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Ferreyra C, Moretó-Planas L, Wagbo Temessadouno F, Alonso B, Tut B, Achut V, Eltom M, Aderie EM, Descalzo-Jorro V. Correction: Evaluation of a community-based HIV test and start program in a conflict affected rural area of Yambio County, South Sudan. PLoS One 2024; 19:e0299906. [PMID: 38412196 PMCID: PMC10898754 DOI: 10.1371/journal.pone.0299906] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0254331.].
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Peck ME, Ong KS, Lucas T, Prainito A, Thomas AG, Brun A, Kiggundu V, Yansaneh A, Busang L, Kgongwana K, Kelaphile D, Seipone K, Letebele MH, Makadzange PF, Marwiro A, Sesinyi M, Lapidos T, Lukhele N, Maziya V, Mkhontfo M, Gultie T, Mulatu D, Shimelis M, Zegeye T, Teka T, Bulterys M, Njenga JN, Odoyo-June E, Juma AW, Soo L, Talam N, Brown M, Chakare T, Nonyana N, Khoabane MA, Auld AF, Maida A, Msungama W, Kapito M, Nyirenda R, Matchere F, Odek J, Canda M, Malimane I, Come J, Gaspar N, Langa A, Aupokolo MA, Vejorerako KC, Kahindi L, Mali D, Zegeye A, Mangoya D, Zemburuka BL, Bamwesigye J, Kankindi I, Kayirangwa E, Malamba SS, Roels T, Kayonde L, Zimulinda E, Ndengo E, Nsanzimana S, Remera E, Rwibasira GN, Sangwayire B, Semakula M, Rugira E, Rugwizangoga E, Tubane E, Yoboka E, Lawrence J, Loykissoonlal D, Maphothi N, Achut V, Bunga S, Moi M, Amuri M, Kazaura K, Simbeye D, Fida N, Kayange AA, Seleman M, Akao J, Alamo ST, Kabuye G, Kyobutungi S, Makumbi FE, Mudiope P, Nantez B, Chituwo O, Godfrey L, Muyunda B, Kamboyi R, Masiye J, Lifuka E, Mandisarisa J, Mhangara M, Xaba S, Toledo C. Effects of COVID-19 Pandemic on Voluntary Medical Male Circumcision Services for HIV Prevention, Sub-Saharan Africa, 2020. Emerg Infect Dis 2022; 28:S262-S269. [PMID: 36502454 DOI: 10.3201/eid2813.212455] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Beginning in March 2020, to reduce COVID-19 transmission, the US President's Emergency Plan for AIDS Relief supporting voluntary medical male circumcision (VMMC) services was delayed in 15 sub-Saharan African countries. We reviewed performance indicators to compare the number of VMMCs performed in 2020 with those performed in previous years. In all countries, the annual number of VMMCs performed decreased 32.5% (from 3,898,960 in 2019 to 2,631,951 in 2020). That reduction is largely attributed to national and local COVID-19 mitigation measures instituted by ministries of health. Overall, 66.7% of the VMMC global annual target was met in 2020, compared with 102.0% in 2019. Countries were not uniformly affected; South Africa achieved only 30.7% of its annual target in 2020, but Rwanda achieved 123.0%. Continued disruption to the VMMC program may lead to reduced circumcision coverage and potentially increased HIV-susceptible populations. Strategies for modifying VMMC services provide lessons for adapting healthcare systems during a global pandemic.
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Hakim AJ, Bolo A, Coy KC, Achut V, Katoro J, Caesar G, Lako R, Taban AI, Sleeman K, Wesson J, Okiria AG. Progress toward the UNAIDS 90–90-90 targets among female sex workers and sexually exploited female adolescents in Juba and Nimule, South Sudan. BMC Public Health 2022; 22:132. [PMID: 35045854 PMCID: PMC8767749 DOI: 10.1186/s12889-022-12533-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 01/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Little is known about HIV in South Sudan and even less about HIV among female sex workers (FSW). We characterized progress towards UNAIDS 90–90-90 targets among female sex workers (FSW) and sexually exploited female adolescents in Juba and Nimule, South Sudan.
