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Tucker E, Reyes Nieva H, Schiffer K, Yin MT, Castor D, Gordon P, Elhadad N, Zucker J. Using a Health Information Exchange to Characterize Changes in HIV Viral Load Suppression and Disparities During the COVID-19 Pandemic in New York City. Open Forum Infect Dis 2023; 10:ofad584. [PMID: 38156044 PMCID: PMC10754646 DOI: 10.1093/ofid/ofad584] [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: 08/30/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Background HIV viral suppression requires sustained engagement in care. The COVID-19 pandemic challenged care accessibility for many people living with HIV (PLWH). We used health information exchange data to evaluate the effect of pandemic-related disruptions in HIV care on viral load suppression (VLS) and to examine racial/ethnic disparities in VLS. Methods We performed a retrospective observational cohort study of PLWH using data from a regional health information exchange in the New York City region between 1 January 2018 and 31 December 2022. We established 2 cohorts: PLWH who received HIV care in 2020 (cohort A) and PLWH who did not receive HIV care in 2020 (cohort B). We categorized HIV VLS outcomes as suppressed or not suppressed and calculated the prevalence of VLS between 2018 and 2022. We compared proportions using chi-square tests and used unadjusted and adjusted logistic regression to estimate the association among variables, including race/ethnicity, cohort, and VLS. Results Of 5 301 578 patients, 34 611 met our inclusion criteria for PLWH, 11 653 for cohort A, and 3141 for cohort B. In 2019, cohort B had a lower prevalence of VLS than cohort A (86% vs 89%, P < .001). Between 2019 and 2021, VLS dropped significantly among cohort B (86% to 81%, P < .001) while staying constant in cohort A (89% to 89%, P = .62). By 2022, members of cohort B were less likely than cohort A to be receiving HIV care in New York City (74% vs 88%, P < .001). Within both cohorts, Black and Hispanic patients had lower odds of VLS than White patients. Conclusions In New York City, VLS remained high among PLWH who continued to receive care in 2020 and dropped among PLWH who did not receive care. VLS was lower among Black and Hispanic patients even after controlling for receipt of care.
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Affiliation(s)
- Emma Tucker
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Harry Reyes Nieva
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Kayla Schiffer
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Michael T Yin
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
| | - Delivette Castor
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
| | - Peter Gordon
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
| | - Noémie Elhadad
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Jason Zucker
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
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Habila MA, Obeng-Kusi M, Ali MJ, Magaji FA, Shambe IH, Daru PH, Jacobs ET, Madhivanan P, Sagay AS, Musa J. The impact of the COVID-19 pandemic on routine HIV care and cervical cancer screening in North-Central Nigeria. BMC Womens Health 2023; 23:640. [PMID: 38037005 PMCID: PMC10687784 DOI: 10.1186/s12905-023-02782-6] [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: 04/11/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Cervical cancer is the fourth most diagnosed cancer among women globally, with much of the burden being carried by women in limited-resource settings often worsened by the high prevalence of HIV. Furthermore, the COVID-19 pandemic disrupted organized screening efforts and HIV management regimens worldwide, and the impact of these disruptions have not been examined in these settings. The purpose of this paper is to describe whether uptake of cervical cancer screening and HIV management changed before, during, and since the COVID-19 pandemic in North-Central Nigeria. METHODS Longitudinal healthcare administration data for women who obtained care between January 2018 and December 2021 were abstracted from the AIDS Prevention Initiative Nigeria (APIN) clinic at Jos University Teaching Hospital. Patient demographics, pap smear outcomes, and HIV management indicators such as viral load and treatment regimen were abstracted and assessed using descriptive and regression analyses. All analyses were conducted comparing two years prior to the COVID-19 pandemic, the four quarters in 2020, and the year following COVID-19 restrictions. RESULTS We included 2304 women in the study, most of whom were between 44 and 47 years of age, were married, and had completed secondary education. About 85% of women were treated with first line highly active retroviral therapy (HAART). Additionally, 84% of women screened using pap smear had normal results. The average age of women who sought care at APIN was significantly lower in Quarter 3, 2020 (p = 0.015) compared to the other periods examined in this study. Conversely, the average viral load for women who sought care during that period was significantly higher in adjusted models (p < 0.0001). Finally, we determined that the average viral load at each clinic visit was significantly associated with the period in which women sought care. CONCLUSIONS Overall, we found that COVID-19 pandemic mitigation efforts significantly influenced women's ability to obtain cervical cancer screening and routine HIV management at APIN clinic. This study buttresses the challenges in accessing routine and preventive care during the COVID-19 pandemic, especially in low-resource settings. Further research is needed to determine how these disruptions to care may influence long-term health in this and similar at-risk populations.
