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Irie WC, Kerkhoff A, Kim HY, Geng E, Eshun-Wilson I. Using stated preference methods to facilitate knowledge translation in implementation science. Implement Sci Commun 2024; 5:32. [PMID: 38549129 PMCID: PMC10979589 DOI: 10.1186/s43058-024-00554-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/01/2024] [Indexed: 04/01/2024] Open
Abstract
Enhancing the arsenal of methods available to shape implementation strategies and bolster knowledge translation is imperative. Stated preference methods, including discrete choice experiments (DCE) and best-worst scaling (BWS), rooted in economics, emerge as robust, theory-driven tools for understanding and influencing the behaviors of both recipients and providers of innovation. This commentary outlines the wide-ranging application of stated preference methods across the implementation continuum, ushering in effective knowledge translation. The prospects for utilizing these methods within implementation science encompass (1) refining and tailoring intervention and implementation strategies, (2) exploring the relative importance of implementation determinants, (3) identifying critical outcomes for key decision-makers, and 4) informing policy prioritization. Operationalizing findings from stated preference research holds the potential to precisely align health products and services with the requisites of patients, providers, communities, and policymakers, thereby realizing equitable impact.
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Affiliation(s)
- Whitney C Irie
- School of Social Work, Boston College, Chestnut Hill, MA, USA.
| | - Andrew Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
| | - Hae-Young Kim
- Department of Population Health at NYU Grossman School of Medicine, New York, NY, USA
| | - Elvin Geng
- Division of Infectious Diseases, School of Medicine, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, School of Medicine, Washington University in Saint Louis, Saint Louis, MO, USA
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Chandiwana N, Venter W, Manne-Goehler J, Wade A, Le Roux C, Mbalati N, Grimbeek A, Kruger P, Montsho E, Zimela Z, Yawa A, Tshabalala S, Rambau N, Mpofu N, Stevenson S, McNulty B, Ntusi N, Pillay Y, Dave J, Murphy A, Goldstein S, Hfman K, Mahomedy S, Thomas E, Mrara B, Wing J, Lubbe J, Koto Z, Conradie-Smit M, Wharton S, May W, Marr I, Kaplan H, Forgan M, Alexander G, Turner J, Fourie VR, Hellig J, Banks M, Ragsdale K, Noeth M, Mohamed F, Myer L, Lebina L, Maswime S, Moosa Y, Thomas S, Mbelle M, Sinxadi P, Bekker LG, Bhana S, Fabian J, Decloedt E, Bayat Z, Daya R, Bobat B, Storie F, Goedecke J, Kahn K, Tollman S, Mansfield B, Siedner M, Marconi V, Mody A, Mtshali N, Geng E, Srinivasa S, Ali M, Lalla-Edwards S, Bentley A, Wolvaardt G, Hill A, Nel J. Obesity is South Africa's new HIV epidemic. S Afr Med J 2024; 114:e1927. [PMID: 38525565 DOI: 10.7196/samj.2024.v114i3.1927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Indexed: 03/26/2024] Open
Affiliation(s)
| | - Willem Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand.
| | | | - Alisha Wade
- Research in Metabolism and Endocrinology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand.
| | - Carel Le Roux
- Diabetes Complications Research Centre, University College Dublin; Chemical Pathology, University of Pretoria.
| | | | | | | | | | | | - Anele Yawa
- General Secretary, Treatment Action Campaign .
| | | | | | - Ngqabutho Mpofu
- Communications, and Research Manager, Treatment Action Campaign .
| | | | | | - Ntobeko Ntusi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital; University of Cape Town/SAMRC Extramural Research Unit on Intersection of Noncommunicable Diseases and Infectious Diseases; ARUA/Guild Cluster of Research Excellence on Noncommunicable Diseases and Associated Multimorbidity.
| | - Yogan Pillay
- Director, HIV & TB Delivery, Bill and Melinda Gates Foundation, Pretoria; Department of Global Health, Stellenbosch University.
| | - Joel Dave
- Division of Endocrinology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town.
| | | | - Sue Goldstein
- SAMRC/Wits Centre for Health Economics and Decision Science; PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
| | - Karen Hfman
- SAMRC/Wits Centre for Health Economics and Decision Science; PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
| | - Sameera Mahomedy
- AMRC/Wits Centre for Health Economics and Decision Science; PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
| | - Elizabeth Thomas
- SAMRC/ Wits Centre for Health Economics and Decision Science; PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
| | - Busi Mrara
- Professor and Head of Anaesthesiology and Critical Care, Walter Sisulu University.
| | - Jeff Wing
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand.
| | - Jeanne Lubbe
- Head, Upper Gastrointestinal Surgery, Tygerberg Hospital and Stellenbosch University; President, South African Metabolic Medicine and Surgery Society.
| | - Zack Koto
- Chair, Department of Surgery, Dr George Mukhari Academic Hospital and Sefako Makgatho Health Sciences University; President, College of Surgeons of South Africa; Senior Vice-President, Colleges of Medicine of South Africa, President, Association of Surgeons of South Africa.
| | | | - Sean Wharton
- McMaster University, York University, and Wharton Weight Management Clinic.
| | | | | | | | | | | | - John Turner
- Honorary Senior Specialist Groote Schuur Hospital and the University of Cape Town, Cape Town Bariatric Clinic .
| | | | | | | | | | | | - Farzahna Mohamed
- Acting Clinical Head of Endocrinology, Charlotte Maxeke Johannesburg Academic Hospital and Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand.
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Cape Town.
| | | | - Salome Maswime
- Global Surgery Division, Faculty of Health Sciences, University of Cape Town.
| | - Yunus Moosa
- Southern African HIV Clinicians Society; Department of Infectious Diseases, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal.
| | - Sumy Thomas
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand.
| | - Mzamo Mbelle
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital; Institute of Liver Studies, King's College Hospital.
| | - Phumla Sinxadi
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town.
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Faculty of Health Sciences, University of Cape Town.
| | - Sindeep Bhana
- Honorary lecturer, Chris Hani Baragwanath Academic Hospital and Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand.
| | - June Fabian
- Wits Donald Gordon Medical Centre, Faculty of Health Sciences, University of the Witwatersrand.
| | - Eric Decloedt
- Head, Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital.
| | - Zaheer Bayat
- Academic Head of Endocrinology, University of the Witwatersrand; Clinical Head of Medicine, Helen Joseph Hospital.
| | - Reyna Daya
- Clinical Head of Endocrinology, Helen Joseph Hospital; Chair, Society for Endocrinology, Metabolism and Diabetes of South Africa.
| | - Bilal Bobat
- Wits Donald Gordon Medical Centre, Faculty of Health Sciences, University of the Witwatersrand.
| | | | - Julia Goedecke
- Biomedical Research and Innovation Platform, South African Medical Research Council.
| | - Kathleen Kahn
- SAMRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
| | - Stephen Tollman
- SAMRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
| | - Brett Mansfield
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand.
| | - Mark Siedner
- Africa Health Research Institute, Harvard Medical School.
| | - Vincent Marconi
- Division of Infectious Diseases and Department of Global Health, Emory University School of Medicine and Rollins School of Public Health.
| | - Aaloke Mody
- Division of Infectious Diseases, Department of Medicine, and Center for Dissemination and Implementation, Institute for Public Health, Washington University.
| | | | - Elvin Geng
- Division of Infectious Diseases, Department of Medicine, and Center for Dissemination and Implementation, Institute for Public Health, Washington University.
| | - Suman Srinivasa
- Division of Endocrinology, Metabolism Unit, Massachusetts General Hospital and Harvard Medical School.
| | - Mohammed Ali
- Department of Family and Preventive Medicine, School of Medicine, and Hubert Department of Global Health, Rollins School of Public Health, Emory University.
| | | | - Alison Bentley
- Restonic Ezintsha sleep clinic, South African Society for Sleep and Health.
| | | | - Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool.
| | - Jeremy Nel
- Division of Infectious Diseases, Department of Medicine, University of the Witwatersrand.
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Baldeh M, Kizito S, Lakoh S, Sesay D, Dennis F, Barrie U, Williams SA, Robinson DR, Lamontagne F, Amahowe F, Turay P, Sensory-Bahar O, Geng E, Ssewamala FM. Prevalence and factors associated with advanced HIV disease among young people aged 15 - 24 years in a national referral hospital in Sierra Leone: A cross-sectional study. medRxiv 2023:2023.11.07.23296880. [PMID: 37986831 PMCID: PMC10659455 DOI: 10.1101/2023.11.07.23296880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Advanced HIV in young people living with HIV is an increasingly pressing public health issue in sub-Saharan Africa. Despite global progress in early HIV testing and reducing HIV-related deaths, many young people with HIV continue to experience HIV disease progression in sub-Saharan Africa. This study provides an overview of the prevalence, clinical manifestations, and factors associated with advanced HIV in young people seeking medical services in a major hospital in Sierra Leone. Methods We used a cross-sectional design to collect data from HIV patients aged 15 to 24 years at a major hospital in Sierra Leone between September 2022 and March 2023. Advanced HIV was defined as (i) CD4+ below 200 cells/mm3 or (ii) WHO clinical stage 3 or 4. Logistic regression models determined the association between observable independent characteristics and advanced HIV. The statistical significance level was set at 0.05 for all statistical tests. Results About 40% (231/574) of patients were recruited; 70.6% (163/231) were inpatients, and 29.4% (68/231) were outpatients. The mean age was approximately 21.6 years (SD ±2.43). The overall prevalence of advanced HIV was 42.9% (99/231), 51.5% (35/68) of outpatients, and 39.3% (64/163) of inpatients. Age of inpatients (OR, 1.23; 95% CI, 1.00-1.52; p= 0.047) was associated with a higher risk. Female sex (OR, 0.51; 95% CI, 0.28-0.94; p= 0.030), higher education (OR, 0.27; 95% CI, 0.10 - 0.78; p= 0.015), and Body Mass (OR, 0.10; 95% CI, 0.01-0.77; p= 0.028) were at lower risk of advance HIV. Common conditions diagnosed in this population are tuberculosis (13.58%), hepatitis B (6.13%), Kaposi sarcoma (3.07%), and esophageal candidiasis (2.45%). Conclusion We reported a high prevalence of advanced HIV among young patients in a referral Hospital in Sierra Leone. This emphasises the need to strengthen public health measures and policies that address challenges of access to HIV services.
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Affiliation(s)
- Mamadu Baldeh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- University of Sierra Leone Teaching Hospital Complex, Freetown, Sierra Leone
| | - Daniel Sesay
- University of Sierra Leone Teaching Hospital Complex, Freetown, Sierra Leone
| | - Frida Dennis
- University of Sierra Leone Teaching Hospital Complex, Freetown, Sierra Leone
| | - Umu Barrie
- University of Sierra Leone Teaching Hospital Complex, Freetown, Sierra Leone
| | - Samuel Adeyemi Williams
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | | | - Franck Amahowe
- Solthis - Solidarité Thérapeutique et Initiatives pour la Santé
| | | | | | - Elvin Geng
- Washington University in St. Louis, Missouri, USA
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Knox J, Schwartz S, Duncan DT, Curran G, Schneider J, Stephenson R, Wilson P, Nash D, Sullivan P, Geng E. Proposing the observational-implementation hybrid approach: designing observational research for rapid translation. Ann Epidemiol 2023; 85:45-50. [PMID: 37015306 DOI: 10.1016/j.annepidem.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/01/2023] [Accepted: 03/24/2023] [Indexed: 04/04/2023]
Abstract
We propose the observational-implementation hybrid approach-the incorporation of implementation science methods and measures into observational studies to collect information that would allow researchers to anticipate, estimate, or infer the effects of interventions and implementation strategies. Essentially, we propose that researchers collect implementation data early in the research pipeline, in situations where they might not typically be thinking about implementation science. We describe three broad contextual scenarios through which the observational-implementation hybrid approach would most productively be applied. The first application is for observational cohorts that individually enroll participants-either for existing (to which implementation concepts could be added) or for newly planned studies. The second application is with routinely collected program data, at either the individual or aggregate levels. The third application is to the collection of data from study participants enrolled in an observational cohort study who are also involved in interventions linked to that study (e.g., collecting data about their experiences with those interventions). Examples of relevant implementation data that could be collected as part of observational studies include factors relevant to transportability, participant preferences, and participant/provider perspectives regarding interventions and implementation strategies. The observational-implementation hybrid model provides a practical approach to make the research pipeline more efficient and to decrease the time from observational research to health impact. If this approach is widely adopted, observational and implementation science studies will become more integrated; this will likely lead to new collaborations, will encourage the expansion of epidemiological training, and, we hope, will push both epidemiologists and implementation scientists to increase the public health impact of their work.
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Affiliation(s)
- Justin Knox
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY; HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York; Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY.
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Geoff Curran
- Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock
| | - John Schneider
- Department of Medicine, University of Chicago, Chicago, IL
| | - Rob Stephenson
- The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor
| | - Patrick Wilson
- Department of Psychology, University of California, Los Angeles
| | - Denis Nash
- Department of Epidemiology, School of Public Health, City University of New York, New York
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Elvin Geng
- Washington University School of Medicine, St. Louis, MO
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Ingle SM, Miro JM, May MT, Cain LE, Schwimmer C, Zangerle R, Sambatakou H, Cazanave C, Reiss P, Brandes V, Bucher HC, Sabin C, Vidal F, Obel N, Mocroft A, Wittkop L, d'Arminio Monforte A, Torti C, Mussini C, Furrer H, Konopnicki D, Teira R, Saag MS, Crane HM, Moore RD, Jacobson JM, Mathews WC, Geng E, Eron JJ, Althoff KN, Kroch A, Lang R, Gill MJ, Sterne JAC. Early Antiretroviral Therapy Not Associated With Higher Cryptococcal Meningitis Mortality in People With Human Immunodeficiency Virus in High-Income Countries: An International Collaborative Cohort Study. Clin Infect Dis 2023; 77:64-73. [PMID: 36883578 PMCID: PMC10320049 DOI: 10.1093/cid/ciad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/13/2022] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Randomized controlled trials (RCTs) from low- and middle-income settings suggested that early initiation of antiretroviral therapy (ART) leads to higher mortality rates among people with HIV (PWH) who present with cryptococcal meningitis (CM). There is limited information about the impact of ART timing on mortality rates in similar people in high-income settings. METHODS Data on ART-naive PWH with CM diagnosed from 1994 to 2012 from Europe/North America were pooled from the COHERE, NA-ACCORD, and CNICS HIV cohort collaborations. Follow-up was considered to span from the date of CM diagnosis to earliest of the following: death, last follow-up, or 6 months. We used marginal structural models to mimic an RCT comparing the effects of early (within 14 days of CM) and late (14-56 days after CM) ART on all-cause mortality, adjusting for potential confounders. RESULTS Of 190 participants identified, 33 (17%) died within 6 months. At CM diagnosis, their median age (interquartile range) was 38 (33-44) years; the median CD4+ T-cell count, 19/μL (10-56/μL); and median HIV viral load, 5.3 (4.9-5.6) log10 copies/mL. Most participants (n = 157 [83%]) were male, and 145 (76%) started ART. Mimicking an RCT, with 190 people in each group, there were 13 deaths among participants with an early ART regimen and 20 deaths among those with a late ART regimen. The crude and adjusted hazard ratios comparing late with early ART were 1.28 (95% confidence interval, .64-2.56) and 1.40 (.66-2.95), respectively. CONCLUSIONS We found little evidence that early ART was associated with higher mortality rates among PWH presenting with CM in high-income settings, although confidence intervals were wide.