Methods
We conducted a biobehavioral survey of FSW and sexually exploited female adolescents using respondent-driven sampling (RDS) in Juba (November 2015–March 2016) and in Nimule (January–March 2017) to estimate achievements toward the UNAIDS 90–90-90 targets (90% of HIV-positive individuals know their status; of these, 90% are receiving antiretroviral therapy [ART]; and of these, 90% are virally suppressed). Eligibility criteria were girls and women who were aged ≥15 years; spoke English, Juba Arabic, or Kiswahili; received money, goods, or services in exchange for sex in the past 6 months; and resided, worked, or socialized in the survey city for ≥1 month. Data were weighted for RDS methods.
Results
We sampled 838 FSW and sexually exploited female adolescents in Juba (HIV-positive, 333) and 409 in Nimule (HIV-positive, 108). Among HIV-positive FSW and sexually exploited female adolescents living in Juba, 74.8% self-reported being aware of their HIV status; of these, 73.3% self-reported being on ART; and of these, 62.2% were virally suppressed. In Nimule, 79.5% of FSW and sexually exploited female adolescents living with HIV self-reported being aware of their HIV status; of these, 62.9% self-reported being on ART; and of these, 75.7% were virally suppressed.
Conclusions
Although awareness of HIV status is the lowest of the 90–90-90 indicators in many countries, treatment uptake and viral suppression were lowest among FSW and sexually exploited female adolescents in South Sudan. Differentiated service delivery facilitate linkage to and retention on treatment in support of attainment of viral suppression.
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Harris TG, Jaszi E, Lamb MR, Laudari CA, Furtado MLM, Nijirazana B, Aimé N, Loni Ekali G, Ebiama Lifanda L, Brou H, Ehui E, Malele Bazola F, Mboyo A, Sahabo R, Advocate Dlamini N, Melaku Z, Getachew Meselu M, Hawken M, Ngugi C, Vitale M, Abudou MAB, Bayoa F, Achut V, Kasonde P, Munsanje P, El-Sadr WM. Effects of the Coronavirus Disease 2019 Pandemic on Human Immunodeficiency Virus Services: Findings from 11 Sub-Saharan African Countries. Clin Infect Dis 2021; 75:e1046-e1053. [PMID: 34791096 PMCID: PMC9402687 DOI: 10.1093/cid/ciab951] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Due to concerns about the effects of the coronavirus disease 2019 (COVID-19 pandemic on health services, we examined its effects on human immunodeficiency virus (HIV) services in sub-Saharan Africa. METHODS Quarterly data (Q1, 10/2019-12/2019; Q2, 1/2020-3/2020; Q3, 4/2020-6/2020; Q4, 7/2020-9/2020) from 1059 health facilities in 11 countries were analyzed and categorized by stringency of pandemic measures. We conducted a difference-in-differences assessment of HIV service changes from Q1-Q2 to Q3-Q4 by higher vs lower stringency. RESULTS There was a 3.3% decrease in the number HIV tested from Q2 to Q3 (572 845 to 553 780), with the number testing HIV-positive declining by 4.9% from Q2 to Q3. From Q3 to Q4, the number tested increased by 10.6% (612 646), with an increase of 8.8% (23 457) in the number testing HIV-positive with similar yield (3.8%). New antiretroviral therapy (ART) initiations declined by 9.8% from Q2 to Q3 but increased in Q4 by 9.8%. Across all quarters, the number on ART increased (Q1, 419 028 to Q4, 476 010). The number receiving viral load (VL) testing in the prior 12 months increased (Q1, 255 290 to Q4, 312 869). No decrease was noted in VL suppression (Q1, 87.5% to Q4, 90.1%). HIV testing (P < .0001) and new ART initiations (P = .001) were inversely associated with stringency. CONCLUSIONS After initial declines, rebound was brisk, with increases noted in the number HIV tested, newly initiated or currently on ART, VL testing, and VL suppression throughout the period, demonstrating HIV program resilience in the face of the COVID-19 crisis.