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Affiliation(s)
- Magdiel A Habila
- Mel and Enid, Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
- Department of Health and Pharmaceutical Outcomes, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA.
| | - Mavis Obeng-Kusi
- Department of Health and Pharmaceutical Outcomes, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Maryam J Ali
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Francis A Magaji
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Iornum H Shambe
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Patrick H Daru
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Elizabeth T Jacobs
- Mel and Enid, Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Purnima Madhivanan
- Mel and Enid, Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- Public Health Research Institute of India, Mysore, India
| | - Atiene S Sagay
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Jonah Musa
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Wells N, Murphy D, Ellard J, Howard C, Keen P, Fairley C, Donovan B, Prestage G. Requesting HIV Results Be Conveyed in-Person: Perspectives of Clinicians and People Recently Diagnosed with HIV. Sex Res Social Policy 2023:1-8. [PMID: 37363348 PMCID: PMC10257370 DOI: 10.1007/s13178-023-00827-x] [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] [Accepted: 05/18/2023] [Indexed: 06/28/2023]
Abstract
Introduction Guidelines recommend that, where possible, clinicians convey HIV-positive test results in person in Australia. However, HIV-negative and all other STI results are routinely delivered by phone or text message. Requesting individuals to obtain positive HIV test results in person could be a deviation from the standard delivery of healthcare and be interpreted as indicating a positive HIV diagnosis. Methods This paper is based on two related, ongoing qualitative studies conducted in Australia with HIV healthcare providers and people recently diagnosed with HIV. In study one, in-depth, semi-structured interviews were conducted with people who had recently received a positive HIV diagnosis. In study two, in-depth, semi-structured interviews were conducted with HIV healthcare and peer support providers. Interviews were analyzed thematically. Results While clinicians were willing to convey HIV-positive diagnoses by phone, most preferred in-person delivery. In-person delivery enabled clinicians to assess visual cues to better respond to the psychological and emotional needs of patients. For some participants living with HIV, however, the requirement to return to the clinic was interpreted as an unofficial HIV-positive diagnosis. This led to a period in which recently diagnosed participants believed they were HIV-positive without having received an explicit diagnosis. Conclusion Protocols for delivering HIV diagnoses by phone, followed by a face-to-face appointment, may reduce the period of anxiety for some patients and assist with an early connection to HIV care and support. Policy Implications In some instances, conveying HIV diagnoses by phone may be more appropriate than recalling individuals to the clinic to deliver a positive HIV diagnosis in person.