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Affiliation(s)
- Suzanne M Ingle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jose M Miro
- Infectious Diseases Service Hospital Clinic–IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Margaret T May
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lauren E Cain
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Global Epidemiology, AbbVie, Chicago, Illinois, USA
| | - Christine Schwimmer
- University of Bordeaux, INSERM, Institut Bergonié, CHU de Bordeaux, CIC-EC 1401, Bordeaux, France
| | - Robert Zangerle
- Department of Dermatology, Venereology, and Allergy, Medical University Innsbruck, Innsbruck, Austria
| | - Helen Sambatakou
- 2nd Department of Internal Medicine, HIV Unit, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charles Cazanave
- Infectious and Tropical Diseases Department, CHU de Bordeaux, Bordeaux, France
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Vanessa Brandes
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology & Biostatistics, Division of Infectious Diseases & Hospital Hygiene, University Hospital Basel, Basel, Switzerland
| | - Caroline Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
| | - Francesc Vidal
- Infectious Diseases Unit, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
- CIBER Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Amanda Mocroft
- Centre of Excellence for Health, Immunity and Infections (CHIP) and PERSIMUNE, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Linda Wittkop
- ISPED, INSERM, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Antonella d'Arminio Monforte
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, University of Milan, San Paolo Hospital, Milan, Italy
| | - Carlo Torti
- Department of Surgical and Medical Sciences, University “Magna Graecia,”, Catanzaro, Italy
| | - Cristina Mussini
- Infectious Diseases Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Hansjakob Furrer
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Deborah Konopnicki
- Infectious Diseases Department, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Ramon Teira
- Service of Internal Medicine, Hospital Universitario de Sierrallana, Torrelavega, Spain
| | - Michael S Saag
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Heidi M Crane
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Richard D Moore
- School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - W Chris Mathews
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Elvin Geng
- Division of Infectious Diseases, Department of Medicine and the Center for Dissemination and Implementation, Institute for Public Health, Washington University in St Louis, St Louis, Missouri, USA
| | - Joseph J Eron
- Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Raynell Lang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - M John Gill
- Department of Medicine, University of Calgary, Southern Alberta HIV Clinic, Calgary, Alberta, Canada
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Sikombe K, Pry JM, Mody A, Rice B, Bukankala C, Eshun-Wilson I, Mutale J, Simbeza S, Beres LK, Mukamba N, Mukumbwa-Mwenechanya M, Mwamba D, Sharma A, Wringe A, Hargreaves J, Bolton-Moore C, Holmes C, Sikazwe IT, Geng E. Comparison of patient exit interviews with unannounced standardised patients for assessing HIV service delivery in Zambia: a study nested within a cluster randomised trial. BMJ Open 2023; 13:e069086. [PMID: 37407057 DOI: 10.1136/bmjopen-2022-069086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES To compare unannounced standardised patient approach (eg, mystery clients) with typical exit interviews for assessing patient experiences in HIV care (eg, unfriendly providers, long waiting times). We hypothesise standardised patients would report more negative experiences than typical exit interviews affected by social desirability bias. SETTING Cross-sectional surveys in 16 government-operated HIV primary care clinics in Lusaka, Zambia providing antiretroviral therapy (ART). PARTICIPANTS 3526 participants aged ≥18 years receiving ART participated in the exit surveys between August 2019 and November 2021. INTERVENTION Systematic sample (every nth file) of patients in clinic waiting area willing to be trained received pre-visit training and post-visit interviews. Providers were unaware of trained patients. OUTCOME MEASURES We compared patient experience among patients who received brief training prior to their care visit (explaining each patient experience construct in the exit survey, being anonymous, without manipulating behaviour) with those who did not undergo training on the survey prior to their visit. RESULTS Among 3526 participants who participated in exit surveys, 2415 were untrained (56% female, median age 40 (IQR: 32-47)) and 1111 were trained (50% female, median age 37 (IQR: 31-45)). Compared with untrained, trained patients were more likely to report a negative care experience overall (adjusted prevalence ratio (aPR) for aggregate sum score: 1.64 (95% CI: 1.39 to 1.94)), with a greater proportion reporting feeling unwelcome by providers (aPR: 1.71 (95% CI: 1.20 to 2.44)) and witnessing providers behaving rude (aPR: 2.28 (95% CI: 1.63 to 3.19)). CONCLUSION Trained patients were more likely to identify suboptimal care. They may have understood the items solicited better or felt empowered to be more critical. We trained existing patients, unlike studies that use 'standardised patients' drawn from outside the patient population. This low-cost strategy could improve patient-centred service delivery elsewhere. TRIAL REGISTRATION NUMBER Assessment was nested within a parent study; www.pactr.org registered the parent study (PACTR202101847907585).
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Affiliation(s)
- Kombatende Sikombe
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Jake M Pry
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Aaloke Mody
- Internal Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Brian Rice
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Chama Bukankala
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Ingrid Eshun-Wilson
- Internal Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Jacob Mutale
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sandra Simbeza
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Laura K Beres
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Njekwa Mukamba
- Social and Behavioural Science Research Group, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Daniel Mwamba
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Social and Behavioural Science Research Group, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Alison Wringe
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - James Hargreaves
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Carolyn Bolton-Moore
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles Holmes
- Center for Innovation in Global Health, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Izukanji T Sikazwe
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Elvin Geng
- Internal Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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Crockett KB, Schember CO, Bian A, Rebeiro PF, Keruly J, Mayer K, Mathews C, Moore RD, Crane H, Geng E, Napravnik S, Shepherd BE, Mugavero MJ, Turan B, Pettit AC. Relationships Between Patient Race and Residential Race Context With Missed Human Immunodeficiency Virus Care Visits in the United States, 2010-2015. Clin Infect Dis 2023; 76:2163-2170. [PMID: 36757336 PMCID: PMC10273374 DOI: 10.1093/cid/ciad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/30/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Racial inequities exist in retention in human immunodeficiency virus (HIV) care and multilevel analyses are needed to contextualize and address these differences. Leveraging data from a multisite clinical cohort of people with HIV (PWH), we assessed the relationships between patient race and residential characteristics with missed HIV care visits. METHODS Medical record and patient-reported outcome (PRO; including mental health and substance-use measures) data were drawn from 7 participating Center for AIDS Research Network of Integrated Clinical Systems (CNICS) sites including N = 20 807 PWH from January 2010 through December 2015. Generalized estimating equations were used to account for nesting within individuals and within census tracts in multivariable models assessing the relationship between race and missed HIV care visits, controlling for individual demographic and health characteristics and census tract characteristics. RESULTS Black PWH resided in more disadvantaged census tracts, on average. Black PWH residing in census tracts with higher proportion of Black residents were more likely to miss an HIV care visit. Non-Black PWH were less likely to miss a visit regardless of where they lived. These relationships were attenuated when PRO data were included. CONCLUSIONS Residential racial segregation and disadvantage may create inequities between Black PWH and non-Black PWH in retention in HIV care. Multilevel approaches are needed to retain PWH in HIV care, accounting for community, healthcare setting, and individual needs and resources.
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Affiliation(s)
- Kaylee B Crockett
- Department of Family and Community Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Cassandra O Schember
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter F Rebeiro
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeanne Keruly
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kenneth Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher Mathews
- School of Medicine, University of California San Diego, San Diego, California, USA
| | - Richard D Moore
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Heidi Crane
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Elvin Geng
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Sonia Napravnik
- Division of Infectious Disease, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Bryan E Shepherd
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Bulent Turan
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Turkey
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - April C Pettit
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Kilbourne AM, Geng E, Eshun-Wilson I, Sweeney S, Shelley D, Cohen DJ, Kirchner JE, Fernandez ME, Parchman ML. How does facilitation in healthcare work? Using mechanism mapping to illuminate the black box of a meta-implementation strategy. Implement Sci Commun 2023; 4:53. [PMID: 37194084 DOI: 10.1186/s43058-023-00435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/06/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Healthcare facilitation, an implementation strategy designed to improve the uptake of effective clinical innovations in routine practice, has produced promising yet mixed results in randomized implementation trials and has not been fully researched across different contexts. OBJECTIVE Using mechanism mapping, which applies directed acyclic graphs that decompose an effect of interest into hypothesized causal steps and mechanisms, we propose a more concrete description of how healthcare facilitation works to inform its further study as a meta-implementation strategy. METHODS Using a modified Delphi consensus process, co-authors developed the mechanistic map based on a three-step process. First, they developed an initial logic model by collectively reviewing the literature and identifying the most relevant studies of healthcare facilitation components and mechanisms to date. Second, they applied the logic model to write vignettes describing how facilitation worked (or did not) based on recent empirical trials that were selected via consensus for inclusion and diversity in contextual settings (US, international sites). Finally, the mechanistic map was created based on the collective findings from the vignettes. FINDINGS Theory-based healthcare facilitation components informing the mechanistic map included staff engagement, role clarification, coalition-building through peer experiences and identifying champions, capacity-building through problem solving barriers, and organizational ownership of the implementation process. Across the vignettes, engagement of leaders and practitioners led to increased socialization of the facilitator's role in the organization. This in turn led to clarifying of roles and responsibilities among practitioners and identifying peer experiences led to increased coherence and sense-making of the value of adopting effective innovations. Increased trust develops across leadership and practitioners through expanded capacity in adoption of the effective innovation by identifying opportunities that mitigated barriers to practice change. Finally, these mechanisms led to eventual normalization and ownership of the effective innovation and healthcare facilitation process. IMPACT Mapping methodology provides a novel perspective of mechanisms of healthcare facilitation, notably how sensemaking, trust, and normalization contribute to quality improvement. This method may also enable more efficient and impactful hypothesis-testing and application of complex implementation strategies, with high relevance for lower-resourced settings, to inform effective innovation uptake.
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Affiliation(s)
- Amy M Kilbourne
- Health Services Research & Development, VA Office of Research and Development, US Department of Veterans Affairs and University of Michigan, 810 Vermont Ave, NW, Washington, D.C., 20420, USA.
| | - Elvin Geng
- Washington University at St. Louis, St. Louis, MO, USA
| | | | | | - Donna Shelley
- New York University School of Global Public Health, New York, New York, USA
| | | | - JoAnn E Kirchner
- Central Arkansas VA Healthcare System and University of Arkansas for Medical Sciences, North Little Rock, AR, USA
| | - Maria E Fernandez
- University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
| | - Michael L Parchman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Beres LK, Mwamba C, Bolton-Moore C, Kennedy CE, Simbeza S, Topp SM, Sikombe K, Mukamba N, Mody A, Schwartz SR, Geng E, Holmes CB, Sikazwe I, Denison JA. Trajectories of re-engagement: factors and mechanisms enabling patient return to HIV care in Zambia. J Int AIDS Soc 2023; 26:e26067. [PMID: 36840391 PMCID: PMC9958345 DOI: 10.1002/jia2.26067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/31/2023] [Indexed: 02/26/2023] Open
Abstract
INTRODUCTION While disengagement from HIV care threatens the health of persons living with HIV (PLWH) and incidence-reduction targets, re-engagement is a critical step towards positive outcomes. Studies that establish a deeper understanding of successful return to clinical care among previously disengaged PLWH and the factors supporting re-engagement are essential to facilitate long-term care continuity. METHODS We conducted narrative, patient-centred, in-depth interviews between January and June 2019 with 20 PLWH in Lusaka, Zambia, who had disengaged and then re-engaged in HIV care, identified through electronic medical records (EMRs). We applied narrative analysis techniques, and deductive and inductive thematic analysis to identify engagement patterns and enablers of return. RESULTS We inductively identified five trajectories of care engagement, suggesting patterns in patient characteristics, experienced barriers and return facilitators that may aid intervention targeting including: (1) intermittent engagement;(2) mostly engaged; (3) delayed linkage after testing; (4) needs time to initiate antiretroviral therapy (ART); and (5) re-engagement with ART initiation. Patient-identified periods of disengagement from care did not always align with care gaps indicated in the EMR. Key, interactive re-engagement facilitators experienced by participants, with varied importance across trajectories, included a desire for physical wellness and social support manifested through verbal encouragement, facility outreach or personal facility connections and family instrumental support. The mechanisms through which facilitators led to return were: (1) the promising of living out one's life priorities; (2) feeling valued; (3) fostering interpersonal accountability; (4) re-entry navigation support; (5) facilitated care and treatment access; and (6) management of significant barriers, such as depression. CONCLUSIONS While preliminary, the identified trajectories may guide interventions to support re-engagement, such as offering flexible ART access to patients with intermittent engagement patterns instead of stable patients only. Further, for re-engagement interventions to achieve impact, they must activate mechanisms underlying re-engagement behaviours. For example, facility outreach that reminds a patient to return to care but does not affirm a patient's value or navigate re-entry is unlikely to be effective. The demonstrated importance of positive health facility connections reinforces a growing call for patient-centred care. Additionally, interventions should consider the important role communities play in fostering treatment motivation and overcoming practical barriers.
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Affiliation(s)
- Laura K Beres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chanda Mwamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Carolyn Bolton-Moore
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sandra Simbeza
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Stephanie M Topp
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Kombatende Sikombe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Public Health Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Njekwa Mukamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Aaloke Mody
- University of Washington St. Louis, St. Louis, Missouri, USA
| | - Sheree R Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elvin Geng
- University of Washington St. Louis, St. Louis, Missouri, USA
| | - Charles B Holmes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Georgetown University, Washington, DC, USA
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Julie A Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Ross W, Reidhead M, Jansen R, Boyd C, Geng E. IMPACT OF THE COVID-19 PANDEMIC ON PUBLIC HOSPITALS IN THE UNITED STATES. Trans Am Clin Climatol Assoc 2023; 133:11-23. [PMID: 37701611 PMCID: PMC10493752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
The country's public hospitals, guided by the principles established by the first such hospital in 1736 and codified through the policies of the Surgeon General in 1936, have played an outsized role as safety net institutions for disadvantaged populations. Public hospitals are predominantly located in urban, under-resourced neighborhoods and treat a larger percentage of low-income individuals who are uninsured or enrolled in Medicaid. In assessing the status of public hospitals and urban communities in the twenty-first century, the impact of the COVID-19 pandemic was evaluated at two high-performing public hospitals, Grady Memorial Hospital and Rush University Medical Center, and a network of safety hospitals affiliated with the Missouri Hospital Association. COVID-19 infections and death rates stratified by race and ethnicity were examined. The results suggest a trend toward lower mortality in African American patients in the first year of the pandemic and possible adverse outcomes in a subset of rural hospitals in Missouri. This study highlights the need to expand funding and support for the nation's essential hospitals.
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11
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Van Heerden A, Humphries H, Geng E. Whole person HIV services: a social science approach. Curr Opin HIV AIDS 2023; 18:46-51. [PMID: 36440805 PMCID: PMC9799045 DOI: 10.1097/coh.0000000000000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Globally, approximately 38.4 million people who are navigating complex lives, are also living with HIV, while HIV incident cases remain high. To improve the effectiveness of HIV prevention and treatment service implementation, we need to understand what drives human behaviour and decision-making around HIV service use. This review highlights current thinking in the social sciences, emphasizing how understanding human behaviour can be leveraged to improve HIV service delivery. RECENT FINDINGS The social sciences offer rich methodologies and theoretical frameworks for investigating how factors synergize to influence human behaviour and decision-making. Social-ecological models, such as the Behavioural Drivers Model (BDM), help us conceptualize and investigate the complexity of people's lives. Multistate and group-based trajectory modelling are useful tools for investigating the longitudinal nature of peoples HIV journeys. Successful HIV responses need to leverage social science approaches to design effective, efficient, and high-quality programmes. SUMMARY To improve our HIV response, implementation scientists, interventionists, and public health officials must respond to the context in which people make decisions about their health. Translating biomedical efficacy into real-world effectiveness is not simply finding a way around contextual barriers but rather engaging with the social context in which communities use HIV services.