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Affiliation(s)
- Tiffany G Harris
- Correspondence: T. G. Harris, MSICAP at Columbia University, 722 West 168th Street, MSPH Box 18, New York, NY 10032 ()
| | - Edward Jaszi
- ICAP Columbia University, New York, New York, USA
| | - Matthew R Lamb
- ICAP and Department of Epidemiology, Columbia University, New York, New York, USA
| | | | | | | | - Ndayizeye Aimé
- Ministry of Public Health and the Fight Against AIDS, Bujumbura, Burundi
| | | | | | - Hermann Brou
- ICAP at Columbia University, Abidjan, Côte d’Ivoire
| | - Eboi Ehui
- Ministry of Health and Public Hygiene, Abidjan, Côte d’Ivoire
| | | | - Aimé Mboyo
- National AIDS Control Program, Kinshasa, Democratic Republic of the Congo
| | | | | | | | | | | | | | | | | | | | | | | | | | - Wafaa M El-Sadr
- ICAP and Department of Epidemiology, Columbia University, New York, New York, USA
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Ferreyra C, Moretó-Planas L, Wagbo Temessadouno F, Alonso B, Tut B, Achut V, Eltom M, Aderie EM, Descalzo-Jorro V. Evaluation of a community-based HIV test and start program in a conflict affected rural area of Yambio County, South Sudan. PLoS One 2021; 16:e0254331. [PMID: 34252129 PMCID: PMC8274874 DOI: 10.1371/journal.pone.0254331] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/24/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) coverage in South Sudan is around 10%. Access to HIV care in settings with low ART coverage or conflict affected is still low; innovative strategies are needed to increase access and ensure continuation of ART during instability. A pilot HIV test and start project was implemented in a conflict-affected area of South Sudan. In a retrospective analysis, we determined the feasibility and outcomes of this intervention. METHODS Programme data from July 2015 to June 2018 was analysed. The project involved five mobile teams offering HIV counselling and testing (HCT) and same day ART initiation at community level. Baseline and follow-up information on clinical, immunological and viral load (VL) was routinely recorded, as well as treatment outcomes. A semi-qualitative study was conducted to assess acceptability of the program among beneficiaries and community members. RESULTS By June 2018, 14824 people received counselling and testing for HIV and 498 (3.4%) tested positive. Out of those 395 (79.3%) started ART. A total of 72 ART patients were organized in 26 Community ART Groups (CAGs) and contingency plan was activated 9 times for 101 patients. Kaplan-Meier estimated retention in care (RIC) at 12 and 18 months was 80.6% [95% CI: 75.9-84.5%] and 69.9% [95% CI: 64.4-74.8%] respectively. RIC was significantly higher at 18 months in patients under community ART groups (CAGs) (90.9% versus 63.4% p<0.001) when compared to patients on regular follow up. VL suppression at 12 months was 90.3% and overall virological suppression reached 91.2%. A total of 279 persons were interviewed about the MSF program perception and acceptance: 98% had heard about the programme and 84% found it beneficial for the community, 98% accepted to be tested and only 4% found disadvantages to the programme. CONCLUSIONS Our study shows that HCT and early ART initiation in conflict affected populations can be provided with good program outcomes. RIC and virological suppression are comparable with facility-based HIV programs and to those in stable contexts. This model could be extrapolated to other similar contexts with low access to ART and where security situation is a concern.