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Affiliation(s)
- Nathanael Wells
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - Dean Murphy
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - Jeanne Ellard
- Australian Research Centre for Sex, Health, and Society, Bundoora, Australia
| | - Chris Howard
- Queensland Positive People (QPP), Brisbane, Australia
- National Association for People With HIV Australia, Sydney, Australia
| | - Phillip Keen
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - Christopher Fairley
- Alfred Health, Melbourne Sexual Health Centre, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Basil Donovan
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - Garrett Prestage
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - on behalf of the RISE Study Team
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
- Australian Research Centre for Sex, Health, and Society, Bundoora, Australia
- Queensland Positive People (QPP), Brisbane, Australia
- National Association for People With HIV Australia, Sydney, Australia
- Alfred Health, Melbourne Sexual Health Centre, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
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Majam M, Phatsoane M, Wonderlik T, Rhagnath N, Schmucker LK, Singh L, Rademeyer M, Thirumurthy H, Marcus N, Lalla-Edward S. Incentives to promote accessing HIV care and viral suppression among HIV self-screening test users who obtain a reactive result. Front Reprod Health 2022; 4:976021. [PMID: 36303657 PMCID: PMC9580778 DOI: 10.3389/frph.2022.976021] [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: 06/22/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Achieving viral suppression in people with HIV is crucial in ending the AIDS epidemic. Among users of HIV self-screening tests, low rates of linkage to care and early retention in care are key obstacles to achieving viral suppression. This study sought to evaluate the efficacy of financial incentives in supporting HIV case management. Methods Young adults within the inner city of Johannesburg, South Africa and surrounding areas who used HIV self-tests, were able to use WhatsApp to communicate with study personnel, reported a reactive or invalid result, and were confirmed to by HIV-positive were enrolled in the study. Participants were randomised to an intervention arm that received reminders and financial rewards for engaging in care, or to a control arm that received the standard of care. The primary outcome was HIV viral load at six months. Results Among 2,388 HIV self-test kits that were distributed, 1757/2,388 (73,58%) recipients were able to use their phones to send photos to study personnel. 142/1,757 (8,08%) of these recipients reported reactive or invalid results. Upon confirmatory testing, 99/142 (69,71%) participants were identified as being HIV-positive and were enrolled in the study. 2 (1,41%) participants received an HIV negative result, and 41(28,87%) participants were either lost to follow-up or did not complete the confirmatory testing step. 20/99 (20,2%) from the intervention arm and 18/99 (18,18%) from the control arm completed the study (i.e., attended a 6 month follow up and participated in the exit interview). 29/99 (29,29%) were virally suppressed by at 6 months. Of those achieving viral suppression 15 (51,72%) were from the intervention arm. Conclusion Financial incentives and reminders were not effective in promoting engagement with HIV care and viral suppression in this setting.
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Affiliation(s)
- Mohammad Majam
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mothepane Phatsoane
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Theodore Wonderlik
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Naleni Rhagnath
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laura K. Schmucker
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, United States
| | - Leanne Singh
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, United States
| | - Noora Marcus
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, United States
| | - Samanta Lalla-Edward
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Correspondence: Samanta Lalla-Edward
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Bulterys MA, Oyaro P, Brown E, Yongo N, Karauki E, Wagude J, Kingwara L, Bowen N, Njogo S, Wagner AD, Mukui I, Oluoch F, Abuogi L, Patel R, Sharma M. Costs of Point-of-Care Viral Load Testing for Adults and Children Living with HIV in Kenya. Diagnostics (Basel) 2021; 11:140. [PMID: 33477850 PMCID: PMC7832863 DOI: 10.3390/diagnostics11010140] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/16/2021] [Accepted: 01/17/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The number of people living with HIV (PLHIV) in need of treatment monitoring in low-and-middle-income countries is rapidly expanding, straining existing laboratory capacity. Point-of-care viral load (POC VL) testing can alleviate the burden on centralized laboratories and enable faster delivery of results, improving clinical outcomes. However, implementation costs are uncertain and will depend on clinic testing volume. We sought to estimate the costs of decentralized POC VL testing compared to centralized laboratory testing for adults and children receiving HIV care in Kenya. METHODS We conducted microcosting to estimate the per-patient costs of POC VL testing compared to known costs of centralized laboratory testing. We completed time-and-motion observations and stakeholder interviews to assess personnel structures, staff time, equipment costs, and laboratory processes associated with POC VL administration. Capital costs were estimated using a 5 year lifespan and a 3% annual discount rate. RESULTS We estimated that POC VL testing cost USD $24.25 per test, assuming a clinic is conducting 100 VL tests per month. Test cartridge and laboratory equipment costs accounted for most of the cost (62% and 28%, respectively). Costs varied by number of VL tests conducted at the clinic, ranging from $54.93 to $18.12 per test assuming 20 to 500 VL tests per month, respectively. A VL test processed at a centralized laboratory was estimated to cost USD $25.65. CONCLUSION POC VL testing for HIV treatment monitoring can be feasibly implemented in clinics within Kenya and costs declined with higher testing volumes. Our cost estimates are useful to policymakers in planning resource allocation and can inform cost-effectiveness analyses evaluating POC VL testing.
