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Keuroghlian AS, Marc L, Goldhammer H, Massaquoi M, Downes A, Stango J, Bryant H, Cahill S, Yen J, Perez AC, Head JM, Mayer KH, Myers J, Rebchook GM, Bourdeau B, Psihopaidas D, Chavis NS, Cohen SM. Correction: A Peer-to-Peer Collaborative Learning Approach for the Implementation of Evidence-Informed Interventions to Improve HIV-Related Health Outcomes. AIDS Behav 2024:10.1007/s10461-024-04296-0. [PMID: 38436808 DOI: 10.1007/s10461-024-04296-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Affiliation(s)
- Alex S Keuroghlian
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Linda Marc
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Department of Biostatistics, The Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Hilary Goldhammer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Massah Massaquoi
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | | | | | | | - Sean Cahill
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Department of Health Sciences, Bouvé College of Health, Northeastern University, Boston, MA, USA
- Kansas City Free Health Clinic, Kansas City, MO, USA
| | - Jessica Yen
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Antonia C Perez
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Jennifer M Head
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Synergy Scientifics LLC, Port Orford, OR, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Janet Myers
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory M Rebchook
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Beth Bourdeau
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Demetrios Psihopaidas
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, MD, USA
| | - Nicole S Chavis
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, MD, USA
| | - Stacy M Cohen
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, MD, USA
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Keuroghlian AS, Marc L, Goldhammer H, Massaquoi M, Downes A, Stango J, Bryant H, Cahill S, Yen J, Perez AC, Head JM, Mayer KH, Myers J, Rebchook GM, Bourdeau B, Psihopaidas D, Chavis NS, Cohen SM. A Peer-to-Peer Collaborative Learning Approach for the Implementation of Evidence-Informed Interventions to Improve HIV-Related Health Outcomes. AIDS Behav 2024:10.1007/s10461-023-04260-4. [PMID: 38340221 DOI: 10.1007/s10461-023-04260-4] [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] [Accepted: 12/26/2023] [Indexed: 02/12/2024]
Abstract
The nationwide scale-up of evidence-based and evidence-informed interventions has been widely recognized as a crucial step in ending the HIV epidemic. Although the successful delivery of interventions may involve intensive expert training, technical assistance (TA), and dedicated funding, most organizations attempt to replicate interventions without access to focused expert guidance. Thus, there is a grave need for initiatives that meaningfully address HIV health disparities while addressing these inherent limitations. Here, the Health Resources and Services Administration HIV/AIDS Bureau (HRSA HAB) initiative Using Evidence-Informed Interventions to Improve HIV Health Outcomes among People Living with HIV (E2i) piloted an alternative approach to implementation that de-emphasized expert training to naturalistically simulate the experience of future HIV service organizations with limited access to TA. The E2i approach combined the HAB-adapted Institute for Healthcare Improvement's Breakthrough Series Collaborative Learning Model with HRSA HAB's Implementation Science Framework, to create an innovative multi-tiered system of peer-to-peer learning that was piloted across 11 evidence-informed interventions at 25 Ryan White HIV/AIDS Program sites. Four key types of peer-to-peer learning exchanges (i.e., intervention, site, staff role, and organization specific) took place at biannual peer learning sessions, while quarterly intervention cohort calls and E2i monthly calls with site staff occurred during the action periods between learning sessions. Peer-to-peer learning fostered both experiential learning and community building and allowed site staff to formulate robust site-specific action plans for rapid cycle testing between learning sessions. Strategies that increase the effectiveness of interventions while decreasing TA could provide a blueprint for the rapid uptake and integration of HIV interventions nationwide.