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Affiliation(s)
- Alastair Van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg
| | - Hilton Humphries
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg
- Department of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Elvin Geng
- Centre for Dissemination and Implementation, Institute of Public Health, Division of Infectious Diseases, Department of Medicine, School of Medicine at Washington University in St. Louis, St. Louis, Missouri, USA
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Rohatgi KW, Fox B, Tram KH, Geng E, Mody A. 1906. Impact of Mask Mandate Timing on Community Transmission of SARS-CoV-2 in the St. Louis Metropolitan Area. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Mask mandates have been a widely used public health tool during the COVID-19 pandemic, but how to optimize their impact in the setting of concurrent but spontaneous population-level behavior changes due to rising case counts is not known. This study aimed to examine how earlier or later mask mandate implementation in the context of spontaneous behavior change would have affected transmission of SARS-CoV-2 and severe COVID-19 outcomes in the St. Louis, Missouri area.
Methods
Our model utilized aggregated hospitalization and death data for St. Louis city and county residents admitted to nearly all hospitals in the metropolitan area. We first fit a real-life model to estimate changes in transmission after the July 3, 2020 mask mandate, and then created counterfactual scenarios in which 1) 10%, 25%, and 50% of the changes were attributed to the mandate (as opposed to spontaneous behavior change) and 2) the mandate was implemented 3 or 7 days earlier, or 7 or 14 days later. We used an SEIR (Susceptible-Exposed-Infectious-Recovered) model framework and fit models in R.
Results
Assuming that 50% of increased masking was due to the mandate, implementing a mandate 7 days earlier was associated with a reduction from 12,685 (IQR: 10,463-16,560) to 12,294 (10,296-15,205) cumulative hospitalizations by September 30, while a 2-week delay was associated with an increase to 13,277 (10,808-17,908) hospitalizations. Trends were similar, but with reduced magnitude, when assuming that 10% or 25% of increased masking was due to the mandate (Figure). Depending on whether 10%, 25%, or 50% of increased masking was due to the mandate, implementing the mandate 1 week early was associated with a return to baseline (June 26) hospital census 1-7 days earlier, while delaying the mandate by 2 weeks led to a 2-12 day delay in return to baseline.
Hospital census and cumulative deaths in the real-life (baseline) model and under 12 counterfactual scenarios which vary mask mandate timing (3 or 7 days earlier, or 7 or 14 days delayed) and percentage of increase in masking that is attributed to the mask mandate (Panels A-B: 10%, Panels C-D: 25%, and Panels E-F: 50%).
As more of the increase in masking is attributed to the mandate, the costs of delaying the mandate and the benefits of earlier implementation increase. While differences in hospital census are most apparent several weeks after the mandate, differences in deaths gradually become more apparent over time.
Conclusion
Impact of a mask mandate depends on both timing and percent of increased masking that is attributed to the mandate. Implementing a mandate even a few days earlier is associated with fewer cumulative hospitalizations and earlier return to baseline, but the overall duration of implementation is slightly longer. Given wide variations in public behavior, locally-tailored models are essential for estimating the impact of interventions and informing the local public health response.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
| | - Branson Fox
- Washington University School of Medicine , Saint Louis, Missouri
| | | | - Elvin Geng
- Washington University School of Medicine , Saint Louis, Missouri
| | - Aaloke Mody
- Washington University School of Medicine , Saint Louis, Missouri
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13
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Mwamba C, Beres LK, Topp SM, Mukamba N, Simbeza S, Sikombe K, Mody A, Geng E, Holmes CB, Kennedy CE, Sikazwe I, Denison JA, Bolton Moore C. 'I need time to start antiretroviral therapy': understanding reasons for delayed ART initiation among people diagnosed with HIV in Lusaka, Zambia'. Ann Med 2022; 54:830-836. [PMID: 35311423 PMCID: PMC8942536 DOI: 10.1080/07853890.2022.2051069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Rapid antiretroviral therapy (ART) initiation can improve patient outcomes such as viral suppression and prevent new infections. However, not everyone who can start ART does so immediately. METHODS We conducted a qualitative study to inform interventions supporting rapid initiation in the 'Test and Start' era. We purposively sampled 20 adult patients living with HIV and a previous gap in care from ten health facilities in Lusaka, Zambia for interviews. We inductively analysed transcripts using a thematic, narrative approach. In their narratives, seven participants discussed delaying ART initiation. RESULTS Drawing on messages gleaned from facility-based counselling and community information, many cited greater fear of rapid sickness or death due to imperfect adherence or treatment side effects than negative health consequences due to delayed initiation. Participants described needing time to 'prepare' their minds for a lifetime treatment commitment. Concerns about inadvertent HIV status disclosure during drug collection discouraged immediate initiation, as did feeling healthy, and worries about the impact of ART initiation on relationship dynamics. CONCLUSION Findings suggest that counselling messages should accurately communicate treatment risks, without perpetuating fear-based narratives about HIV. Identifying and managing patient-specific concerns and reasons for the 'need for time' may be important for supporting individuals to rapidly accept lifelong treatment.Key messagesFear-based adherence messaging in health facilities about the dangers of missing a treatment dose or changing the time when ART is taken contributes to Zambian patients' refusals of immediate ART initiationResponsive health systems that balance a stated need for time to accept one's diagnosis and prepare to embark on a lifelong treatment plan with interventions to identify and manage patient-specific treatment related fears and concerns may support more rapid ART initiationPerceived social stigma around HIV continues to be a significant challenge for treatment initiation.
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Affiliation(s)
- Chanda Mwamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Laura K Beres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephanie M Topp
- College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, Australia
| | - Njekwa Mukamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sandra Simbeza
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Kombatende Sikombe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,Department of Public Health Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aaloke Mody
- Washington University School of Medicine in St. Louis, MO, USA
| | - Elvin Geng
- Washington University School of Medicine in St. Louis, MO, USA
| | | | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Julie A Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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14
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Eshun-Wilson I, Ford N, Le Tourneau N, Baral S, Schwartz S, Kemp C, Geng E. A Living Database of HIV Implementation Research (LIVE Project): Protocol for Rapid Living Reviews. JMIR Res Protoc 2022; 11:e37070. [PMID: 36197704 PMCID: PMC9582919 DOI: 10.2196/37070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/25/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background HIV implementation research evolves rapidly and is often complex and poorly characterized, which makes the synthesis of data on HIV implementation strategies inherently difficult. This is further compromised by prolonged data abstraction processes due to variable interventions, outcomes, and context, and delays in the publication of review findings; this can all result in outdated and irrelevant systematic reviews. Objective The LIVE project (A Living Database of HIV Implementation Research) aims to overcome these challenges by applying an implementation science lens to the conduct of rapid living systematic reviews and meta-analyses to inform HIV service delivery priorities and guideline development. Methods The LIVE project will generate a series of living systematic reviews exploring implementation strategies for improving HIV cascade outcomes (HIV infection, HIV diagnosis, linkage and retention in HIV care, viral suppression, and mortality). We will search Embase and MEDLINE as well databases specific to review questions for studies conducted after 2004 using predefined search terms to identify studies conducted in any age group or setting, and using implementation strategies that target policy makers, society, health organizations, health workers, and beneficiaries of care and their families. Both randomized controlled trials and observational studies will be included to ensure reviews include pragmatic data. In addition to assessments of methodological quality, features of the implementation strategies, relevance for implementation, and evidence quality will be determined using recognized frameworks. After initial publication, knowledge gaps will be identified, and review questions and search strategies revised to address ongoing critical areas of inquiry. Updated searches will be conducted every 6 months, with subsequent ongoing screening, data abstraction, and revision of meta-analyses. Results As of July 2022, five reviews are at various stages of development within the LIVE project. Three systematic reviews are underway and living review processes are in development for two reviews with estimated completion over the next 12 months. Conclusions This project and resulting systematic reviews will provide critical insights for HIV service delivery to inform international guideline development. International Registered Report Identifier (IRRID) DERR1-10.2196/37070
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Affiliation(s)
- Ingrid Eshun-Wilson
- Division of Infectious Diseases, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Nathan Ford
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Noelle Le Tourneau
- Division of Infectious Diseases, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Stefan Baral
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Sheree Schwartz
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Christopher Kemp
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Elvin Geng
- Division of Infectious Diseases, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
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15
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Coats JV, Humble S, Johnson KJ, Pedamallu H, Drake BF, Geng E, Goss CW, Davis KL. Employment Loss and Food Insecurity - Race and Sex Disparities in the Context of COVID-19. Prev Chronic Dis 2022; 19:E52. [PMID: 35980832 PMCID: PMC9390793 DOI: 10.5888/pcd19.220024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction Applying an intersectional framework, we examined sex and racial inequality in COVID-19–related employment loss (ie, job furlough, layoff, and reduced pay) and food insecurity (ie, quality and quantity of food eaten, food worry, and receipt of free meals or groceries) among residents in Saint Louis County, Missouri. Methods We used cross-sectional data from adults aged 18 or older (N = 2,146), surveyed by using landlines or cellular phones between August 12, 2020, and October 27, 2020. We calculated survey-weighted prevalence of employment loss and food insecurity for each group (Black female, Black male, White female, White male). Odds ratios for each group were estimated by using survey-weighted binary and multinomial logistic regression models. Results Black female residents had higher odds of being laid off, as compared with White male residents (OR = 2.61, 95% CI, 1.24–5.46). Both Black female residents (OR = 4.13, 95% CI, 2.29–7.45) and Black male residents (OR = 2.41, 95% CI, 1.15–5.07) were more likely to receive free groceries, compared with White male residents. Black female (OR = 4.25, 95% CI, 2.28–7.94) and White female residents (OR = 1.93, 95% CI, 1.04–3.60) had higher odds of sometimes worrying about food compared with White male residents. Black women also had higher odds of always or nearly always worrying about food, compared with White men (OR = 2.99, 95% CI, 1.52–5.87). Conclusion Black women faced the highest odds of employment loss and food insecurity, highlighting the disproportionate impact of COVID-19 among people with intersectional disadvantages of being both Black and female. Interventions to reduce employment loss and food insecurity can help reduce the disproportionately negative social effects among Black women.
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Affiliation(s)
- Jacquelyn V Coats
- Brown School at Washington University in St. Louis, MSC1196-251-46, 1 Brookings Drive, St. Louis, MO 63130. Email
| | - Sarah Humble
- Brown School at Washington University, School of Medicine, Department of Surgery, St. Louis, Missouri
| | | | - Havisha Pedamallu
- Brown School at Washington University, School of Medicine, Department of Surgery, St. Louis, Missouri
| | - Bettina F Drake
- Brown School at Washington University, School of Medicine, Department of Surgery, St. Louis, Missouri
| | - Elvin Geng
- Brown School at Washington University, School of Medicine, Division of Infectious Diseases, St. Louis, Missouri
| | - Charles W Goss
- Brown School at Washington University, School of Medicine, Division of Biostatistics, St. Louis, Missouri
| | - Kia L Davis
- Brown School at Washington University, School of Medicine, Department of Surgery, St. Louis, Missouri
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16
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Buzaalirwa L, Nambala L, Banturaki G, Amor PI, Katahoire A, Geng E, Semeere A. Implementing screening for hypertension in archetypal HIV primary care: a mixed-methods assessment. BMC Health Serv Res 2022; 22:1041. [PMID: 35971141 PMCID: PMC9380283 DOI: 10.1186/s12913-022-08362-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High prevalence of HIV and hypertension in sub-Saharan Africa puts adults living with HIV (ALWH) at high risk of end-organ complications. Both World Health Organization (WHO) and national guidelines recommend screening and treatment of hypertension among ALWH on antiretroviral therapy (ART). We evaluated the implementation of hypertension screening among adults on ART at three Uganda Cares Primary care facilities. METHODS Using a sequential explanatory mixed-methods approach, we reviewed patient records, and interviewed both patients and providers during 2018 and 2019. We obtained demographics, clinical and blood pressure (BP) measurements via records review. We estimate the period prevalence of screening and use adjusted modified Poisson regression models to evaluate predictors of screening. In-depth interviews were analysed using a thematic approach to explain the observed prevalence and predictors of BP screening. RESULTS Records for 1426 ALWH were reviewed. Patients had a median age of 35 years and 65% of them were female. Most were on ART (89% on first-line) with a median duration of 4 years. Only 262 (18%) were overweight or obese with a body mass index (BMI) > 25 Kg/M2. In 2017 or 2018 patients made a median of 3 visits and 783 patients had a BP recorded, hence a period prevalence 55%. Older age, male sex, more clinic visits, and clinic site were associated with screening in the adjusted analyses. Erratic BP screening was corroborated by patients' and providers' interviews. Challenges included; high patient numbers, low staffing, provider apathy, no access to treatment, and lack of functioning of BP equipment. CONCLUSION Almost half of regular HIV clinic attendees at these prototypical primary care HIV clinics were not screened for hypertension for a whole year. Improving BP screening requires attention to address modifiable challenges and ensure local buy-in beyond just providing equipment.
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Affiliation(s)
| | - Lydia Nambala
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace Banturaki
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Anne Katahoire
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Elvin Geng
- Washington University St. Louis, St. Louis, MO, USA
| | - Aggrey Semeere
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
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17
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Schwartz S, Ortiz JC, Smith JD, Beres L, Mody A, Eshun-Wilson I, Benbow N, Mallela DP, Tan S, Baral S, Geng E. Data Velocity in HIV-Related Implementation Research: Estimating Time From Funding to Publication. J Acquir Immune Defic Syndr 2022; 90:S32-S40. [PMID: 35703753 PMCID: PMC9204847 DOI: 10.1097/qai.0000000000002963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Given available effective biomedical and behavioral prevention and treatment interventions, HIV-related implementation research (IR) is expanding. The rapid generation and dissemination of IR to inform guidelines and practice has the potential to optimize the impact of the Ending the Epidemic Initiative and the HIV pandemic response more broadly. METHODS We leveraged a prior mapping review of NIH-funded awards in HIV and IR from January 2013 to March 2018 and identified all publications linked to those grants in NIH RePORTER through January 1, 2021 (n = 1509). Deduplication and screening of nonoriginal research reduced the count to 1032 articles, of which 952 were eligible and included in this review. Publication volume and timing were summarized; Kaplan-Meier plots estimated time to publication. RESULTS Among the 215 NIH-funded IR-related awards, 127 of 215 (59%) published original research directly related to the grant, averaging 2.0 articles (SD: 3.3) per award, largely in the early IR phases. Many articles (521 of 952, 55%) attributed to grants did not report grant-related data. Time from article submission to publication averaged 205 days (SD: 107). The median time-to-first publication from funding start was 4 years. Data dissemination velocity varied by award type, trending toward faster publication in recent years. Delays in data velocity included (1) time from funding to enrollment, (2) enrollment length, and (3) time from data collection completion to publication. CONCLUSION Research publication was high overall, and time-to-publication is accelerating; however, over 40% of grants have yet to publish findings from grant-related data. Addressing bottlenecks in the production and dissemination of HIV-related IR would reinforce its programmatic and policy relevance in the HIV response.