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Affiliation(s)
- Michelle Ann Bulterys
- Departments of Epidemiology and Global Health, University of Washington, Seattle, WA 98105, USA; (P.O.); (A.D.W.); (I.M.); (R.P.); (M.S.)
| | - Patrick Oyaro
- Departments of Epidemiology and Global Health, University of Washington, Seattle, WA 98105, USA; (P.O.); (A.D.W.); (I.M.); (R.P.); (M.S.)
- Health Innovations Kenya, Kisumu, Kenya
| | - Evelyn Brown
- Department of HIV Research, University of Washington Kenya, Nairobi, Kenya; (E.B.); (N.Y.); (E.K.)
| | - Nashon Yongo
- Department of HIV Research, University of Washington Kenya, Nairobi, Kenya; (E.B.); (N.Y.); (E.K.)
| | - Enericah Karauki
- Department of HIV Research, University of Washington Kenya, Nairobi, Kenya; (E.B.); (N.Y.); (E.K.)
| | | | - Leonard Kingwara
- National HIV Reference Laboratory, National Public Health Laboratory, Nairobi, Kenya; (L.K.); (N.B.); (F.O.)
| | - Nancy Bowen
- National HIV Reference Laboratory, National Public Health Laboratory, Nairobi, Kenya; (L.K.); (N.B.); (F.O.)
| | - Susan Njogo
- National AIDS and STI Control Programme, Ministry of Health, Nairobi 19361, Kenya;
| | - Anjuli D. Wagner
- Departments of Epidemiology and Global Health, University of Washington, Seattle, WA 98105, USA; (P.O.); (A.D.W.); (I.M.); (R.P.); (M.S.)
| | - Irene Mukui
- Departments of Epidemiology and Global Health, University of Washington, Seattle, WA 98105, USA; (P.O.); (A.D.W.); (I.M.); (R.P.); (M.S.)
| | - Frederick Oluoch
- National HIV Reference Laboratory, National Public Health Laboratory, Nairobi, Kenya; (L.K.); (N.B.); (F.O.)
| | - Lisa Abuogi
- Department of Pediatrics, University of Colorado, Denver, CO 80045, USA;
| | - Rena Patel
- Departments of Epidemiology and Global Health, University of Washington, Seattle, WA 98105, USA; (P.O.); (A.D.W.); (I.M.); (R.P.); (M.S.)
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA 98105, USA
| | - Monisha Sharma
- Departments of Epidemiology and Global Health, University of Washington, Seattle, WA 98105, USA; (P.O.); (A.D.W.); (I.M.); (R.P.); (M.S.)