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Affiliation(s)
- Alex S Keuroghlian
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Linda Marc
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Department of Biostatistics, The Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Hilary Goldhammer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Massah Massaquoi
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | | | | | | | - Sean Cahill
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- Kansas City Free Health Clinic, Kansas City, MO, USA
| | - Jessica Yen
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Antonia C Perez
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Jennifer M Head
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Synergy Scientifics LLC, Port Orford, OR, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Janet Myers
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory M Rebchook
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Beth Bourdeau
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Demetrios Psihopaidas
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, MD, USA
| | - Nicole S Chavis
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, MD, USA
| | - Stacy M Cohen
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, MD, USA
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Goldhammer H, Marc LG, Psihopaidas D, Chavis NS, Massaquoi M, Cahill S, Rebchook G, Reisner S, Mayer KA, Cohen SM, Keuroghlian AS. HIV Care Continuum Interventions for Transgender Women: A Topical Review. Public Health Rep 2023; 138:19-30. [PMID: 35060802 PMCID: PMC9730173 DOI: 10.1177/00333549211065517] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 11/17/2022] Open
Abstract
Transgender women experience a disproportionate prevalence of HIV and barriers to linkage to care, retention in care, medication adherence, and viral suppression. As part of a national cooperative agreement funded by the Health Resources and Services Administration's HIV/AIDS Bureau, we searched the literature from January 1, 2010, through June 1, 2020, for English-language articles on interventions designed to improve at least 1 HIV care continuum outcome or address 1 barrier to achieving HIV care continuum outcomes among transgender women diagnosed with HIV in the United States. To be included, articles needed to identify transgender women as a priority population for the intervention. We found 22 interventions, of which 15 reported quantitative or qualitative outcomes and 7 reported study protocols. Recent interventions have incorporated a range of strategies that show promise for addressing pervasive structural and individual barriers rooted in societal and cultural stigma and discrimination against transgender people. Cross-cutting themes found among the interventions included meaningful community participation in the design and implementation of the interventions; culturally affirming programs that serve as a gateway to HIV care and combine gender-affirming care and social services with HIV care; interventions to improve behavioral health outcomes; peer-led counseling, education, and navigation; and technology-based interventions to increase access to care management and online social support. Ongoing studies will further elucidate the efficacy and effectiveness of these interventions, with the goal of reducing disparities in the HIV care continuum and bringing us closer to ending the HIV epidemic among transgender women in the United States.
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Affiliation(s)
| | - Linda G. Marc
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Nicole S. Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | | | - Sean Cahill
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
- Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Greg Rebchook
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Sari Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kenneth A. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stacy M. Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Alex S. Keuroghlian
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
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Goldhammer H, Marc LG, Chavis NS, Psihopaidas D, Massaquoi M, Cahill S, Bryant H, Bourdeau B, Mayer KH, Cohen SM, Keuroghlian AS. Interventions for Integrating Behavioral Health Services into HIV Clinical Care: A Narrative Review. Open Forum Infect Dis 2022; 9:ofac365. [PMID: 35967264 PMCID: PMC9364372 DOI: 10.1093/ofid/ofac365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
The integration of behavioral health services within human immunodeficiency virus (HIV) care settings holds promise for improving substance use, mental health, and HIV-related health outcomes for people with HIV. As part of an initiative funded by the Health Resources and Services Administration’s HIV/AIDS Bureau, we conducted a narrative review of interventions focused on behavioral health integration (BHI) in HIV care in the United States (US). Our literature search yielded 19 intervention studies published between 2010 and 2021. We categorized the interventions under 6 approaches: collaborative care; screening, brief intervention, and referral to treatment (SBIRT); patient-reported outcomes (PROs); onsite psychological consultation; integration of addiction specialists; and integration of buprenorphine/naloxone (BUP/NX) treatment. All intervention approaches appeared feasible to implement in diverse HIV care settings and most showed improvements in behavioral health outcomes; however, measurement of HIV outcomes was limited. Future research studies of BHI interventions should evaluate HIV outcomes and assess facilitators and barriers to intervention uptake.