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Affiliation(s)
- Sheree Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Joel Chavez Ortiz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Justin D. Smith
- Department of Population Health Sciences, University of Utah, Spencer Fox Eccles School of Medicine, Salt Lake City, UT
| | - Laura Beres
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD
| | - Aaloke Mody
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Nanette Benbow
- Department of Psychiatry and Behavioral Sciences at the Northwestern University Feinberg School of Medicine
| | | | - Stephen Tan
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Elvin Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO
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18
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Beres LK, Schwartz S, Mody A, Geng E, Baral S. Five Common Myths Limiting Engagement in HIV-Related Implementation Research. J Acquir Immune Defic Syndr 2022; 90:S41-S45. [PMID: 35703754 PMCID: PMC9204845 DOI: 10.1097/qai.0000000000002964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT HIV-related implementation research holds great promise in achieving the potential of efficacious prevention and treatment tools in reducing the incidence of HIV and improving HIV treatment outcomes among people living with HIV. From the perspectives of HIV-related implementation research training and academia and through consultations with funders and investigators new to implementation research, we identified 5 myths that act as barriers to engagement in implementation research among new investigators. Prevailing myths broadly include (1) one must rigidly apply all aspects of an implementation framework for it to be valid, (2) implementation research limits the type of designs available to researchers, (3) implementation strategies cannot be patient-level or client-level approaches, (4) only studies prioritizing implementation outcomes are "true" implementation research, and (5) if not explicitly labeled implementation research, it may have limited impact on implementation. We offer pragmatic approaches to negotiate these myths with the goal of encouraging dialog, ensuring high-quality research, and fostering a more inclusive and dynamic field of implementation research. Ultimately, the goal of dispelling these myths was to lower the perceived bar to engagement in HIV-related implementation research while still ensuring quality in the methods and measures used.
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Affiliation(s)
- Laura K. Beres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aaloke Mody
- University of Washington, St. Louis, St. Louis, MO, USA
| | - Elvin Geng
- University of Washington, St. Louis, St. Louis, MO, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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19
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Pilar M, Elwy AR, Lushniak L, Huang G, McLoughlin GM, Hooley C, Nadesan-Reddy N, Sandler B, Moshabela M, Alonge O, Geng E, Proctor E. A Perspective on Implementation Outcomes and Strategies to Promote the Uptake of COVID-19 Vaccines. Front Health Serv 2022; 2:897227. [PMID: 36925818 PMCID: PMC10012688 DOI: 10.3389/frhs.2022.897227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022]
Abstract
Recent articles have highlighted the importance of incorporating implementation science concepts into pandemic-related research. However, limited research has been documented to date regarding implementation outcomes that may be unique to COVID-19 vaccinations and how to utilize implementation strategies to address vaccine program-related implementation challenges. To address these gaps, we formed a global COVID-19 implementation workgroup of implementation scientists who met weekly for over a year to review the available literature and learn about ongoing research during the pandemic. We developed a hierarchy to prioritize the applicability of "lessons learned" from the vaccination-related implementation literature. We identified applications of existing implementation outcomes as well as identified additional implementation outcomes. We also mapped implementation strategies to those outcomes. Our efforts provide rationale for the utility of using implementation outcomes in pandemic-related research. Furthermore, we identified three additional implementation outcomes: availability, health equity, and scale-up. Results include a list of COVID-19 relevant implementation strategies mapped to the implementation outcomes.
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Affiliation(s)
- Meagan Pilar
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Larissa Lushniak
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Grace Huang
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Gabriella M. McLoughlin
- College of Public Health, Temple University, Philadelphia, PA, United States
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Cole Hooley
- School of Social Work, Brigham Young University, Provo, UT, United States
| | - Nisha Nadesan-Reddy
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Brittney Sandler
- Bernard Becker Medical Library, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Olakunle Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elvin Geng
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Enola Proctor
- Shanti K. Khinduka Distinguished Professor Emerita, Brown School, Washington University in St. Louis, St. Louis, MO, United States
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20
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Tram KH, Saeed S, Bradley C, Fox B, Eshun-Wilson I, Mody A, Geng E. Deliberation, Dissent, and Distrust: Understanding Distinct Drivers of Coronavirus Disease 2019 Vaccine Hesitancy in the United States. Clin Infect Dis 2022; 74:1429-1441. [PMID: 34272559 PMCID: PMC8406882 DOI: 10.1093/cid/ciab633] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite the availability of safe and efficacious coronavirus disease 2019 vaccines, a significant proportion of the American public remains unvaccinated and does not appear to be immediately interested in receiving the vaccine. METHODS In this study, we analyzed data from the US Census Bureau's Household Pulse Survey, a biweekly cross-sectional survey of US households. We estimated the prevalence of vaccine hesitancy across states and nationally and assessed the predictors of vaccine hesitancy and vaccine rejection. In addition, we examined the underlying reasons for vaccine hesitancy, grouped into thematic categories. RESULTS A total of 459 235 participants were surveyed from 6 January to 29 March 2021. While vaccine uptake increased from 7.7% to 47%, vaccine hesitancy rates remained relatively fixed: overall, 10.2% reported that they would probably not get a vaccine and 8.2% that they would definitely not get a vaccine. Income, education, and state political leaning strongly predicted vaccine hesitancy. However, while both female sex and black race were factors predicting hesitancy, among those who were hesitant, these same characteristics predicted vaccine reluctance rather than rejection. Those who expressed reluctance invoked mostly "deliberative" reasons, while those who rejected the vaccine were also likely to invoke reasons of "dissent" or "distrust." CONCLUSIONS Vaccine hesitancy comprises a sizable proportion of the population and is large enough to threaten achieving herd immunity. Distinct subgroups of hesitancy have distinctive sociodemographic associations as well as cognitive and affective predilections. Segmented public health solutions are needed to target interventions and optimize vaccine uptake.
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Affiliation(s)
- Khai Hoan Tram
- Division of Infectious Diseases, Department of Medicine,
Washington University in St Louis, St Louis,
Missouri, USA
| | - Sahar Saeed
- Division of Infectious Diseases, Department of Medicine,
Washington University in St Louis, St Louis,
Missouri, USA
| | - Cory Bradley
- Division of Infectious Diseases, Department of Medicine,
Washington University in St Louis, St Louis,
Missouri, USA
| | - Branson Fox
- Division of Infectious Diseases, Department of Medicine,
Washington University in St Louis, St Louis,
Missouri, USA
| | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, Department of Medicine,
Washington University in St Louis, St Louis,
Missouri, USA
| | - Aaloke Mody
- Division of Infectious Diseases, Department of Medicine,
Washington University in St Louis, St Louis,
Missouri, USA
| | - Elvin Geng
- Division of Infectious Diseases, Department of Medicine,
Washington University in St Louis, St Louis,
Missouri, USA
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21
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Johnson KJ, Goss CW, Thompson JJ, Trolard AM, Maricque BB, Anwuri V, Cohen R, Donaldson K, Geng E. Assessment of the impact of the COVID-19 pandemic on health services use. Public Health in Practice 2022; 3:100254. [PMID: 35403073 PMCID: PMC8979834 DOI: 10.1016/j.puhip.2022.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives The coronavirus disease of 2019 (COVID-19) pandemic declared by the World Health Organization on March 11, 2020 impacted healthcare services with provider and patient cancellations, delays, and patient avoidance or delay of emergency department or urgent care. Limited data exist on the population proportion affected by delayed healthcare, which is important for future healthcare planning efforts. Our objective was to evaluate the impact of the COVID-19 pandemic on healthcare service cancellations or delays and delays/avoidance of emergency/urgent care overall and by population characteristics. Study design This was a cross-sectional study. Methods Our sample (n = 2314) was assembled through a phone survey from 8/12/2020–10/27/2020 among non-institutionalized St. Louis County, Missouri, USA residents ≥18 years. We asked about provider and patient-initiated cancellations or delays of appointments and pandemic-associated delays/avoidance of emergency/urgent care overall and by participant characteristics. We calculated weighted prevalence estimates by select resident characteristics. Results Healthcare services cancellations or delays affected ∼54% (95% CI 50.6%–57.1%) of residents with dental (31.1%, 95% CI 28.1%–34.0%) and primary care (22.1%, 95% CI 19.5%–24.6%) being most common. The highest prevalences were among those who were White, ≥65 years old, female, in fair/poor health, who had health insurance, and who had ≥1 medical condition. Delayed or avoided emergency/urgent care impacted ∼23% (95% CI 19.9%–25.4%) of residents with a higher prevalence in females than males. Conclusions Healthcare use disruptions impacted a substantial proportion of residents. Future healthcare planning efforts should consider these data to minimize potential morbidity and mortality from delayed care.
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22
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Huebschmann AG, Johnston S, Davis R, Kwan BM, Geng E, Haire-Joshu D, Sandler B, McNeal DM, Brownson RC, Rabin BA. Promoting rigor and sustainment in implementation science capacity building programs: A multi-method study. Implement Res Pract 2022; 3:26334895221146261. [PMID: 37091073 PMCID: PMC9924281 DOI: 10.1177/26334895221146261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background The field of Implementation science (IS) continues to evolve, and the number and type of IS capacity building Programs (ISCBPs) are in flux. These changes push the field to revisit the accepted IS competencies and to guide sustainment of ISCBPs. Our objectives were: (1) compare characteristics of current ISCBPs; (2) identify recommendations to support ISCBP sustainment; (3) measure how often ISCBPs address IS competencies; (4) identify novel and important IS competencies for the field. Method This multi-method study included ISCBPs delivering structured, longitudinal IS training, excluding single courses and brief workshops. We used three complementary methods to meet our objectives. First, we identified ISCBPs via an internet search and snowball sampling methods. Second, we surveyed these ISCBPs to identify areas of program focus, types of trainees, IS competencies addressed, and recommendations to sustain ISCBPs. Third, we conducted a modified Delphi process with IS researchers/leaders to reach consensus on the IS competencies that were both important and novel as compared to the IS competencies published to date. Results Among 74 eligible ISCBPs identified, 46 responded (62% response rate). Respondent ISCBPs represented diverse areas of focus (e.g., global health, cardiopulmonary disease) and trainee stages (e.g., graduate students, mid-career faculty). While most respondent ISCBPs addressed core IS methods, targeting IS competencies was less consistent (33% for nongraduate/non-fellowship ISCBPs; >90% for graduate/national ISCBPs). Our modified Delphi process identified eight novel and important IS competencies related to increasing health equity or the speed of translation. Recommendations to sustain ISCBPs included securing financial administrative support. Conclusions Current ISCBPs train learners across varying career stages in diverse focus areas. To promote rigor, we recommend ISCBPs address specific IS competencies, with consideration of these eight novel/emerging competencies. We also recommend ISCBPs report on their IS competencies, focus area(s), and trainee characteristics. ISCBP programs need administrative financial support. Plain Language Summary There is a limited workforce capacity to conduct implementation science (IS) research. To address this gap, the number and type of IS capacity building Programs (ISCBPs) focusing on training researchers and practitioners in IS methods continue to increase. Our efforts to comprehensively identify and describe ISCBPs for researchers and practitioners highlighted four implications for leaders of ISCBPs related to program sustainment and rigor. First, we identified a range of contextual characteristics of ISCBPs, including the research topics, methods, and IS competencies addressed, and the types of trainees accepted. Second, given the variability of trainee types and research, rigorous ISCBP programs should tailor the IS competencies and methods addressed to the skills needed by the types of trainees in their program. Third, the field of IS needs to periodically revisit the competencies needed with attention to the skills needed in the field. We used a consensus-building process with ISCBP leaders and other IS experts to expand existing IS competencies and identified eight important, novel IS competencies that broadly relate to promoting health equity and speeding the translation of research to practice. Finally, as more institutions consider developing ISCBPs, we identified factors needed to support ISCBP sustainment, including ongoing financial support. In addition to these implications for ISCBP leaders, there are also policy implications. For example, IS journals may enact policies to require manuscripts evaluating ISCBP performance to report on certain contextual characteristics, such as the IS competencies addressed and types of trainees accepted. The field may also consider developing an accreditation body to evaluate the rigor of ISCBP curricula.
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Affiliation(s)
- Amy G. Huebschmann
- Adult and Child Center for Outcomes Research and Delivery Science,
University of Colorado Anschutz Medical Campus (CU-Anschutz), Aurora, CO, USA
- Division of General Internal Medicine, CU-Anschutz, Aurora, CO,
USA
- Ludeman Family Center for Women’s Health Research, CU-Anschutz,
Aurora, CO, USA
| | - Shelly Johnston
- Washington University Center for Diabetes Translation Research, Washington University in St.
Louis, St. Louis, MO, USA
| | - Rachel Davis
- Health Service and Population Research Department, Centre for
Implementation Science, King’s College London, London, UK
| | - Bethany M. Kwan
- Adult and Child Center for Outcomes Research and Delivery Science,
University of Colorado Anschutz Medical Campus (CU-Anschutz), Aurora, CO, USA
- Department of Emergency Medicine, CU-Anschutz, Aurora, CO, USA
- Colorado Clinical & Translational Sciences Institute,
CU-Anschutz, Aurora, CO, USA
| | - Elvin Geng
- Department of Medicine (Division of Infectious Diseases), Washington
University School of Medicine, Washington University in St.
Louis, St. Louis, MO, USA
| | - Debra Haire-Joshu
- Washington University Center for Diabetes Translation Research, Washington University in St.
Louis, St. Louis, MO, USA
- Department of Medicine (Division of Geriatrics and Nutritional
Sciences), Washington University School of Medicine, Washington University in St.
Louis, St. Louis, MO, USA
| | - Brittney Sandler
- Department of Medicine (Division of Infectious Diseases), Washington
University School of Medicine, Washington University in St.
Louis, St. Louis, MO, USA
| | - Demetria M. McNeal
- Adult and Child Center for Outcomes Research and Delivery Science,
University of Colorado Anschutz Medical Campus (CU-Anschutz), Aurora, CO, USA
- Division of General Internal Medicine, CU-Anschutz, Aurora, CO,
USA
- Colorado Clinical & Translational Sciences Institute,
CU-Anschutz, Aurora, CO, USA
| | - Ross C. Brownson
- Prevention Research Center, Brown School at Washington University,
St. Louis, MO, USA
- Department of Surgery (Division of Public Health Sciences) and
Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington
University, St. Louis, MO, USA
| | - Borsika A. Rabin
- Adult and Child Center for Outcomes Research and Delivery Science,
University of Colorado Anschutz Medical Campus (CU-Anschutz), Aurora, CO, USA
- ACTRI Dissemination and Implementation Science Center, University
of California San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity
Science, University of California San Diego, La Jolla, CA, USA
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23
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Mwamba C, Mukamba N, Sharma A, Lumbo K, Foloko M, Nyirenda H, Simbeza S, Sikombe K, Holmes CB, Sikazwe I, Moore CB, Mody A, Geng E, Beres LK. "Provider discretionary power practices to support implementation of patient-centered HIV care in Lusaka, Zambia". Front Health Serv 2022; 2:918874. [PMID: 36925865 PMCID: PMC10012689 DOI: 10.3389/frhs.2022.918874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022]
Abstract
Introduction Traditional patient-provider relationships privilege the providers, as they possess the formal authority and clinical knowledge applied to address illness, but providers also have discretion over how they exercise their power to influence patients' services, benefits, and sanctions. In this study, we assessed providers' exercise of discretionary power in implementing patient-centered care (PCC) practices in Lusaka, Zambia. Methods HIV clinical encounters between patients on antiretroviral therapy (ART) and providers across 24 public health facilities in Lusaka Province were audio recorded and transcribed verbatim. Using qualitative content analysis, we identified practices of discretionary power (DP) employed in the implementation of PCC and instances of withholding DP. A codebook of DP practices was inductively and iteratively developed. We compared outcomes across provider cadres and within sites over time. Results We captured 194 patient-provider interactions at 24 study sites involving 11 Medical Officers, 58 Clinical Officers and 10 Nurses between August 2019 to May 2021. Median interaction length was 7.5 min. In a hierarchy where providers dominate patients and interactions are rapid, some providers invited patients to ask questions and responded at length with information that could increase patient understanding and agency. Others used inclusive language, welcomed patients, conducted introductions, and apologized for delayed services, narrowing the hierarchical distance between patient and provider, and facilitating recognition of the patient as a partner in care. Although less common, providers shared their decision-making powers, allowing patients to choose appointment dates and influence regimens. They also facilitated resource access, including access to services and providers outside of scheduled appointment times. Application of DP was not universal and missed opportunities were identified. Conclusion Supporting providers to recognize their power and intentionally share it is both inherent to the practice of PCC (e.g., making a patient a partner), and a way to implement improved patient support. More research is needed to understand the application of DP practices in improving the patient-centeredness of care in non-ART settings.
