghosh P, Stiles H, Iriowen R. Risk Factors for COVID-19 Mortality Among People Living with HIV: A Scoping Review. AIDS Behav 2022; 26:2256-2265. [PMID: 35024992 PMCID: PMC8756751 DOI: 10.1007/s10461-022-03578-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 11/01/2022]
Abstract
People living with HIV (PLWH) are particularly vulnerable to worsened outcomes of COVID-19. Therefore, the purpose of this work was to provide a scoping review of the literature to assess the risk factors for COVID-19 mortality among PLWH. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR), searches were conducted in PubMed, Scopus, Global Health, and WHO Coronavirus Database. Articles were eligible for inclusion if they were in English, included PLWH who died after COVID-19 infection, and described risk factors for mortality. Results were descriptively synthesized and pooled thereafter. Study quality was assessed using the Joanna Brigg Institute's critical appraisal tools. 20 studies were eligible for inclusion, with the pooled death rate being 11.7%. Age was a major risk factor, especially after 50 (23.2%) and after 70 (41.8%), and males had a death rate nearly double that of females. As total comorbidities increased, the death rate also greatly increased; among those with comorbidities, the highest fatality rates were those with cardiovascular disease (30.2%), chronic kidney disease (23.5%), obesity (22.4%), and diabetes (18.4%). Other risk factors for mortality among PLWH included having a Black racial background, being an injection drug user, being a smoker, and having a CD4 cell count below 200. There is a need to better study confounding factors, and to understand how vaccination influences mortality risk. Overall, the findings highlight a need to ensure that focus is placed on the varying demographics of PLWH amidst COVID-19 control efforts.
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Affiliation(s)
- Karan Varshney
- College of Population Health, Thomas Jefferson University, Philadelphia, PA USA
- School of Medicine, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC 3216 Australia
| | - Prerana Ghosh
- School of Medicine, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC 3216 Australia
| | - Helena Stiles
- School of Medicine, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC 3216 Australia
| | - Rosemary Iriowen
- College of Population Health, Thomas Jefferson University, Philadelphia, PA USA
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Varshney K, Anaele B, Molaei M, Frasso R, Maio V. Risk Factors for Poor Outcomes Among Patients with Extensively Drug-Resistant Tuberculosis (XDR-TB): A Scoping Review. Infect Drug Resist 2021; 14:5429-5448. [PMID: 34938089 PMCID: PMC8687707 DOI: 10.2147/idr.s339972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
In recent years, there has been an upsurge in cases of drug-resistant TB, and strains of TB resistant to all forms of treatment have begun to emerge; the highest level of resistance is classified as extensively drug-resistant tuberculosis (XDR-TB). There is an urgent need to prevent poor outcomes (death/default/failed treatment) of XDR-TB, and knowing the risk factors can inform such efforts. The objective of this scoping review was to therefore identify risk factors for poor outcomes among XDR-TB patients. We searched three scientific databases, PubMed, Scopus, and ProQuest, and identified 25 articles that examined relevant risk factors. Across the included studies, the proportion of patients with poor outcomes ranged from 8.6 to 88.7%. We found that the most commonly reported risk factor for patients with XDR-TB developing poor outcomes was having a history of TB. Other risk factors were human immunodeficiency virus (HIV), a history of incarceration, low body mass, being a smoker, alcohol use, unemployment, being male, and being middle-aged. Knowledge and understanding of the risk factors associated with poor outcomes of XDR-TB can help policy makers and organizations in the process of designing and implementing effective programs.
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Affiliation(s)
- Karan Varshney
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Beverly Anaele
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Molaei
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rosemary Frasso
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vittorio Maio
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
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