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Affiliation(s)
| | - Linda G Marc
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Harvard T.H. Chan School of Public Health , Boston, MA , USA
| | - Nicole S Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration , Rockville, MD , USA
| | | | | | - Sean Cahill
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Boston University School of Public Health , Boston, MA , USA
- Bouve College of Health Sciences, Northeastern University , Boston, MA , USA
| | | | - Beth Bourdeau
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California San Francisco , San Francisco, CA , USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Harvard T.H. Chan School of Public Health , Boston, MA , USA
- Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
| | - Stacy M Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration , Rockville, MD , USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
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Goldhammer H, Marc LG, Chavis NS, Psihopaidas D, Massaquoi M, Cahill S, Nortrup E, Dawson Rose C, Meyers J, Mayer KH, Cohen SM, Keuroghlian AS. Interventions for addressing trauma among people with HIV: a narrative review. AIDS Care 2021; 34:505-514. [PMID: 34612097 DOI: 10.1080/09540121.2021.1984382] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Traumatic experiences are disproportionately prevalent among people with HIV and adversely affect HIV-related health outcomes. As part of a national cooperative agreement funded by the Health Resources and Services Administration's HIV/AIDS Bureau, we searched the literature for interventions designed to address trauma among people with HIV in the U.S. Our search yielded 22 articles on 14 studies that fell into five intervention categories: expressive writing, prolonged exposure therapy, coping skills, cognitive-behavioral approaches integrated with other methods, and trauma-informed care. Thematic elements among the interventions included adaptating existing interventions for subpopulations with a high burden of trauma and HIV, such as transgender women and racial/ethnic minorities; addressing comorbid substance use disorders; and implementing organization-wide trauma-informed care approaches. Few studies measured the effect of the interventions on HIV-related health outcomes. To address the intersecting epidemics of HIV and trauma, it is critical to continue developing, piloting, and evaluating trauma interventions for people with HIV, with the goal of wide-scale replication of effective interventions in HIV settings.
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Affiliation(s)
| | - Linda G Marc
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nicole S Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | | | | | - Sean Cahill
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA.,Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | | | - Carol Dawson Rose
- Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Janet Meyers
- Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stacy M Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Marc LG, Goldhammer H, Mayer KH, Cahill S, Massaquoi M, Nortrup E, Cohen SM, Psihopaidas DA, Carney JT, Keuroghlian AS. Rapid Implementation of Evidence-Informed Interventions to Improve HIV Health Outcomes Among Priority Populations : The E2i Initiative. Public Health Rep 2021; 137:617-624. [PMID: 34185594 DOI: 10.1177/00333549211027849] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Linda G Marc
- 446213 The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Kenneth H Mayer
- 446213 The Fenway Institute, Fenway Health, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,314506 HIV Prevention Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sean Cahill
- 446213 The Fenway Institute, Fenway Health, Boston, MA, USA.,17225 Bouve College of Health Sciences, Northeastern University, Boston, MA, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | | | | | - Stacy M Cohen
- Evaluation, Analysis, and Dissemination Branch, Division of Policy and Data, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Demetrios A Psihopaidas
- Evaluation, Analysis, and Dissemination Branch, Division of Policy and Data, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Jhetari T Carney
- Evaluation, Analysis, and Dissemination Branch, Division of Policy and Data, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Alex S Keuroghlian
- 446213 The Fenway Institute, Fenway Health, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Aluisio A, Yam D, Peters J, Cho D, Perera S, Kennedy S, Massaquoi M, Sahr F, Garbern S, Liu T, Levine A. 314 Treatment With Intravenous Fluid Therapy Was Not Associated With Improved Survival Among Patients With Ebola Virus Disease: An International Multisite Cohort Study. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Despite provisional recommendations from the World Health Organization and UNAIDS that cotrimoxazole (CTX) prophylaxis be offered to all individuals living with AIDS, including HIV-positive patients with TB, its routine use in developing countries particularly Africa has been minimal. Concerns were expressed regarding its effectiveness in areas of high bacterial resistance, that its widespread use might substantially increase bacterial cross-resistance in the community and that this intervention might promote resistance of malaria parasites to sulphadoxine-pyrimethamine. We review the current evidence on the above concerns and highlight the main operational considerations related to implementing CTX prophylaxis as a basic component of care for HIV-positive TB patients in developing countries.