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Affiliation(s)
- Chanda Mwamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Njekwa Mukamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Kasapo Lumbo
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Marksman Foloko
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Herbert Nyirenda
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sandra Simbeza
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Kombatende Sikombe
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Charles B Holmes
- Department of Medicine, Georgetown University Medical Centre, Georgetown University, Washington, DC, United States
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Aaloke Mody
- Washington University School of Medicine, St. Louis, MO, United States
| | - Elvin Geng
- Washington University School of Medicine, St. Louis, MO, United States
| | - Laura K Beres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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24
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Iguna S, Getahun M, Lewis-Kulzer J, Odhiambo G, Adhiambo F, Montoya L, Petersen ML, Bukusi E, Odeny T, Geng E, Camlin CS. Attitudes towards and experiences with economic incentives for engagement in HIV care and treatment: Qualitative insights from a randomized trial in Kenya. PLOS Glob Public Health 2022; 2:e0000204. [PMID: 36962322 PMCID: PMC10021832 DOI: 10.1371/journal.pgph.0000204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022]
Abstract
Growing literature has shown heterogenous effects of conditional cash incentives (CCIs) on HIV care retention. The field lacks insights into reasons why incentives impact various patients in different ways-differences that may be due to variations in psychological and social mechanisms of effect. A deeper understanding of patients' perceptions and experiences of CCIs for retention may help to clarify these mechanisms. We conducted a qualitative study embedded in the ADAPT-R trial (NCT#02338739), a sequential multiple assignment randomized trial (SMART) that evaluated economic incentives to support retention in HIV care among persons living with HIV (PLHIV) initiating antiretroviral therapy in Kenya. Participants who attended their scheduled clinic visits received an incentive of approximately $4 each visit. Interviews were conducted between July 2016 and June 2017 with 39 participants to explore attitudes and experiences with economic incentives conditional on care engagement. Analyses revealed that incentives helped PLHIV prioritize care-seeking by alleviating transport barriers and food insecurity: "I decided to forgo [work] and attend clinic […] the voucher relieved me". Patients who borrowed money for care-seeking reported feeling relieved from the burden of indebtedness to others: "I borrow with confidence that I will pay after my appointment." Incentives fostered their autonomy, and enabled them to support others: "I used the money to buy some clothes and Pampers for the children." Participants who were intrinsically motivated to engage in care ("my life depends on the drugs, not the incentive"), and those who mistrusted researchers, reported being less prompted by the incentive itself. For patients not already prioritizing care-seeking, incentives facilitated care engagement through alleviating transport costs, indebtedness and food insecurity, and also supported social role fulfillment. Conditional cash incentives may be an important cue to action to improve progression through the HIV treatment cascade, and contribute to better care retention.
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Affiliation(s)
- Sarah Iguna
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Jayne Lewis-Kulzer
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Gladys Odhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Fridah Adhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Lina Montoya
- Division of Biostatistics, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Maya L Petersen
- Divisions of Biostatistics and Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Elizabeth Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Thomas Odeny
- Department of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Elvin Geng
- Division of Infectious Diseases, Department of Internal Medicine, Washington University, St. Louis, Missouri, United States of America
| | - Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, California, United States of America
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Mando RO, Moghadassi M, Juma E, Ogollah C, Packel L, Kulzer JL, Kadima J, Odhiambo F, Eshun-Wilson I, Kim HY, Cohen CR, Bukusi EA, Geng E. Patient preferences for HIV service delivery models; a Discrete Choice Experiment in Kisumu, Kenya. PLOS Glob Public Health 2022; 2:e0000614. [PMID: 36962597 PMCID: PMC10021384 DOI: 10.1371/journal.pgph.0000614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
Novel "differentiated service delivery" models for HIV treatment that reduce clinic visit frequency, minimize waiting time, and deliver treatment in the community promise retention improvement for HIV treatment in Sub-Saharan Africa. Quantitative assessments of differentiated service delivery (DSD) feature most preferred by patient populations do not widely exist but could inform selection and prioritization of different DSD models. We used a discrete choice experiment (DCE) to elicit patient preferences of HIV treatment services and how they differ across DSD models. We surveyed 18+year-olds, enrolled in HIV care for ≥6 months between February-March, 2019 at four facilities in Kisumu County, Kenya. DCE offered patients a series of comparisons between three treatment models, each varying across seven attributes: ART refill location, quantity of dispensed ART at each refill, medication pick-up hours, type of adherence support, clinical visit frequency, staff attitude, and professional cadre of person providing ART refills. We used hierarchical Bayesian model to estimate attribute importance and relative desirability of care characteristics, latent class analysis (LCA) for groups of preferences and mixed logit model for willingness to trade analysis. Of 242 patients, 128 (53.8%) were females and 150 (62.8%) lived in rural areas. Patients placed greatest importance on ART refill location [19.5% (95% CI 18.4, 10.6) and adherence support [19.5% (95% CI 18.17, 20.3)], followed by staff attitude [16.1% (95% CI 15.1, 17.2)]. In the mixed logit, patients preferred nice attitude of staff (coefficient = 1.60), refill ART health center (Coeff = 1.58) and individual adherence support (Coeff = 1.54), 3 or 6 months for ART refill (Coeff = 0.95 and 0.80, respectively) and pharmacists (instead of lay health workers) providing ART refill (Coeff = 0.64). No differences were observed by gender or urbanicity. LCA revealed two distinct groups (59.5% vs. 40.5%). Participants preferred 3 to 6-month refill interval or clinic visit spacing, which DSD offers stable patients. While DSD has encouraged community ART group options, our results suggest strong preferences for ART refills from health-centers or pharmacists over lay-caregivers or community members. These preferences held across gender&urban/rural subpopulations.
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Affiliation(s)
- Raphael Onyango Mando
- Research Care and Training Program, Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Michelle Moghadassi
- Department of Gynecology, Obstetrics, and Reproductive Sciences, University of California San Francisco, California, United States of America
| | - Eric Juma
- Research Care and Training Program, Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Cirilus Ogollah
- Research Care and Training Program, Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Laura Packel
- The University of California Berkeley, Berkeley, California, United States of America
| | - Jayne Lewis Kulzer
- Department of Gynecology, Obstetrics, and Reproductive Sciences, University of California San Francisco, California, United States of America
- The University of California Berkeley, Berkeley, California, United States of America
| | - Julie Kadima
- Research Care and Training Program, Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Francesca Odhiambo
- Research Care and Training Program, Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Hae-Young Kim
- School of Medicine, New York University, New York, New York, United States of America
| | - Craig R Cohen
- Department of Gynecology, Obstetrics, and Reproductive Sciences, University of California San Francisco, California, United States of America
| | - Elizabeth A Bukusi
- Research Care and Training Program, Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Gynecology, Obstetrics, and Reproductive Sciences, University of California San Francisco, California, United States of America
- The University of California Berkeley, Berkeley, California, United States of America
| | - Elvin Geng
- Division of Infectious Diseases, Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri, United States of America
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Abstract
A recent Science editorial on the social and political headwinds that have blunted, obfuscated, and confused public behavior in the United States' COVID-19 response cautioned both politicians who appoint themselves scientists and scientists-including virologists and epidemiologists-to stay in their lanes. The warning raises an important question: Should science add another lane?
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Affiliation(s)
- Enola K Proctor
- Enola K. Proctor is the Shanti K. Khinduka Distinguished Professsor Emerita, Brown School, Washington University in St. Louis, MO, USA
| | - Elvin Geng
- Elvin Geng is a professor of Medicine in the Department of Medicine, Division of Infectious Diseases, Washington University in St. Louis, MO, USA
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Ford N, Eshun-Wilson I, Ameyan W, Newman M, Vojnov L, Doherty M, Geng E. Future directions for HIV service delivery research: Research gaps identified through WHO guideline development. PLoS Med 2021; 18:e1003812. [PMID: 34555010 PMCID: PMC8496797 DOI: 10.1371/journal.pmed.1003812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 10/07/2021] [Indexed: 11/19/2022] Open
Abstract
Nathan Ford and co-authors discuss the systematic identification of research gaps in improving HIV service delivery.
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Affiliation(s)
- Nathan Ford
- Department of HIV, Viral Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Wole Ameyan
- Department of HIV, Viral Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Morkor Newman
- Department of HIV, Viral Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Lara Vojnov
- Department of HIV, Viral Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Meg Doherty
- Department of HIV, Viral Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Elvin Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
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Dommaraju S, Hagey J, Odeny TA, Okaka S, Kadima J, Bukusi EA, Cohen CR, Kwena Z, Eshun-Wilson I, Geng E. Preferences of people living with HIV for differentiated care models in Kenya: A discrete choice experiment. PLoS One 2021; 16:e0255650. [PMID: 34432795 PMCID: PMC8386850 DOI: 10.1371/journal.pone.0255650] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 07/21/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION To improve retention on HIV treatment in Africa, public health programs are promoting a family of innovations to service delivery-referred to as "differentiated service delivery" (DSD) models-which seek to better meet the needs of both systems and patients by reducing unnecessary encounters, expanding access, and incorporating peers and patients in patient care. Data on the relative desirability of different models to target populations, which is currently sparse, can help guide prioritization of specific models during scale-up. METHODS We conducted a discrete choice experiment to assess patient preferences for various characteristics of treatment services. Clinically stable people living with HIV were recruited from an HIV clinic in Kisumu, Kenya. We selected seven attributes of DSD models drawn from literature review and previous qualitative work. We created a balanced and orthogonal design to identify main term effects. A total of ten choice tasks were solicited per respondent. We calculated relative utility (RU) for each attribute level, a numerical representation of the strength of patient preference. Data were analyzed using a Hierarchical Bayesian model via Sawtooth Software. RESULTS One hundred and four respondents (37.5% men, 41.1 years mean age) preferred receiving care at a health facility, compared with home-delivery or a community meeting point (RU = 69.3, -16.2, and -53.1, respectively; p << 0.05); receiving those services from clinicians and pharmacists-as opposed to lay health workers or peers (RU = 21.5, 5.9, -24.5; p < 0.05); and preferred an individual support system over a group support system (RU = 15.0 and 4.2; p < 0.05). Likewise, patients strongly preferred longer intervals between both clinical reviews (RU = 40.1 and -50.7 for 6- and 1-month spacing, respectively; p < 0.05) and between ART collections (RU = 33.6 and -49.5 for 6- and1-month spacing, respectively; p < 0.05). CONCLUSION Although health systems find community- and peer-based DSD models attractive, clinically stable patients expressed a preference for facility-based care as long as clinical visits were extended to biannual. These data suggest that multi-month scripting and fast-track models best align with patient preferences, an insight which can help prioritize use of different DSD models in the region.
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Affiliation(s)
- Sagar Dommaraju
- Department of Global Health, University of California San Francisco, San Francisco, California, United States of America
| | - Jill Hagey
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina, United States of America
| | - Thomas A. Odeny
- Department of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Sharon Okaka
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Julie Kadima
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Craig R. Cohen
- Department of Global Health, University of California San Francisco, San Francisco, California, United States of America
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | | | - Ingrid Eshun-Wilson
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Elvin Geng
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
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Jamil MS, Eshun-Wilson I, Witzel TC, Siegfried N, Figueroa C, Chitembo L, Msimanga-Radebe B, Pasha MS, Hatzold K, Corbett E, Barr-DiChiara M, Rodger AJ, Weatherburn P, Geng E, Baggaley R, Johnson C. Examining the effects of HIV self-testing compared to standard HIV testing services in the general population: A systematic review and meta-analysis. EClinicalMedicine 2021; 38:100991. [PMID: 34278282 PMCID: PMC8271120 DOI: 10.1016/j.eclinm.2021.100991] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We updated a 2017 systematic review and compared the effects of HIV self-testing (HIVST) to standard HIV testing services to understand effective service delivery models among the general population. METHODS We included randomized controlled trials (RCTs) comparing testing outcomes with HIVST to standard testing in the general population and published between January 1, 2006 and June 4, 2019. Random effects meta-analysis was conducted and pooled risk ratios (RRs) were reported. The certainty of evidence was determined using the GRADE methodology. FINDINGS We identified 14 eligible RCTs, 13 of which were conducted in sub-Saharan Africa. Support provided to self-testers ranged from no/basic support to one-on-one in-person support. HIVST increased testing uptake overall (RR:2.09; 95% confidence interval: 1.69-2.58; p < 0.0001;13 RCTs; moderate certainty evidence) and by service delivery model including facility-based distribution, HIVST use at facilities, secondary distribution to partners, and community-based distribution. The number of persons diagnosed HIV-positive among those tested (RR:0.81, 0.45-1.47; p = 0.50; 8 RCTs; moderate certainty evidence) and number linked to HIV care/treatment among those diagnosed (RR:0.95, 0.79-1.13; p = 0.52; 6 RCTs; moderate certainty evidence) were similar between HIVST and standard testing. Reported harms/adverse events with HIVST were rare and appeared similar to standard testing (RR:2.52: 0.52-12.13; p = 0.25; 4 RCTs; very low certainty evidence). INTERPRETATION HIVST appears to be safe and effective among the general population in sub-Saharan Africa with a range of delivery models. It identified and linked additional people with HIV to care. These findings support the wider availability of HIVST to reach those who may not otherwise access testing.
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Affiliation(s)
- Muhammad S. Jamil
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
- Corresponding author.
| | - Ingrid Eshun-Wilson
- Washington University School of Medicine in St. Louis, St Louis, United States
| | - T. Charles Witzel
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nandi Siegfried
- Independent Clinical Epidemiologist, Cape Town, South Africa
| | - Carmen Figueroa
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Lastone Chitembo
- World Health Organization Country Office for Zambia, Lusaka, Zambia
| | | | - Muhammad S. Pasha
- World Health Organization Country Office for Pakistan, Islamabad, Pakistan
| | - Karin Hatzold
- Population Services International, Cape Town, South Africa
| | - Elizabeth Corbett
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- TB/HIV Group, Malawi–Liverpool–Wellcome Clinical Research Programme, Blantyre, Malawi
| | | | - Alison J. Rodger
- Institute for Global Health, University College London, London, United Kingdom
| | - Peter Weatherburn
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elvin Geng
- Washington University School of Medicine in St. Louis, St Louis, United States
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl Johnson
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
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30
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Mehrotra ML, Westreich D, Glymour MM, Geng E, Glidden DV. Transporting Subgroup Analyses of Randomized Controlled Trials for Planning Implementation of New Interventions. Am J Epidemiol 2021; 190:1671-1680. [PMID: 33615327 DOI: 10.1093/aje/kwab045] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 11/19/2020] [Accepted: 02/18/2021] [Indexed: 02/01/2023] Open
Abstract
Subgroup analyses of randomized controlled trials guide resource allocation and implementation of new interventions by identifying groups of individuals who are likely to benefit most from the intervention. Unfortunately, trial populations are rarely representative of the target populations of public health or clinical interest. Unless the relevant differences between trial and target populations are accounted for, subgroup results from trials might not reflect which groups in the target population will benefit most from the intervention. Transportability provides a rigorous framework for applying results derived in potentially highly selected study populations to external target populations. The method requires that researchers measure and adjust for all variables that 1) modify the effect of interest and 2) differ between the target and trial populations. To date, applications of transportability have focused on the external validity of overall study results and understanding within-trial heterogeneity; however, this approach has not yet been used for subgroup analyses of trials. Through an example from the Iniciativa Profilaxis Pre-Exposición (iPrEx) study (multiple countries, 2007-2010) of preexposure prophylaxis for human immunodeficiency virus, we illustrate how transporting subgroup analyses can produce target-specific subgroup effect estimates and numbers needed to treat. This approach could lead to more tailored and accurate guidance for resource allocation and cost-effectiveness analyses.