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Elharti E, Abbadi H, Bensghir R, Marhoum El Filali K, Elmrabet H, Oumzil H. Assessment of two POC technologies for CD4 count in Morocco. AIDS Res Ther 2020; 17:31. [PMID: 32522235 PMCID: PMC7285615 DOI: 10.1186/s12981-020-00289-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background In the era of “test and treat strategy”, CD4 testing remains an important tool for monitoring HIV-infected individuals. Since conventional methods of CD4 count measurement are costly and cumbersome, POC CD4 counting technique are more affordable and practical for countries with limited resources. Before introducing such methods in Morocco, we decided to assess their reliability. Methods In this study 92 blood samples from HIV-infected patients, were tested by PIMA and FACSPresto to derive CD4 count. Flow cytometry using FacsCalibur, was used as reference method for CD4 count comparison. Linear regression, Bland–Altman analysis were performed to assess correlation and agreement between these POC methods and the reference method. In addition, sensitivity and specificity, positive predictive value (PPV), negative predictive value (NPV) and misclassification percentage at 350 and 200 CD4 count thresholds; were also determined. Finally, because FACSPresto can also measure hemoglobin (Hb) concentration, 52 samples were used to compare FACSPresto against an automated hematology analyzer. Results The coefficient of determination R2 was 0.93 for both methods. Bland–Altman analysis displayed a mean bias of − 32.3 and − 8.1 cells/µl for PIMA and FACSPresto, respectively. Moreover, with a threshold of 350 CD4 count, PIMA displayed a sensitivity, specificity, PPV, NPV, were 88.57%, 94.12%, 91.18%, 92.31%; respectively. FACSPresto showed 88.23%, 96.23%, 93.75% and 92.73%; respectively. Furthermore, the upward misclassification percentage was 8.57 and 5.88%, for PIMA and FACSPresto, respectively; whereas the downward misclassification percentage was 7.84% and 7.54%; respectively. With 200 cells/µl threshold, PIMA had a sensitivity, specificity, PPV and NPV of 83.33%, 98.53%, 93.75% and 95.71%, respectively. Regarding FACSPresto, sensitivity, specificity, PPV and NPV was 82.35%, 98.57%, 88.57% and 95.83%; respectively. Upward misclassification percentage was 5.56% and 5.88%, for PIMA and FACSPresto, respectively; whereas downward misclassification percentage was 4.41% and 4.29%; respectively. Finally, the hemoglobin measurement evaluation displayed an R2 of 0.80 and a mean bias of − 0.12 with a LOA between − 1.75 and 1.51. Conclusion When compared to the reference method, PIMA and FACSPresto have shown good performance, for CD4 counting. The introduction of such POC technology will speed up the uptake of patients in the continuum of HIV care, in our country.
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Tarkang EE. The fight against COVID-19 in sub-Saharan Africa-a threat to the continuous management of HIV patients: application of the action areas of the Ottawa charter for health promotion. Pan Afr Med J 2020; 35:25. [PMID: 33623550 PMCID: PMC7875743 DOI: 10.11604/pamj.supp.2020.35.2.23224] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 11/11/2022] Open
Abstract
The Novel Coronavirus (2019-nCoV) was detected in December 2019 in the Hubei Province of China. Also known as COVID-19, the outbreak was declared a pandemic by the World Health Organization (WHO) in March 2020. Sub-Saharan Africa (SSA), which is the region hardest hit by HIV, is also highly affected by COVID-19. The fight against COVID-19 in SSA might threaten the continuous management of persons living with HIV (PLHIV). This commentary uses the five action areas of the Ottawa charter for health promotion to address the issue. If the issues raised in this commentary are not addressed quickly by SSA governments, every single link of the supply chain in the HIV response will be disrupted. This disruption might result in more stock-outs, shortages and a lack of access to ART in the months ahead. The SSA governments must ensure that HIV treatment adherence is not compromised owing to a shift of focus to the fight against COVID-19. They should ensure that everyone on HIV treatment gets an adequate supply of antiretroviral therapy (ART).