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Affiliation(s)
- R Zachariah
- Medecins sans Frontieres, Operational Research HIV-TB, Medical department, Brussels Operational Center, 68 Rue de Gaspench, L-1617 Luxemburg.
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Olivier H, Tyee TT, Mulbah J, Massaquoi M, Dahn B, Bengaly L, Bonnabry P, Cingria L, Khouiti MBM, Weber S, Riegger L, Deuble A, Wallis S, Comtesse P, Pittet D. Local production of alcohol based handrub solution (ABHS) in Liberia during the Ebola outbreak. Antimicrob Resist Infect Control 2015. [PMCID: PMC4474841 DOI: 10.1186/2047-2994-4-s1-p8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Moseson H, Gerdts C, Massaquoi M. Testing a new method to reduce underreporting in abortion measurement. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bawo LL, Harries AD, Reid T, Massaquoi M, Jallah-Macauley R, Jones JJ, Wesseh CS, Enders J, Hinneh L. Coverage and use of insecticide-treated bed nets in households with children aged under five years in Liberia. Public Health Action 2012; 2:112-6. [PMID: 26392967 DOI: 10.5588/pha.12.0040] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 10/02/2012] [Indexed: 11/10/2022] Open
Abstract
SETTING St John's District, Grand Bassa County, Liberia. OBJECTIVES In households with children aged <5 years, to examine the coverage and use of long-lasting insecticide-treated bed nets (LLINs), factors associated with non-use and the characteristics and conditions of bed nets. DESIGN Cross-sectional study involving interviews with mothers and visual inspection of LLINs. RESULTS Of 663 households visited, 492 (74%) had no LLIN and 135 (20%) had one LLIN. Of 171 households with LLINs, these were consistently used by 73 (43%) children. The main reasons for inconsistent use included LLINs being old or damaged, and LLINs generating too much heat for 20-30% of children. Visual inspection of LLINs in 130 households showed that 98% of LLINs were white, 20% were not hung above the child's sleeping place, 30% had holes, 84% were double-bed sized and 82% had been washed in the previous 6 months. CONCLUSION Despite reports of 100% LLIN coverage in St John's District, this study showed that only a quarter of households had an LLIN, over half of the children used LLINs inconsistently and the LLINs had several deficiencies. More surveys should be conducted to determine the true coverage of LLINs in Liberia, and measures must be taken to improve the use of LLINs.