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31
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Dionne-Odom J, Westfall AO, Dombrowski JC, Kitahata MM, Crane HM, Mugavero MJ, Moore RD, Karris M, Christopoulos K, Geng E, Mayer KH, Marrazzo J. Intersecting Epidemics: Incident Syphilis and Drug Use in Women Living With Human Immunodeficiency Virus in the United States (2005-2016). Clin Infect Dis 2021; 71:2405-2413. [PMID: 31712815 DOI: 10.1093/cid/ciz1108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/08/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Rates of early syphilis in US women are steadily increasing, but predictors of infection in this group are not clearly defined. METHODS This retrospective analysis focused on women enrolled in the US CFAR Network of Integrated Clinical Systems cohort between January 2005 and December 2016 with syphilis testing performed. The primary outcome of incident syphilis infection was defined serologically as a newly positive test with positive confirmatory testing after a negative test or a 2-dilution increase in rapid plasma regain titer. Infection rates were calculated for each woman-year in care with testing. Predictors of syphilis were sought among sociodemographics, clinical information, and self-reported behaviors. Multivariable logistic regression models were created; a subgroup analysis assessed predictors in women of reproductive age. RESULTS The annual rate of incident syphilis among 4416 women engaged in human immunodeficiency virus (HIV) care and tested during the 12-year study period was 760/100 000 person-years. Independent predictors of infection were injection drug use as a risk factor for HIV acquisition (aOR, 2.2; 95% CI, 1.3-3.9), hepatitis C infection (aOR, 1.9; 95% CI, 1.1-3.4), black race (aOR, 2.2; 95% CI, 1.3-3.7 compared with white race), and more recent entry to care (since 2005 compared with 1994-2004). Predictors were similar in women aged 18-49. CONCLUSIONS Syphilis infection is common among US women in HIV care. Syphilis screening and prevention efforts should focus on women reporting drug use and with hepatitis C coinfection. Future studies should identify specific behaviors that mediate syphilis acquisition risk in women who use drugs.
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Affiliation(s)
- Jodie Dionne-Odom
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrew O Westfall
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Julia C Dombrowski
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Mari M Kitahata
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Heidi M Crane
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard D Moore
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maile Karris
- Division of Infectious Diseases, Department of Medicine, University of California at San Diego, San Diego, California, USA
| | - Katerina Christopoulos
- Division of Infectious Diseases, Department of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Elvin Geng
- Division of Infectious Diseases, Department of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Kenneth H Mayer
- Division of Infectious Diseases, Fenway Health and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Jeanne Marrazzo
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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32
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Oliver CD, Rebeiro PF, Shepherd BE, Keruly J, Mayer KH, Mathews WC, Turan B, Moore RD, Crane HM, Geng E, Napravnik S, Kitahata MM, Mugavero MJ, Pettit AC. Clinic-Level Factors Associated With Retention in Care Among People Living With Human Immunodeficiency Virus in a Multisite US Cohort, 2010-2016. Clin Infect Dis 2021; 71:2592-2598. [PMID: 31758196 DOI: 10.1093/cid/ciz1144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/21/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Retention in care (RIC) leads to reduced HIV transmission and mortality. Few studies have investigated clinic services and RIC among people living with HIV (PLWH) in the United States. We conducted a multisite retrospective cohort study to identify clinic services associated with RIC from 2010-2016 in the United States. METHODS PLWH with ≥1 HIV primary care visit from 2010-2016 at 7 sites in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) were included. Clinic-level factors evaluated via site survey included patients per provider/trainee, navigation, RIC posters/brochures, laboratory test timing, flexible scheduling, appointment reminder methods, and stigma support services. RIC was defined as ≥2 encounters per year, ≥90 days apart, observed until death, administrative censoring (31 December 2016), or loss to follow-up (censoring at first 12-month interval without a visit with no future visits). Poisson regression with robust error variance, clustered by site adjusting for calendar year, age, sex, race/ethnicity, and HIV transmission risk factor, estimated risk ratios (RRs) and 95% confidence intervals (CIs) for RIC. RESULTS Among 21 046 PLWH contributing 103 348 person-years, 67% of person-years were retained. Availability of text appointment reminders (RR, 1.13; 95% CI, 1.03-1.24) and stigma support services (RR, 1.11; 95% CI, 1.04-1.19) were associated with better RIC. Disparities persisted for age, sex, and race. CONCLUSIONS Availability of text appointment reminders and stigma support services was associated with higher rates of RIC, indicating that these may be feasible and effective approaches for improving RIC.
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Affiliation(s)
- Cassandra D Oliver
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter F Rebeiro
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bryan E Shepherd
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeanne Keruly
- Division of Infectious Diseases, Johns Hopkins, Baltimore, MD, USA
| | | | | | - Bulent Turan
- Division of Infectious Diseases, University of Washington School of Medicine, Seattle, WA, USA
| | - Richard D Moore
- Division of Infectious Diseases, Johns Hopkins, Baltimore, MD, USA
| | - Heidi M Crane
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Elvin Geng
- Division of Infectious Diseases, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Sonia Napravnik
- and Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Mari M Kitahata
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, University of Washington School of Medicine, Seattle, WA, USA
| | - April C Pettit
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
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Pettit AC, Bian A, Schember CO, Rebeiro PF, Keruly JC, Mayer KH, Mathews WC, Moore RD, Crane HM, Geng E, Napravnik S, Shepherd BE, Mugavero MJ. Development and Validation of a Multivariable Prediction Model for Missed HIV Health Care Provider Visits in a Large US Clinical Cohort. Open Forum Infect Dis 2021; 8:ofab130. [PMID: 34327249 PMCID: PMC8314944 DOI: 10.1093/ofid/ofab130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/12/2021] [Indexed: 11/12/2022] Open
Abstract
Background Identifying individuals at high risk of missing HIV care provider visits could support proactive intervention. Previous prediction models for missed visits have not incorporated data beyond the individual level. Methods We developed prediction models for missed visits among people with HIV (PWH) with ≥1 follow-up visit in the Center for AIDS Research Network of Integrated Clinical Systems from 2010 to 2016. Individual-level (medical record data and patient-reported outcomes), community-level (American Community Survey), HIV care site–level (standardized clinic leadership survey), and structural-level (HIV criminalization laws, Medicaid expansion, and state AIDS Drug Assistance Program budget) predictors were included. Models were developed using random forests with 10-fold cross-validation; candidate models with the highest area under the curve (AUC) were identified. Results Data from 382 432 visits among 20 807 PWH followed for a median of 3.8 years were included; the median age was 44 years, 81% were male, 37% were Black, 15% reported injection drug use, and 57% reported male-to-male sexual contact. The highest AUC was 0.76, and the strongest predictors were at the individual level (prior visit adherence, age, CD4+ count) and community level (proportion living in poverty, unemployed, and of Black race). A simplified model, including readily accessible variables available in a web-based calculator, had a slightly lower AUC of .700. Conclusions Prediction models validated using multilevel data had a similar AUC to previous models developed using only individual-level data. The strongest predictors were individual-level variables, particularly prior visit adherence, though community-level variables were also predictive. Absent additional data, PWH with previous missed visits should be prioritized by interventions to improve visit adherence.
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Affiliation(s)
- April C Pettit
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cassandra O Schember
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter F Rebeiro
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeanne C Keruly
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kenneth H Mayer
- Fenway Health and Harvard Medical School, Boston, Massachusetts, USA
| | - W Christopher Mathews
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Richard D Moore
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Heidi M Crane
- Division of Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | - Elvin Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
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Lesko CR, Nance RM, Lau B, Fojo AT, Hutton HE, Delaney JAC, Crane HM, Cropsey KL, Mayer KH, Napravnik S, Geng E, Mathews WC, McCaul ME, Chander G. Changing Patterns of Alcohol Use and Probability of Unsuppressed Viral Load Among Treated Patients with HIV Engaged in Routine Care in the United States. AIDS Behav 2021; 25:1072-1082. [PMID: 33064249 DOI: 10.1007/s10461-020-03065-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 01/13/2023]
Abstract
We examined HIV viral load non-suppression ([Formula: see text] 200 copies/mL) subsequent to person-periods (3-18 months) bookended by two self-reports of alcohol use on a standardized patient reported outcome assessment among adults in routine HIV care. We examined the relative risk (RR) of non-suppression associated with increases and decreases in alcohol use (relative to stable use), stratified by use at the start of the person-period. Increases in drinking from abstinence were associated with higher risk of viral non-suppression (low-risk without binge: RR 1.16, 95% CI 1.03, 1.32; low-risk with binge: RR 1.35, 95% CI 1.11, 1.63; high-risk: RR 1.89, 95% CI 1.16, 3.08). Decreases in drinking from high-risk drinking were weakly, and not statistically significantly associated with lower risk of viral non-suppression. Other changes in alcohol use were not associated with viral load non-suppression. Most changes in alcohol consumption among people using alcohol at baseline were not strongly associated with viral non-suppression.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - Robin M Nance
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Anthony T Fojo
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Heidi M Crane
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Karen L Cropsey
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AB, USA
| | - Kenneth H Mayer
- Fenway Health, Beth Israel Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Elvin Geng
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | | | - Mary E McCaul
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Beres LK, Schwartz S, Simbeza S, McGready J, Eshun-Wilson I, Mwamba C, Sikombe K, Topp SM, Somwe P, Mody A, Mukamba N, Ehrenkranz PD, Padian N, Pry J, Moore CB, Holmes CB, Sikazwe I, Denison JA, Geng E. Patterns and Predictors of Incident Return to HIV Care Among Traced, Disengaged Patients in Zambia: Analysis of a Prospective Cohort. J Acquir Immune Defic Syndr 2021; 86:313-322. [PMID: 33149000 PMCID: PMC7878284 DOI: 10.1097/qai.0000000000002554] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Dynamic movement of patients in and out of HIV care is prevalent, but there is limited information on patterns of patient re-engagement or predictors of return to guide HIV programs to better support patient engagement. METHODS From a probability-based sample of lost to follow-up, adult patients traced by peer educators from 31 Zambian health facilities, we prospectively followed disengaged HIV patients for return clinic visits. We estimated the cumulative incidence of return and the time to return using Kaplan-Meier methods. We used univariate and multivariable Cox proportional hazards regression to conduct a risk factor analysis identifying predictors of incident return across a social ecological framework. RESULTS Of the 556 disengaged patients, 73.0% [95% confidence interval (CI): 61.0 to 83.8] returned to HIV care. The median follow-up time from disengagement was 32.3 months (interquartile range: 23.6-38.9). The rate of return decreased with time postdisengagement. Independent predictors of incident return included a previous gap in care [adjusted Hazard Ratio (aHR): 1.95, 95% CI: 1.23 to 3.09] and confronting a stigmatizer once in the past year (aHR: 2.14, 95% CI: 1.25 to 3.65). Compared with a rural facility, patients were less likely to return if they sought care from an urban facility (aHR: 0.68, 95% CI: 0.48 to 0.96) or hospital (aHR: 0.52, 95% CI: 0.33 to 0.82). CONCLUSIONS Interventions are needed to hasten re-engagement in HIV care. Early and differential interventions by time since disengagement may improve intervention effectiveness. Patients in urban and tertiary care settings may need additional support. Improving patient resilience, outreach after a care gap, and community stigma reduction may facilitate return. Future re-engagement research should include causal evaluation of identified factors.
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Affiliation(s)
- Laura K. Beres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sandra Simbeza
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;
| | - John McGready
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, Washington University School of Medicine, University of Washington, St. Louis, St. Louis, MO
| | - Chanda Mwamba
- 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;
| | - Paul Somwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;
| | - Aaloke Mody
- Division of Infectious Diseases, Washington University School of Medicine, University of Washington, St. Louis, St. Louis, MO
| | - Njekwa Mukamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;
| | | | - Nancy Padian
- Division of Epidemiology, University of California Berkeley, Berkeley, CA; and
| | - Jake Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;
- Division of Infectious Diseases, Washington University School of Medicine, University of Washington, St. Louis, St. Louis, MO
| | - Carolyn Bolton Moore
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
| | - Charles B. Holmes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
- Department of Medicine, Georgetown University, Washington, DC
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;
| | - Julie A. Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
| | - Elvin Geng
- Division of Infectious Diseases, Washington University School of Medicine, University of Washington, St. Louis, St. Louis, MO
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Ruderman SA, Crane HM, Nance RM, Whitney BM, Harding BN, Mayer KH, Moore RD, Eron JJ, Geng E, Mathews WC, Rodriguez B, Willig AL, Burkholder GA, Lindström S, Wood BR, Collier AC, Vannappagari V, Henegar C, Van Wyk J, Curtis L, Saag MS, Kitahata MM, Delaney JAC. Brief Report: Weight Gain Following ART Initiation in ART-Naïve People Living With HIV in the Current Treatment Era. J Acquir Immune Defic Syndr 2021; 86:339-343. [PMID: 33148997 PMCID: PMC7878311 DOI: 10.1097/qai.0000000000002556] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/09/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Evaluate differences in weight change by regimen among people living with HIV (PLWH) initiating antiretroviral therapy (ART) in the current era. METHODS Between 2012 and 2019, 3232 ART-naïve PLWH initiated ≥3-drug ART regimens in 8 Centers for AIDS Research Network of Integrated Clinical Systems sites. We estimated weight change by regimen for 11 regimens in the immediate (first 6 months) and extended (all follow-up on initial regimen) periods using linear mixed models adjusted for time on regimen, interaction between time and regimen, age, sex, race/ethnicity, hepatitis B/C coinfection, nadir CD4, smoking, diabetes, antipsychotic medication, and site. We included more recently approved regimens [eg, with tenofovir alafenamide fumarate (TAF)] only in the immediate period analyses to ensure comparable follow-up time. RESULTS Mean follow-up was 1.9 years on initial ART regimen. In comparison to efavirenz/tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC), initiating bictegravir/TAF/FTC {3.9 kg [95% confidence interval (CI): 2.2 to 5.5]} and dolutegravir/TAF/FTC [4.4 kg (95% CI: 2.1 to 6.6)] were associated with the greatest weight gain in the immediate period, followed by darunavir/TDF/FTC [3.7 kg (95% CI: 2.1 to 5.2)] and dolutegravir/TDF/FTC [2.6 kg (95% CI: 1.3 to 3.9)]. In the extended period, compared with efavirenz/TDF/FTC, initiating darunavir/TDF/FTC was associated with a 1.0 kg (95% CI: 0.5 to 1.5) per 6-months greater weight gain, whereas dolutegravir/abacavir/FTC was associated with a 0.6-kg (95% CI: 0.3 to 0.9) and dolutegravir/TDF/FTC was associated with a 0.6-kg (95% CI: 0.1 to 1.1) per 6-months greater gain. Weight gain on dolutegravir/abacavir/FTC and darunavir/TDF/FTC was significantly greater than that for several integrase inhibitor-based regimens. CONCLUSIONS There is heterogeneity between regimens in weight gain following ART initiation among previously ART-naïve PLWH; we observed greater gain among PLWH taking newer integrase strand transfer inhibitors (DTG, BIC) and DRV-based regimens.