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Affiliation(s)
- Elvis Enowbeyang Tarkang
- Department of Population and Behevioural Sciences, School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana.,HIV/AIDS Prevention Research Network Cameroon, Kumba, Southwest Region, Cameroon
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López JD, Shacham E, Brown T. The Impact of Clinic Policy Attendance and the Ryan White HIV/AIDS Medical Case Management Program on HIV Clinical Outcomes: A Retrospective Longitudinal Study. AIDS Behav 2020; 24:1161-9. [PMID: 31768689 DOI: 10.1007/s10461-019-02738-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Clinic appointment attendance is a significant determinant of improved HIV health outcomes. A retrospective longitudinal analysis from 2009 to 2015 examined the relationship of clinic policy attendance with and without medical case management (MCM) on HIV clinical outcomes. Clinical parameters were abstracted across the study years and latent growth models measured HIV clinical outcomes as a function of time. A total of 2773 patients were included in this study. More than the majority of individuals had 75% clinic policy attendance during each of the study years and the median number of MCM contact visits with the case manager was 4.0 visits per year (p < 0.01). While the overall trend identified improved HIV clinical outcomes across the clinic population over the study period, it also revealed individuals receiving MCM and with 75% clinic policy attendance had significantly faster improvement in HIV clinical outcomes compared to the individuals who did not receive MCM nor had 75% clinic policy attendance. This study identified how MCM, in combination with clinic policy attendance efforts, are useful in quickly improving HIV viral load and CD4 T-cell count. These findings support the continued need for funding of the Ryan White Care Act as it assists with the support of MCM and appointment attendance through the guidance of wrap-around services.
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Bello TK, Gericke GJ, Maclntyre UE, Becker P. A nutrition education programme improves quality of life but not anthropometric status of adults living with HIV in Abeokuta, Nigeria. Public Health Nutr 2019; 22:2290-302. [PMID: 31084656 DOI: 10.1017/S1368980019000636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The focus of interventions for adults living with HIV (ALH) in Nigeria has been mostly on prevention and provision of antiretroviral therapy (ART) with little consideration to nutrition-related matters. Therefore, the present study aimed to improve the quality of life (QoL) and anthropometric status of ALH in Abeokuta, Nigeria. DESIGN A quasi-experimental design where 200 conveniently selected participants were stratified by gender and duration on ART. The intervention group (n 100) received the nutrition education programme (NEP) for 12 weeks. The control group received a brochure on nutrition guidelines for ALH. Socio-biographical information, QoL and anthropometric status were assessed using previously validated questionnaires and standard techniques at baseline, week 12 and week 24. Generalised least squares (GLS) regression analysis was used for group comparisons. Anthropometric status was summarised by gender. SETTING Two tertiary hospitals in Abeokuta, Nigeria. PARTICIPANTS ALH. RESULTS The NEP led to significant improvement in the physical functioning (week 12 and 24: P < 0·01), role limitation due to physical health (week 12: P = 0·01; week 24: P = 0·002) and pain (week 12: P = 0·01) constructs of the QoL of the intervention group compared with the control group. There was no significant difference (P = 0·07) between the mean weights of the two groups at baseline. CONCLUSIONS There was a significant improvement at week 12 and week 24 in the QoL of the intervention participants. The results indicated that a tailored NEP could make a positive contribution to the management of ALH.
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Shacham E, López JD, Brown TM, Tippit K, Ritz A. Enhancing Adherence to Care in the HIV Care Continuum: The Barrier Elimination and Care Navigation (BEACON) Project Evaluation. AIDS Behav 2018; 22:258-264. [PMID: 28597342 DOI: 10.1007/s10461-017-1819-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Interventions are needed to address each phase of the HIV care continuum in order to improve health outcomes and reduce likelihood of HIV transmission. The purpose of this study was to assess the impact of a community- and clinic-based intervention designed and implemented to reengage individuals who were lost to HIV care. Eligible participants had either never engaged in HIV care or had not had a medical visit for at least 12 months. Participants enrolled in a community- and clinic-based intervention that included intensive case management, access to a community nurse and peer navigator, as well as emergency stabilization funds. Data were collected at baseline and 6-month time points by the case managers; which included sociodemographics, general health, abstracted HIV viral loads and CD4 cell counts from their medical records. Descriptive and GEE analyses were conducted to assess changes from baseline to 6 months. A total of 322 participants enrolled over a 5-year period, of whom the majority were male (n = 250) and African American with a mean age of 42.0 years. After 6 months of the intervention, there was a significant increase of individuals who had undetectable HIV viral loads and their median CD4 cell counts increased (p < 0.01 for both). General health improved as well (p < 0.01). It is clear that this method of engagement, while staff intensive, is successful at engaging and retaining individuals in HIV care at least through 6 months.