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Affiliation(s)
- L L Bawo
- Ministry of Health and Social Welfare, Monrovia, Liberia
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - T Reid
- Médecins Sans Frontières, Operational Centre Brussels, Luxembourg
| | - M Massaquoi
- Clinton Health Access Initiatives, Monrovia, Liberia
| | | | - J J Jones
- National Malaria Control Program, Monrovia, Liberia
| | - C S Wesseh
- Ministry of Health and Social Welfare, Monrovia, Liberia
| | - J Enders
- National Malaria Control Program, Monrovia, Liberia
| | - L Hinneh
- National Malaria Control Program, Monrovia, Liberia
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Zachariah R, Gomani P, Massaquoi M, Harries A. In reply. Int J Tuberc Lung Dis 2011; 15:1714-1715. [DOI: 10.5588/ijtld.11.0545-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- R Zachariah
- Medical Department (Operational Research) Médecins Sans Frontières MSF-Luxembourg Brussels Operational Center Luxembourg
| | - P Gomani
- Partners in Health Blantyre, Malawi
| | - M Massaquoi
- Initiative (CHAI) Ministry of Health and Social Welfare Monrovia, Liberia
| | - A.D. Harries
- International Union Against Tuberculosis and Lung Disease Paris, France London School of Hygiene & Tropical Medicine London, United Kingdom zachariah@internet. lu
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Zachariah R, Tayler-Smith K, Manzi M, Massaquoi M, Mwagomba B, van Griensven J, van Engelgem I, Arnould L, Schouten EJ, Chimbwandira FM, Harries AD. Retention and attrition during the preparation phase and after start of antiretroviral treatment in Thyolo, Malawi, and Kibera, Kenya: implications for programmes? Trans R Soc Trop Med Hyg 2011; 105:421-30. [PMID: 21724219 DOI: 10.1016/j.trstmh.2011.04.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 04/19/2011] [Accepted: 04/19/2011] [Indexed: 11/26/2022] Open
Abstract
Among adults eligible for antiretroviral therapy (ART) in Thyolo (rural Malawi) and Kibera (Nairobi, Kenya), this study (a) reports on retention and attrition during the preparation phase and after starting ART and (b) identifies risk factors associated with attrition. 'Retention' implies being alive and on follow-up, whilst 'attrition' implies loss to follow-up, death or stopping treatment (if on ART). There were 11,309 ART-eligible patients from Malawi and 3633 from Kenya, of whom 8421 (74%) and 2792 (77%), respectively, went through the preparation phase and started ART. In Malawi, 2649 patients (23%) were lost to attrition in the preparation phase and 2189 (26%) after starting ART. Similarly, in Kenya 546 patients (15%) were lost to attrition in the ART preparation phase and 647 (23%) while on ART. Overall programme attrition was 43% (4838/11,309) for Malawi and 33% (1193/3633) for Kenya. Restricting cohort evaluation to 'on ART' (as is usually done) underestimates overall programme attrition by 38% in Malawi and 36% in Kenya. Risk factors associated with attrition in the preparation phase included male sex, age <35 years, advanced HIV/AIDS disease and increasing malnutrition. Considerable attrition occurs during the preparation phase of ART, and programme evaluations confined to on-treatment analysis significantly underestimate attrition. This has important operational implications, which are discussed here.
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Affiliation(s)
- R Zachariah
- Médecins sans Frontières, Medical Department (Operational Research), Brussels Operational Center, 68 Rue de Gasperich, L-1617, Luxembourg, Luxembourg.
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Beltman JJ, Fitzgerald M, Buhendwa L, Moens M, Massaquoi M, Kazima J, Alide N, van Roosmalen J. Accelerated HIV testing for PMTCT in maternity and labour wards is vital to capture mothers at a critical point in the programme at district level in Malawi. AIDS Care 2011; 22:1367-72. [PMID: 20711887 DOI: 10.1080/09540121003758473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Round the clock (24 hours×7 days) HIV testing is vital to maintain a high prevention of mother to child transmission (PMTCT) coverage for women delivering in district health facilities. PMTCT coverage increases when most of the pregnant women will have their HIV status tested. Therefore routine offering of HIV testing should be integrated and seen as a part of comprehensive antenatal care. For women who miss antenatal care and deliver in a health facility without having had their HIV status tested, the labour and maternity ward could still serve as other entry points.
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Affiliation(s)
- J J Beltman
- Department of Obstetrics, Leiden University Medical Centre, RC, The Netherlands.
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15
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Zachariah R, Reid SD, Chaillet P, Massaquoi M, Schouten EJ, Harries AD. Viewpoint: Why do we need a point-of-care CD4 test for low-income countries? Trop Med Int Health 2010; 16:37-41. [PMID: 21371207 DOI: 10.1111/j.1365-3156.2010.02669.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In this paper, we discuss the reasons why we urgently need a point-of-care (POC) CD4 test, elaborate the problems we have experienced with the current technology which hampers CD4-count coverage and highlight the ideal characteristics of a universal CD4 POC test. It is high-time that CD4 technology is simplified and adapted for wider use in low-income countries to change the current paradigm of restricted access once and for all.