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Affiliation(s)
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA
| | - Robin M Nance
- Department of Medicine, University of Washington, Seattle, WA
| | | | | | | | | | - Joseph J Eron
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Elvin Geng
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - William C Mathews
- Department of Medicine, University of California San Diego, San Diego, CA
| | - B Rodriguez
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | - Brian R Wood
- Department of Medicine, University of Washington, Seattle, WA
| | - Ann C Collier
- Department of Medicine, University of Washington, Seattle, WA
| | | | | | | | | | | | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA
| | - Joseph A C Delaney
- University of Washington, Seattle, WA
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
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Conte M, Eshun-Wilson I, Geng E, Imbert E, Hickey MD, Havlir D, Gandhi M, Clemenzi-Allen A. Brief Report: Understanding Preferences for HIV Care Among Patients Experiencing Homelessness or Unstable Housing: A Discrete Choice Experiment. J Acquir Immune Defic Syndr 2020; 85:444-449. [PMID: 33136742 PMCID: PMC8028840 DOI: 10.1097/qai.0000000000002476] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Homelessness and unstable housing (HUH) negatively impact care outcomes for people living with HIV (PLWH). To inform the design of a clinic program for PLWH experiencing HUH, we quantified patient preferences and trade-offs across multiple HIV-service domains using a discrete choice experiment (DCE). METHODS We sequentially sampled PLWH experiencing HUH presenting at an urban HIV clinic with ≥1 missed primary care visit and viremia in the last year to conduct a DCE. Participants chose between 2 hypothetical clinics varying across 5 service attributes: care team "get to know me as a person" versus not; receiving $10, $15, or $20 gift cards for clinic visits; drop-in versus scheduled visits; direct phone communication to care team versus front-desk staff; and staying 2 versus 20 blocks from the clinic. We estimated attribute relative utility (ie, preference) using mixed-effects logistic regression and calculated the monetary trade-off of preferred options. RESULTS Among 65 individuals interviewed, 61% were >40 years old, 45% White, 77% men, 25% heterosexual, 56% lived outdoors/emergency housing, and 44% in temporary housing. Strongest preferences were for patient-centered care team [β = 3.80; 95% confidence interval (CI): 2.57 to 5.02] and drop-in clinic appointments (β = 1.33; 95% CI: 0.85 to 1.80), with a willingness to trade $32.79 (95% CI: 14.75 to 50.81) and $11.45 (95% CI: 2.95 to 19.95) in gift cards/visit, respectively. CONCLUSIONS In this DCE, PLWH experiencing HUH were willing to trade significant financial gain to have a personal relationship with and drop-in access to their care team rather than more resource-intensive services. These findings informed Ward 86's "POP-UP" program for PLWH-HUH and can inform "ending the HIV epidemic" efforts.
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Affiliation(s)
- Madellena Conte
- Division of HIV, ID and Global Medicine, University of California, San Francisco, San Francisco, CA
- Institute of Global Health Sciences, University of California, San Francisco, San Francisco, CA
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO; and
| | - Elvin Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO; and
| | - Elizabeth Imbert
- Division of HIV, ID and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - Matthew D Hickey
- Division of HIV, ID and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - Diane Havlir
- Division of HIV, ID and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - Monica Gandhi
- Division of HIV, ID and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - Angelo Clemenzi-Allen
- Division of HIV, ID and Global Medicine, University of California, San Francisco, San Francisco, CA
- San Francisco Department of Public Health, San Francisco, CA
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Affiliation(s)
- Denis Nash
- Denis Nash is with the Institute for Implementation Science in Population Health, City University of New York (CUNY) and the CUNY Graduate School of Public Health and Health Policy, New York, NY. Elvin Geng is with the Center for Implementation and Dissemination, Institute for Public Health, and the Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, MO
| | - Elvin Geng
- Denis Nash is with the Institute for Implementation Science in Population Health, City University of New York (CUNY) and the CUNY Graduate School of Public Health and Health Policy, New York, NY. Elvin Geng is with the Center for Implementation and Dissemination, Institute for Public Health, and the Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, MO
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Roy M, Bolton-Moore C, Sikazwe I, Mukumbwa-Mwenechanya M, Efronson E, Mwamba C, Somwe P, Kalunkumya E, Lumpa M, Sharma A, Pry J, Mutale W, Ehrenkranz P, Glidden DV, Padian N, Topp S, Geng E, Holmes CB. Participation in adherence clubs and on-time drug pickup among HIV-infected adults in Zambia: A matched-pair cluster randomized trial. PLoS Med 2020; 17:e1003116. [PMID: 32609756 PMCID: PMC7329062 DOI: 10.1371/journal.pmed.1003116] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 05/27/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Current models of HIV service delivery, with frequent facility visits, have led to facility congestion, patient and healthcare provider dissatisfaction, and suboptimal quality of services and retention in care. The Zambian urban adherence club (AC) is a health service innovation designed to improve on-time drug pickup and retention in HIV care through off-hours facility access and pharmacist-led group drug distribution. Similar models of differentiated service delivery (DSD) have shown promise in South Africa, but observational analyses of these models are prone to bias and confounding. We sought to evaluate the effectiveness and implementation of ACs in Zambia using a more rigorous study design. METHODS AND FINDINGS Using a matched-pair cluster randomized study design (ClinicalTrials.gov: NCT02776254), 10 clinics were randomized to intervention (5 clinics) or control (5 clinics). At each clinic, between May 19 and October 27, 2016, a systematic random sample was assessed for eligibility (HIV+, age ≥ 14 years, on ART >6 months, not acutely ill, CD4 count not <200 cells/mm3) and willingness to participate in an AC. Clinical and antiretroviral drug pickup data were obtained through the existing electronic medical record. AC meeting attendance data were collected at intervention facilities prospectively through October 28, 2017. The primary outcome was time to first late drug pickup (>7 days late). Intervention effect was estimated using unadjusted Kaplan-Meier survival curves and a Cox proportional hazards model to derive an adjusted hazard ratio (aHR). Medication possession ratio (MPR) and implementation outcomes (adoption, acceptability, appropriateness, feasibility, and fidelity) were additionally evaluated as secondary outcomes. Baseline characteristics were similar between 571 intervention and 489 control participants with respect to median age (42 versus 41 years), sex (62% versus 66% female), median time since ART initiation (4.8 versus 5.0 years), median CD4 count at study enrollment (506 versus 533 cells/mm3), and baseline retention (53% versus 55% with at least 1 late drug pickup in previous 12 months). The rate of late drug pickup was lower in intervention participants compared to control participants (aHR 0.26, 95% CI 0.15-0.45, p < 0.001). Median MPR was 100% in intervention participants compared to 96% in control participants (p < 0.001). Although 18% (683/3,734) of AC group meeting visits were missed, on-time drug pickup (within 7 days) still occurred in 51% (350/683) of these missed visits through alternate means (use of buddy pickup or early return to the facility). Qualitative evaluation suggests that the intervention was acceptable to both patients and providers. While patients embraced the convenience and patient-centeredness of the model, preference for traditional adherence counseling and need for greater human resources influenced intervention appropriateness and feasibility from the provider perspective. The main limitations of this study were the small number of clusters, lack of viral load data, and relatively short follow-up period. CONCLUSIONS ACs were found to be an effective model of service delivery for reducing late ART drug pickup among HIV-infected adults in Zambia. Drug pickup outside of group meetings was relatively common and underscores the need for DSD models to be flexible and patient-centered if they are to be effective. TRIAL REGISTRATION ClinicalTrials.gov NCT02776254.
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Affiliation(s)
- Monika Roy
- University of California, San Francisco, San Fancisco, California, United States of America
| | - Carolyn Bolton-Moore
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- University of Alabama, Tuscaloosa, Alabama, United States of America
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Emilie Efronson
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Chanda Mwamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Paul Somwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Mwansa Lumpa
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Jake Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- University of California, Davis, Davis, California, United States of America
| | - Wilbroad Mutale
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Peter Ehrenkranz
- Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | - David V. Glidden
- University of California, San Francisco, San Fancisco, California, United States of America
| | - Nancy Padian
- University of California, Berkeley, Berkeley, California, United States of America
| | - Stephanie Topp
- James Cook University, Townsville, Queensland, Australia
| | - Elvin Geng
- University of California, San Francisco, San Fancisco, California, United States of America
| | - Charles B. Holmes
- Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Global Health Practice and Impact, Georgetown University School of Medicine, Washington, District of Columbia, United States of America
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Burnham JP, Geng E, Venkatram C, Colditz GA, McKay VR. Putting the Dissemination and Implementation in Infectious Diseases. Clin Infect Dis 2020; 71:218-225. [PMID: 31608379 PMCID: PMC7312236 DOI: 10.1093/cid/ciz1011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/08/2019] [Indexed: 12/15/2022] Open
Abstract
Dissemination and implementation science seeks generalizable knowledge about closing the gap between clinical discovery and actual use in routine practice and public health. The field of infectious diseases enjoys an abundance of highly efficacious interventions (eg, antimicrobial agents, human immunodeficiency virus treatment) which are not adequately used in routine care, thereby missing critical opportunities to improve population health. In this article, we summarize salient features of dissemination and implementation science, reviewing definitions and methodologies for infectious diseases clinicians and researchers. We give examples of the limited use of dissemination and implementation science in infectious diseases thus far, suggest opportunities for application, and provide resources for interested readers to use and apply to their own research and practice.
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Affiliation(s)
- Jason P Burnham
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Elvin Geng
- Division of Infectious Diseases, University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - Graham A Colditz
- Division of Public Health Sciences, Washington University School of Medicine, St Louis, Missouri, USA
| | - Virginia R McKay
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
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Williams-Nguyen J, Hawes SE, Nance RM, Lindström S, Heckbert SR, Kim HN, Mathews WC, Cachay ER, Budoff M, Hurt CB, Hunt PW, Geng E, Moore RD, Mugavero MJ, Peter I, Kitahata MM, Saag MS, Crane HM, Delaney JA. Association Between Chronic Hepatitis C Virus Infection and Myocardial Infarction Among People Living With HIV in the United States. Am J Epidemiol 2020; 189:554-563. [PMID: 31712804 DOI: 10.1093/aje/kwz236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 09/13/2019] [Accepted: 10/01/2019] [Indexed: 01/01/2023] Open
Abstract
Hepatitis C virus (HCV) infection is common among people living with human immunodeficiency virus (PLWH). Extrahepatic manifestations of HCV, including myocardial infarction (MI), are a topic of active research. MI is classified into types, predominantly atheroembolic type 1 MI (T1MI) and supply-demand mismatch type 2 MI (T2MI). We examined the association between HCV and MI among patients in the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems, a US multicenter clinical cohort of PLWH. MIs were centrally adjudicated and categorized by type using the Third Universal Definition of Myocardial Infarction. We estimated the association between chronic HCV (RNA+) and time to MI while adjusting for demographic characteristics, cardiovascular risk factors, clinical characteristics, and history of injecting drug use. Among 23,407 PLWH aged ≥18 years, there were 336 T1MIs and 330 T2MIs during a median of 4.7 years of follow-up between 1998 and 2016. HCV was associated with a 46% greater risk of T2MI (adjusted hazard ratio (aHR) = 1.46, 95% confidence interval (CI): 1.09, 1.97) but not T1MI (aHR = 0.87, 95% CI: 0.58, 1.29). In an exploratory cause-specific analysis of T2MI, HCV was associated with a 2-fold greater risk of T2MI attributed to sepsis (aHR = 2.01, 95% CI: 1.25, 3.24). Extrahepatic manifestations of HCV in this high-risk population are an important area for continued research.
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Xu J, Geng E, Brake L, Wiemken A, Keenan B, Kubin L, Schwab R. 0237 Effect of Chronic Intermittent Hypoxia on Spatial Performance in Rats. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Cognitive and spatial dysfunction is common among patients with obstructive sleep apnea (OSA). The cause of these abnormalities may be related to the effects of hypoxic damage in the brain during sleep. Here we report a rodent model for chronic intermittent hypoxia (CIH) that examines spatial performance tasks via a Barnes Maze paradigm. We hypothesized that increased severity of CIH yields decreased cognitive and spatial performance.
Methods
Three groups of rats were subject to varying levels of hypoxia conditions: sham (21% oxygen; n = 19), moderate (11% oxygen; n = 14), and severe (6% oxygen; n = 21). To deliver hypoxia, rats were exposed to three-minute cycles of oxygen between 21% and condition-specific nadir oxygen for 12 hours daily (during sleep) in specialized chambers. Barnes maze testing was performed at 0, 1, 2, and 3 months. Rats were placed on a circular platform with 19 shallow holes and one deeper target hole to escape the noxious sound. Each month, rats had 3 minutes to find the target hole in four daily trials over four consecutive days. Average maze completion time on day 4 was recorded.
Results
Rats from the three hypoxia groups did not differ significantly in mean maze completion time at baseline (0 months). Throughout the three months of exposure to hypoxic conditions, maze completion time on day 4 did not differ significantly from baseline for sham rats. However, by month 3, rats exposed to severe hypoxic conditions had a significantly larger percent increase from baseline compared to sham rats (p = 0.0358).
Conclusion
Our findings indicate that rats undergoing intermittent hypoxia perform worse than normoxic rats in spatial performance tasks. These data suggest there is a relationship between CIH and cognitive/spatial impairment.
Support
Funded by NIH P01 HL094307
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Affiliation(s)
- J Xu
- University of Pennsylvania, Philadelphia, PA
| | - E Geng
- University of Pennsylvania, Philadelphia, PA
| | - L Brake
- University of Pennsylvania, Philadelphia, PA
| | - A Wiemken
- University of Pennsylvania, Philadelphia, PA
| | - B Keenan
- University of Pennsylvania, Philadelphia, PA
| | - L Kubin
- University of Pennsylvania, Philadelphia, PA
| | - R Schwab
- University of Pennsylvania, Philadelphia, PA
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Xu J, Geng E, Brake L, Wiemken A, Keenan B, Kubin L, Schwab R. 0424 Effect of Chronic Intermittent Hypoxia on Global Cerebral Metabolic Rate of Oxygen Consumption in Rats. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Patients with obstructive sleep apnea (OSA) commonly exhibit grey and white matter loss, which may be related to hypoxic damage in the brain during sleep. Our preliminary data demonstrated lower values of cerebral metabolic rate of oxygen (CMRO2) consumption in apneics versus controls. As such, reduced CMRO2 may be an important contributor to the neurologic consequences of OSA. Here we report a rodent model for chronic intermittent hypoxia (CIH) to quantify effects on CMRO2 consumption. We hypothesized that increased severity of CIH results in decreased CMRO2 levels.
Methods
Three groups of rats were subject to varying levels of hypoxia: sham (21% oxygen; n = 19), moderate (11% oxygen; n = 14), and severe (6% oxygen; n = 21). To deliver hypoxia, rats were exposed to three-minute cycles of oxygen between 21% and condition-specific nadir O2 for 12 hours daily during their sleep cycle. CMRO2 values were measured with MRI techniques, performed on anesthetized rats before and after 3 months exposure to CIH.
Results
Rats from the three hypoxia groups did not differ significantly in CMRO2 values at baseline (0 months). After 3 months of exposure to hypoxic conditions, there was a trending difference (p=0.0726) in percent change from baseline between severely hypoxic (-35.3%) and sham (+12.3%) rats. Moderately hypoxic rats demonstrated an intermediate decrease from baseline after 3 months (-19.0%).
Conclusion
Our findings suggest that increased severity of intermittent hypoxia yields a dose-response decrease in brain oxygen consumption. Our data add to the growing body of evidence on the relationship between obstructive sleep apnea and hypoxic damage in the brain, suggesting that CMRO2 levels may be an indicator of the neurologic consequences of OSA.