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Affiliation(s)
| | | | | | | | - Buai Tut
- Médecins sans Frontières, Juba, South Sudan
| | - Victoria Achut
- Ministry of Health, Republic of South Sudan, HIV/AIDS/STI, Juba, South Sudan
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Boyd AT, Lodiongo DK, Benson JM, Aragaw S, Pasquale MS, Ayalneh H, Olemukan R, Avaku I, Baabe N, Achut V, Chun H, Bunga S. Implementation of tuberculosis preventive treatment among people living with HIV, South Sudan. Bull World Health Organ 2020; 99:34-40. [PMID: 33716332 DOI: 10.2471/blt.20.254789] [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] [Received: 03/13/2020] [Revised: 08/27/2020] [Accepted: 09/24/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To describe an intervention to scale up tuberculosis preventive treatment for people living with human immunodeficiency virus (HIV) in South Sudan, 2017-2020. Methods Staff of the health ministry and United States President's Emergency Plan for AIDS Relief designed an intervention targeting the estimated 30 400 people living with HIV on antiretroviral therapy across South Sudan. The intervention comprised: (i) developing sensitization and operational guidance for clinicians to put tuberculosis preventive treatment delivery into clinical practice; (ii) disseminating monitoring and evaluation tools to document scale-up; (iii) implementing a programmatic pilot of tuberculosis preventive treatment; and (iv) identifying a mechanism for procurement and delivery of isoniazid to facilities dispensing tuberculosis preventive treatment. Staff aggregated routine programme data from facility registers on the numbers of people living with HIV who started on tuberculosis preventive treatment across all clinical sites providing this treatment during July 2019-March 2020. Findings Tuberculosis preventive treatment was implemented in 13 HIV treatment sites during July-October 2019, then in 26 sites during November 2019-March 2020. During July 2019-March 2020, 6503 people living with HIV started tuberculosis preventive treatment. Conclusion Lessons for other low-resource settings may include supplementing national guidelines with health ministry directives, clinician guidance and training, and an implementation pilot. A cadre of field supervisors can rapidly disseminate a standardized approach to implementation and monitoring of tuberculosis preventive treatment, and this approach can be used to strengthen other tuberculosis-HIV services. Procuring a reliable and steady supply of tuberculosis preventive treatment medication is crucial.
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Affiliation(s)
- Andrew T Boyd
- Division of Global HIV and TB, Centers for Disease Control and Prevention, 1600 Clifton Road NE, US1-1, Atlanta, GA 30329, United States of America
| | - Dennis Kenyi Lodiongo
- Division of Global HIV and TB, Centers for Disease Control and Prevention (South Sudan), Juba, South Sudan
| | - John Mondi Benson
- Division of Global HIV and TB, Centers for Disease Control and Prevention (South Sudan), Juba, South Sudan
| | - Shambel Aragaw
- International Center for AIDS Care and Treatment Programs (ICAP) South Sudan, Juba, South Sudan
| | | | - Habtamu Ayalneh
- International Center for AIDS Care and Treatment Programs (ICAP) South Sudan, Juba, South Sudan
| | - Robert Olemukan
- International Center for AIDS Care and Treatment Programs (ICAP) South Sudan, Juba, South Sudan
| | - Isaac Avaku
- International Center for AIDS Care and Treatment Programs (ICAP) South Sudan, Juba Teaching Hospital, Juba, South Sudan
| | - Nicholas Baabe
- United States Agency for International Development (South Sudan), Juba, South Sudan
| | - Victoria Achut
- HIV/AIDS/STI Directorate, Ministry of Health, Juba, South Sudan
| | - Helen Chun
- Division of Global HIV and TB, Centers for Disease Control and Prevention, 1600 Clifton Road NE, US1-1, Atlanta, GA 30329, United States of America
| | - Sudhir Bunga
- Division of Global HIV and TB, Centers for Disease Control and Prevention (South Sudan), Juba, South Sudan
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Hakim AJ, Bolo A, Werner M, Achut V, Katoro J, Caesar G, Lako R, Taban AI, Wesson J, Okiria AG. High HIV and syphilis prevalence among female sex workers in Juba, South Sudan. PLoS One 2020; 15:e0239543. [PMID: 32986767 PMCID: PMC7521730 DOI: 10.1371/journal.pone.0239543] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 09/08/2020] [Indexed: 11/24/2022] Open
Abstract
HIV prevalence is estimated to be 2.7% in South Sudan; however, little is known about the young country’s epidemic. We conducted a respondent-driven sampling biobehavioral survey in Juba of female sex workers (FSW) aged ≥15 years who sold or exchanged sex in the last 6 months to learn more about this population. We enrolled 838 FSW from November 2015 to March 2016 and estimated HIV prevalence to be 37.8%. Prevalence of active syphilis was 7.3%. FSW were from South Sudan and most neighboring countries. Comprehensive knowledge of HIV was 11.1% and 64.2% of FSW had never spoken with an outreach worker. In multivariable analysis, HIV was associated with being from Uganda (aOR: 3.3, 95% CI: 1.7–6.1) or Kenya (aOR: 4.3, 95% CI: 1.5–13.0) versus from South Sudan. Our survey suggests that FSW may play a critical role in South Sudan’s HIV epidemic and highlights the importance of tailoring services to the unique needs of FSW of all nationalities in Juba.