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Affiliation(s)
- R Zachariah
- Médecins sans Frontières, Operational Centre Brussels, Operational Research Unit, Medical Department, MSF- Luxembourg, Luxembourg.
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16
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Massaquoi M, Zachariah R, Manzi M, Pasulani O, Misindi D, Mwagomba B, Bauernfeind A, Harries AD. Patient retention and attrition on antiretroviral treatment at district level in rural Malawi. Trans R Soc Trop Med Hyg 2009; 103:594-600. [DOI: 10.1016/j.trstmh.2009.02.012] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 02/16/2009] [Accepted: 02/16/2009] [Indexed: 11/26/2022] Open
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17
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Zachariah R, Ford N, Philips M, Lynch S, Massaquoi M, Janssens V, Harries AD. Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa. Trans R Soc Trop Med Hyg 2008; 103:549-58. [PMID: 18992905 DOI: 10.1016/j.trstmh.2008.09.019] [Citation(s) in RCA: 255] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Revised: 09/26/2008] [Accepted: 09/26/2008] [Indexed: 10/21/2022] Open
Abstract
Sub-Saharan Africa is facing a crisis in human health resources due to a critical shortage of health workers. The shortage is compounded by a high burden of infectious diseases; emigration of trained professionals; difficult working conditions and low motivation. In particular, the burden of HIV/AIDS has led to the concept of task shifting being increasingly promoted as a way of rapidly expanding human resource capacity. This refers to the delegation of medical and health service responsibilities from higher to lower cadres of health staff, in some cases non-professionals. This paper, drawing on Médecins Sans Frontières' experience of scaling-up antiretroviral treatment in three sub-Saharan African countries (Malawi, South Africa and Lesotho) and supplemented by a review of the literature, highlights the main opportunities and challenges posed by task shifting and proposes specific actions to tackle the challenges. The opportunities include: increasing access to life-saving treatment; improving the workforce skills mix and health-system efficiency; enhancing the role of the community; cost advantages and reducing attrition and international 'brain drain'. The challenges include: maintaining quality and safety; addressing professional and institutional resistance; sustaining motivation and performance and preventing deaths of health workers from HIV/AIDS. Task shifting should not undermine the primary objective of improving patient benefits and public health outcomes.
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Affiliation(s)
- R Zachariah
- Médecins Sans Frontières, Medical Department, Brussels Operational Center, Rue de Gasperich, Luxembourg.
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18
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Raguenaud M, Zachariah R, Massaquoi M, Ombeka V, Ritter H, Chakaya J. High adherence to anti-tuberculosis treatment among patients attending a hospital and slum health centre in Nairobi, Kenya. Glob Public Health 2008. [DOI: 10.1080/17441690802063205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Buhendwa L, Zachariah R, Teck R, Massaquoi M, Kazima J, Firmenich P, Harries AD. Cabergoline for suppression of puerperal lactation in a prevention of mother-to-child HIV-transmission programme in rural Malawi. Trop Doct 2008; 38:30-2. [DOI: 10.1258/td.2007.060091] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study shows that cabergoline (single oral-dose) is an acceptable, safe and effective drug for suppressing puerperal lactation. It could be of operational benefit not only for artificial feeding, but also for weaning in those that breast-feed within preventive mother-to-child HIV transmission programmes in resource-limited settings.