Support
Funded by NIH P01 HL094307
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Affiliation(s)
- J Xu
- University of Pennsylvania, Philadelphia, PA
| | - E Geng
- University of Pennsylvania, Philadelphia, PA
| | - L Brake
- University of Pennsylvania, Philadelphia, PA
| | - A Wiemken
- University of Pennsylvania, Philadelphia, PA
| | - B Keenan
- University of Pennsylvania, Philadelphia, PA
| | - L Kubin
- University of Pennsylvania, Philadelphia, PA
| | - R Schwab
- University of Pennsylvania, Philadelphia, PA
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44
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Mukamba N, Chilyabanyama ON, Beres LK, Simbeza S, Sikombe K, Padian N, Holmes C, Sikazwe I, Geng E, Schwartz SR. Patients' Satisfaction with HIV Care Providers in Public Health Facilities in Lusaka: A Study of Patients who were Lost-to-Follow-Up from HIV Care and Treatment. AIDS Behav 2020; 24:1151-1160. [PMID: 31673912 PMCID: PMC7082366 DOI: 10.1007/s10461-019-02712-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Prognosis among those who are HIV infected has improved but long-term retention is challenging. Health systems may benefit from routinely measuring patient satisfaction which is a potential driver of engagement in HIV care, but it is not often measured in Africa, and Zambia in particular. This study aims to internally validate a patient satisfaction tool, assess satisfaction among patients previously lost-to-follow up (LTFU) from HIV care in Lusaka province and to measure association between patient satisfaction with their original clinic and re-engagement in HIV care. A cross-sectional assessment of satisfaction was conducted by tracing sampled patients drawn from public health facilities. Our findings suggest that satisfaction tool, previously validated in USA, exhibits high internal consistency for measuring patient satisfaction in the Zambian health system. Patient satisfaction with healthcare providers is associated with re-engagement in HIV care. Future interventions on patient-centred care are likely to optimize and support retention in care.
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Affiliation(s)
- Njekwa Mukamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
| | | | - Laura K Beres
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Sandra Simbeza
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Nancy Padian
- Division of Epidemiology, University of California, Berkeley, Berkeley, CA, USA
| | - Charles Holmes
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Centre for Global Health and Quality, Georgetown University Medical Center, Washington, DC, USA
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Elvin Geng
- Division of HIV, ID and Global Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Sheree R Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
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Tucker A, Tembo T, Tampi RP, Mutale J, Mukumba‐Mwenechanya M, Sharma A, Dowdy DW, Moore CB, Geng E, Holmes CB, Sikazwe I, Sohn H. Redefining and revisiting cost estimates of routine ART care in Zambia: an analysis of ten clinics. J Int AIDS Soc 2020; 23:e25431. [PMID: 32064766 PMCID: PMC7025092 DOI: 10.1002/jia2.25431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/11/2019] [Accepted: 11/20/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Accurate costing is key for programme planning and policy implementation. Since 2011, there have been major changes in eligibility criteria and treatment regimens with price reductions in ART drugs, programmatic changes resulting in clinical task-shifting and decentralization of ART delivery to peripheral health centres making existing evidence on ART care costs in Zambia out-of-date. As decision makers consider further changes in ART service delivery, it is important to understand the current drivers of costs for ART care. This study provides updates on costs of ART services for HIV-positive patients in Zambia. METHODS We evaluated costs, assessed from the health systems perspective and expressed in 2016 USD, based on an activity-based costing framework using both top-down and bottom-up methods with an assessment of process and capacity. We collected primary site-level costs and resource utilization data from government documents, patient chart reviews and time-and-motion studies conducted in 10 purposively selected ART clinics. RESULTS The cost of providing ART varied considerably among the ten clinics. The average per-patient annual cost of ART service was $116.69 (range: $59.38 to $145.62) using a bottom-up method and $130.32 (range: $94.02 to $162.64) using a top-down method. ART drug costs were the main cost driver (67% to 7% of all costs) and are highly sensitive to the types of patient included in the analysis (long-term vs. all ART patients, including those recently initiated) and the data sources used (facility vs. patient level). Missing capacity costs made up 57% of the total difference between the top-down and bottom-up estimates. Variability in cost across the ten clinics was associated with operational characteristics. CONCLUSIONS Real-world costs of current routine ART services in Zambia are considerably lower than previously reported estimates and sensitive to operational factors and methods used. We recommend collection and monitoring of resource use and capacity data to periodically update cost estimates.
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Affiliation(s)
- Austin Tucker
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Tannia Tembo
- Center for Infectious Disease Research (CIDRZ)LusakaZambia
| | - Radhika P Tampi
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Jacob Mutale
- Center for Infectious Disease Research (CIDRZ)LusakaZambia
| | | | - Anjali Sharma
- Center for Infectious Disease Research (CIDRZ)LusakaZambia
| | - David W Dowdy
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Carolyn B Moore
- Center for Infectious Disease Research (CIDRZ)LusakaZambia
- University of AlabamaBirminghamALUSA
| | - Elvin Geng
- Department of Internal MedicineWashington University School of Medicine in St. LouisSt. LouisMOUSA
- Center for Dissemination and ImplementationInstitute for Public Health at Washington University in St. LouisSt. LouisMOUSA
| | - Charles B Holmes
- Center for Infectious Disease Research (CIDRZ)LusakaZambia
- Johns Hopkins University School of MedicineBaltimoreMDUSA
- Georgetown University School of MedicineWashingtonDCUSA
| | | | - Hojoon Sohn
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
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46
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Ford N, Geng E, Ellman T, Orrell C, Ehrenkranz P, Sikazwe I, Jahn A, Rabkin M, Ayisi Addo S, Grimsrud A, Rosen S, Zulu I, Reidy W, Lejone T, Apollo T, Holmes C, Kolling AF, Phate Lesihla R, Nguyen HH, Bakashaba B, Chitembo L, Tiriste G, Doherty M, Bygrave H. Emerging priorities for HIV service delivery. PLoS Med 2020; 17:e1003028. [PMID: 32059023 PMCID: PMC7021280 DOI: 10.1371/journal.pmed.1003028] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Nathan Ford and co-authors discuss global priorities in the provision of HIV prevention and treatment services.
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Affiliation(s)
- Nathan Ford
- Department HIV & Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
- * E-mail:
| | - Elvin Geng
- Center for Dissemination and Implementation, Institute for Public Health, Washington University, St. Louis, Missouri, United States of America
| | - Tom Ellman
- Southern African Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - Catherine Orrell
- Department of Medicine, Faculty of Health Sciences, Cape Town, South Africa
| | - Peter Ehrenkranz
- Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Miriam Rabkin
- ICAP, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | | | | | - Sydney Rosen
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Isaac Zulu
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - William Reidy
- ICAP, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Thabo Lejone
- SolidarMed, Swiss Organization for Health in Africa, Butha-Buthe, Lesotho
| | - Tsitsi Apollo
- Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| | - Charles Holmes
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Georgetown University, Washington, DC, United States of America
| | - Ana Francisca Kolling
- Department of Surveillance, Prevention and Control of STIs, HIV/AIDS and Viral Hepatitis, Ministry of Health, Brasilia, Brazil
| | | | - Huu Hai Nguyen
- Treatment and Care Department, Viet Nam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | | | | | - Ghion Tiriste
- Department HIV, World Health Organization, Addis Ababa, Ethiopia
| | - Meg Doherty
- Department HIV & Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | - Helen Bygrave
- Southern African Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
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47
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Roy M, Holmes C, Sikazwe I, Savory T, Mwanza MW, Bolton Moore C, Mulenga K, Czaicki N, Glidden DV, Padian N, Geng E. Application of a Multistate Model to Evaluate Visit Burden and Patient Stability to Improve Sustainability of Human Immunodeficiency Virus Treatment in Zambia. Clin Infect Dis 2019; 67:1269-1277. [PMID: 29635466 DOI: 10.1093/cid/ciy285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/06/2018] [Indexed: 11/13/2022] Open
Abstract
Background Differentiated service delivery (DSD) for human immunodeficiency virus (HIV)-infected persons who are clinically stable on antiretroviral therapy (ART) has been embraced as a solution to decrease access barriers and improve quality of care. However, successful DSD implementation is dependent on understanding the prevalence, incidence, and durability of clinical stability. Methods We evaluated visit data in a cohort of HIV-infected adults who made at least 1 visit between 1 March 2013 and 28 February 2015 at 56 clinics in Zambia. We described visit frequency and appointment intervals using conventional stability criteria and used a mixed-effects linear regression model to identify predictors of appointment interval. We developed a multistate model to characterize patient stability over time and calculated incidence rates for transition between states. Results Overall, 167819 patients made 3418018 post-ART initiation visits between 2004 and 2015. Fifty-four percent of visits were pharmacy refill-only visits, and 24% occurred among patients on ART for >6 months and whose current CD4 was >500 cells/mm3. Median appointment interval at clinician visits was 59 days, and time on ART and current CD4 were not strong predictors of appointment interval. Cumulative incidence of clinical stability was 66.2% at 2 years after enrollment, but transition to instability (31 events per 100 person-years) and lapses in care (41 events per100 person-years) were common. Conclusions Current facility-based care was characterized by high visit burden due to pharmacy refills and among treatment-experienced patients. Differentiated service delivery models targeted toward stable patients need to be adaptive given that clinical stability was highly transient and lapses in care were common.
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Affiliation(s)
- Monika Roy
- Division of HIV/AIDS, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco General Hospital
| | - Charles Holmes
- Centre for Infectious Diseases Research in Zambia, Lusaka.,Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Thea Savory
- Centre for Infectious Diseases Research in Zambia, Lusaka
| | | | - Carolyn Bolton Moore
- Centre for Infectious Diseases Research in Zambia, Lusaka.,University of Alabama, Birmingham
| | - Kafula Mulenga
- Centre for Infectious Diseases Research in Zambia, Lusaka
| | - Nancy Czaicki
- Division of HIV/AIDS, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco General Hospital
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Nancy Padian
- Division of Epidemiology, University of California Berkeley
| | - Elvin Geng
- Division of HIV/AIDS, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco General Hospital
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48
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Sikombe K, Hantuba C, Musukuma K, Sharma A, Padian N, Holmes C, Czaicki N, Simbeza S, Somwe P, Bolton-Moore C, Sikazwe I, Geng E. Accurate dried blood spots collection in the community using non-medically trained personnel could support scaling up routine viral load testing in resource limited settings. PLoS One 2019; 14:e0223573. [PMID: 31622394 PMCID: PMC6797100 DOI: 10.1371/journal.pone.0223573] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/24/2019] [Indexed: 12/20/2022] Open
Abstract
Regular plasma HIV-RNA testing for persons living with HIV on antiretroviral therapy (ART) is now the global standard, but as many as 60% of persons in Africa today on ART do not have access to standard laboratory HIV-RNA assays. As a result, patients in Zambia often receive treatment without any means of determining true virologic failure, which poses a risk of premature switch of ART regimens and widespread HIV drug resistance. Dry blood spots (DBS) on the other hand require unskilled personnel and less complex storage supply chain so are ideal to capture viral-load results from HIV patients outside clinic settings. We assess collection of DBS in the community using non-medically trained personnel (NMP) and documented challenges. We trained 23 NMP to collect DBS from lost to follow-up (LTFU) patients in 4 rural and urban Zambian districts. We developed a phlebotomy box to transport DBS without contamination at ambient temperature and concomitant training and standard operating procedures. We evaluated this through field observations, bi-weekly meetings, reports, and staff meetings. The laboratory assessed DBS quality for testing validity. We attempted to collect DBS from 357 participants in the community. Though individual reasons for refusal from the remaining 37% were not collected, NMPs reported privacy concerns, awkward box-size which drew attention in the community and fears of undisclosed uses of samples related to witchcraft and circulating narratives about past research. Successful DBS collection was not associated with patient gender, age, time on ART, enrolment CD4, facility. DBS viral-load collection by NMP is feasible in Zambia. Our training approach and assessments of NMP not part of the health system can be extended to patients by giving them more responsibility to manage their own differentiated care groups. Concerted efforts that compare collection of DBS by NMP to those collected by skilled-medical personnel are needed.
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Affiliation(s)
| | - Cardinal Hantuba
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Kalo Musukuma
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Nancy Padian
- Division of Epidemiology, University of California, Berkeley, Berkeley, California, United States of America
| | - Charles Holmes
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Center for Global Health and Quality, Georgetown University, Washington, District of Columbia, United States of America
| | - Nancy Czaicki
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
| | - Sandra Simbeza
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Paul Somwe
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Carolyn Bolton-Moore
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
- Division of Infectious Diseases, University of Alabama, Birmingham, Alabama, United States of America
| | - Izukanji Sikazwe
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Elvin Geng
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
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Mody A, Roy M, Sikombe K, Savory T, Holmes C, Bolton-Moore C, Padian N, Sikazwe I, Geng E. Improved Retention With 6-Month Clinic Return Intervals for Stable Human Immunodeficiency Virus-Infected Patients in Zambia. Clin Infect Dis 2019; 66:237-243. [PMID: 29020295 DOI: 10.1093/cid/cix756] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/21/2017] [Indexed: 11/14/2022] Open
Abstract
Background Extending appointment intervals for stable HIV-infected patients in sub-Saharan Africa can reduce patient opportunity costs and decongest overcrowded facilities. Methods We analyzed a cohort of stable HIV-infected adults (on treatment with CD4 >200 cells/μL for more than 6 months) who presented for clinic visits in Lusaka, Zambia. We used multilevel, mixed-effects logistic regression adjusting for patient characteristics, including prior retention, to assess the association between scheduled appointment intervals and subsequent missed visits (>14 days late to next visit), gaps in medication (>14 days late to next pharmacy refill), and loss to follow-up (LTFU; >90 days late to next visit). Results A total of 62084 patients (66.6% female, median age 38, median CD4 438 cells/μL) made 501281 visits while stable on antiretroviral therapy. Most visits were scheduled around 1-month (25.0% clinical, 44.4% pharmacy) or 3-month intervals (49.8% clinical, 35.2% pharmacy), with fewer patients scheduled at 6-month intervals (10.3% clinical, 0.4% pharmacy). After adjustment and compared to patients scheduled to return in 1 month, patients with six-month clinic return intervals were the least likely to miss visits (adjusted odds ratio [aOR], 0.20; 95% confidence interval [CI], 0.17-0.24); miss medication pickups (aOR, 0.47; 95% CI 0.39-0.57), and become LTFU prior to the next visit (aOR, 0.41; 95% CI, 0.31-0.54). Conclusions Six-month clinic return intervals were associated with decreased lateness, gaps in medication, and LTFU in stable HIV-infected patients and may represent a promising strategy to reduce patient burdens and decongest clinics.
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Affiliation(s)
- Aaloke Mody
- Division of HIV, ID, and Global Medicine, University of California, San Francisco and Zuckerberg San Francisco General Hospital
| | - Monika Roy
- Division of HIV, ID, and Global Medicine, University of California, San Francisco and Zuckerberg San Francisco General Hospital
| | | | - Thea Savory
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Charles Holmes
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carolyn Bolton-Moore
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.,Division of Infectious Diseases, University of Alabama, Birmingham
| | - Nancy Padian
- Division of Epidemiology, University of California, Berkeley
| | - Izukanji Sikazwe
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Elvin Geng
- Division of HIV, ID, and Global Medicine, University of California, San Francisco and Zuckerberg San Francisco General Hospital
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50
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Sikazwe I, Eshun-Wilson I, Sikombe K, Czaicki N, Somwe P, Mody A, Simbeza S, Glidden DV, Chizema E, Mulenga LB, Padian N, Duncombe CJ, Bolton-Moore C, Beres LK, Holmes CB, Geng E. Correction: Retention and viral suppression in a cohort of HIV patients on antiretroviral therapy in Zambia: Regionally representative estimates using a multistage-sampling-based approach. PLoS Med 2019; 16:e1002918. [PMID: 31469847 PMCID: PMC6716623 DOI: 10.1371/journal.pmed.1002918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pmed.1002811.].
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