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Affiliation(s)
- Avi J. Hakim
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Alex Bolo
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Margaret Werner
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | - Joel Katoro
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Golda Caesar
- South Sudan Ministry of Health, Juba, South Sudan
| | - Richard Lako
- South Sudan Ministry of Health, Juba, South Sudan
| | | | - Jennifer Wesson
- IntraHealth International, Chapel Hill, NC, United States of America
| | - Alfred G. Okiria
- IntraHealth International, Chapel Hill, NC, United States of America
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Okiria AG, Bolo A, Achut V, Arkangelo GC, Michael ATI, Katoro JS, Wesson J, Gutreuter S, Hundley L, Hakim A. Novel Approaches for Estimating Female Sex Worker Population Size in Conflict-Affected South Sudan. JMIR Public Health Surveill 2019; 5:e11576. [PMID: 30882356 PMCID: PMC6441857 DOI: 10.2196/11576] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/25/2018] [Accepted: 12/14/2018] [Indexed: 11/18/2022] Open
Abstract
Background Limited data exist describing the population size of female sex workers (FSW) in South Sudan. A population size estimation exercise among FSW was undertaken in Juba and Nimule during the Eagle Survey. Objective The study aimed to estimate the number of FSW in Juba and Nimule to inform resource allocation and service provision for FSW. Methods We utilized service and unique object multipliers, and 3-source capture-recapture methods in conjunction with a respondent-driven sampling (RDS) survey to estimate the number of FSW in Juba and Nimule. For service multiplier, the number of FSW testing for HIV in 2015 (Juba) and 2016 (Nimule) was obtained from the LINKAGES program targeting FSW. Survey participants were asked whether they had been tested for HIV by LINKAGES during the relevant period. A total of 2 separate unique object distributions were conducted in Juba and Nimule. In Nimule, these were combined to produce a 3-source capture-recapture estimate. The exercise involved distribution of key chains and bangles to FSW, documentation of the number of those who received unique objects, and questions during RDS survey to assess whether participants received unique objects. Results In Juba, the service multiplier method yielded an estimate of 5800 (95% CI 4927-6673) FSW. The unique object estimate (key chain and RDS participation) yielded 5306 (95% CI 4673-5939). Another estimate using RDS participation and receipt of a bangle yielded a much lower estimate of 1863 (95% CI 1776-1951), as did a 2-source estimate of key chain and bangle (2120, 95% CI 2028-2211). A 3-source capture-recapture estimate could not be produced because aggregate rather than individual level data were collected during the third capture. The multiplier estimate using key chain and RDS participation was taken as the final population estimate for FSW in Juba, which constitutes more than 6% of the female population aged 15 to 64 years. In Nimule, the service multiplier method yielded an estimate of 9384 (95% CI 8511-10,257). The 2-source estimates for key chain and RDS yielded 6973 (95% CI 4759-9186); bangles and RDS yielded a higher estimate of 13,104 (95% CI 7101-19,106); key chains and bangles yielded a lower estimate of 1322 (95% CI 1223-1420). The 3-source capture-recapture method using Bayesian nonparametric latent-class model-based estimate yielded a population of 2694 (95% CI 1689-6945), and this was selected as the final estimate for Nimule, which constitutes nearly 40% of female population aged 15 to 64 years. Conclusions The service and unique object multiplier, and 3-source capture-recapture methods were successfully used to estimate the number of FSW in Nimule, whereas service and unique object multiplier methods were successfully used in Juba. These methods yielded higher than previously estimated FSW population sizes. These estimates will inform resource allocation and advocacy efforts to support services for FSW.
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Affiliation(s)
| | - Alex Bolo
- United States Centres for Disease Control and Prevention, Juba, South Sudan
| | | | | | | | - Joel Sua Katoro
- United States Centres for Disease Control and Prevention, Juba, South Sudan
| | | | - Steve Gutreuter
- United States Centres for Disease Control and Prevention, Atlanta, GA, United States
| | - Lee Hundley
- United States Centres for Disease Control and Prevention, Atlanta, GA, United States
| | - Avi Hakim
- United States Centres for Disease Control and Prevention, Atlanta, GA, United States
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