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Affiliation(s)
- L Buhendwa
- Medecins sans Frontieres, Thyolo District, Malawi
| | - R Zachariah
- Medecins sans Frontieres, Operational Research, Medical Department, Brussels Operational Center B-1090 Belgium
| | - R Teck
- Medecins sans Frontieres, Thyolo District, Malawi
| | - M Massaquoi
- Medecins sans Frontieres, Thyolo District, Malawi
| | - J Kazima
- Thyolo District Health Services, Ministry of Health and Population, Thyolo, Malawi
| | - P Firmenich
- Medecins Sans Frontieres, Operations Department, L-1617 Luxembourg
| | - A D Harries
- HIV Care and Support, Ministry of Health, Lilongwe, Malawi and
- London School of Hygiene and Tropical Medicine, UK
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20
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Zachariah R, Fitzgerald M, Massaquoi M, Acabu A, Chilomo D, Salaniponi FML, Harries AD. Does antiretroviral treatment reduce case fatality among HIV-positive patients with tuberculosis in Malawi? Int J Tuberc Lung Dis 2007; 11:848-53. [PMID: 17705949] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
SETTING Thyolo district, Malawi. OBJECTIVES To report on 1) case fatality among human immunodeficiency virus (HIV) positive tuberculosis (TB) patients while on anti-tuberculosis treatment and 2) whether antiretroviral treatment (ART) initiated during the continuation phase of TB treatment reduces case fatality. DESIGN Retrospective cohort analysis. METHODS Comparative analysis of treatment outcomes for TB patients registered between January and December 2004. RESULTS Of 983 newly registered TB patients receiving diagnostic HIV testing, 658 (67%) were HIV-positive. A total of 132 (20%) patients died during the 8-month course of anti-tuberculosis treatment, of whom 82 (62%) died within the first 2 months of treatment when ART was not provided (cumulative incidence 3.0, 95%CI 2.5-3.6 per 100 person-years). A total of 576 TB patients started the continuation phase of anti-tuberculosis treatment, 180 (31%) of whom were started on ART. The case-fatality rate per 100 person-years was not significantly different for patients on ART (1.0, 95%CI 0.6-1.7) and those without ART (1.2, 95%CI 0.9-1.7, adjusted hazard ratio 0.86, 95%CI 0.4-1.6, P = 0.6) CONCLUSIONS ART provided in the continuation phase of TB treatment does not have a significant impact on reducing case fatality. Reasons for this and possible measures to reduce high case fatality in the initial phase of TB treatment are discussed.
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Affiliation(s)
- R Zachariah
- Medical Department (Operational Research), Médecins sans Frontières, Brussels Operational Centre, Luxembourg.
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21
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Checchi F, Balkan S, Vonhm BT, Massaquoi M, Biberson P, Eldin de Pecoulas P, Brasseur P, Guthmann JP. Efficacy of amodiaquine for uncomplicated Plasmodium falciparum malaria in Harper, Liberia. Trans R Soc Trop Med Hyg 2002; 96:670-3. [PMID: 12625148 DOI: 10.1016/s0035-9203(02)90348-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In the face of spreading chloroquine and sulfadoxine-pyrimethamine (SP) resistance, amodiaquine remains a cheap and efficacious alternative for treating uncomplicated Plasmodium falciparum malaria in many settings. In Harper, south-eastern Liberia, a previous study we conducted showed very high levels of resistance to both chloroquine and SP. In 2001, in an effort to look for possible alternatives, we measured in the same setting the efficacy of amodiaquine in a 28-d study in vivo, with results corrected by polymerase chain reaction genotyping to distinguish recrudescences from reinfections. In total, 107 children were included in the study and received a 3-d supervised course of 25 mg/kg amodiaquine. Of these, 81 were analysable at day 28. The overall failure rate was 19.8% (95% CI 11.7-30.1%) considering both parasitological and clinical outcomes. These results provide hitherto missing data on amodiaquine in Liberia, and confirm that the drug may still be efficacious in settings where chloroquine and SP are failing. We recommend the introduction of amodiaquine in association with artesunate as a first-line antimalarial in Harper.
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Affiliation(s)
- F Checchi
- Malaria Control Program, Ministry of Health and Social Welfare, Monrovia, Liberia
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