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Shacham E, López JD, Souza P, Overton ET. Examining Sexual Function Among Individuals With HIV in a Midwestern US Urban Outpatient Clinic Setting. J Int Assoc Provid AIDS Care 2017; 16:481-486. [PMID: 28791913 DOI: 10.1177/2325957417724205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/16/2022] Open
Abstract
The role of sexual function and its impact on HIV management have been inadequately evaluated. A cross-sectional study in 2009 of 202 patients with HIV were recruited to examine sexual function and psychosocial/HIV management factors. Analyses assessed the relationship between sexual function, sociodemographic factors, biomedical markers, and depressive symptomology. The M-Estimator compared differences in the means of the HIV, cancer survivors, and the normative cohorts. More than 75% were on combination antiretroviral therapy, of which 70% had suppressed HIV viral loads. Patients with unsuppressed HIV viral loads reported lower rates of arousal. Better overall health was associated with higher rates of overall sexual function, arousal, and interest. Compared to the normative and cancer survivor cohorts, mean sexual function was significantly lower in the HIV-infected cohort in all subscales, except for masturbation. These findings suggest lower sexual function impacts individuals with HIV in ways related to negative biomedical and psychosocial factors.
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Affiliation(s)
- E Shacham
- 1 Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Julia D López
- 1 Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - P Souza
- 2 Dana-Farber Cancer Institute, Boston, MA, USA
| | - E Turner Overton
- 3 Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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12
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Abstract
This study aimed at assessing knowledge of HIV/AIDS among residents of three rural communities in Nigeria. A total of 371 persons residing in selected rural communities were recruited for this study. A structured questionnaire was used to collect data from all participants. Results of the study showed a generally high level of awareness of HIV/AIDS in all communities surveyed. However, among study participants, knowledge of mode of prevention and management of HIV infection was poor as was knowledge of HIV status and readiness to utilize free voluntary counseling and testing for HIV/AIDS services. Scale-up of HIV/AIDS education by relevant health authorities is strongly advocated.
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Affiliation(s)
- Bankole Henry Oladeinde
- a Department of Medical Microbiology , College of Health Sciences, Igbinedion University , Okada , Nigeria
| | - Richard Omoregie
- b School of Medical Laboratory Sciences, University of Benin Teaching Hospital , Benin City , Nigeria
| | - Ikpomwonsa Odia
- c Institute of Laser Fever Research and Control, Irrua Specialist Hospital , Irrua , Nigeria
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13
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Shacham E, López JD, Önen NF, Overton ET. The Relationship of Social Support and Neighborhood Perceptions among Individuals with HIV. J Int Assoc Provid AIDS Care 2016; 16:440-445. [PMID: 27619537 DOI: 10.1177/2325957416668033] [Citation(s) in RCA: 2] [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] [Indexed: 11/17/2022] Open
Abstract
Social support has been noted to improve health outcomes for individuals with HIV. Understanding how neighborhoods contribute to feelings of social support is beneficial to create environments where populations with HIV can be supported. This study assessed the relationship between neighborhood perceptions and social support with HIV management. A total of 201 individuals were recruited; individuals with HIV, 18 years or older, who were eligible to participate in the 2-hour interview. Psychiatric diagnostic interviews were conducted alongside assessments of social support and neighborhood perceptions; biomedical markers were abstracted from medical records. Correlations and linear regression analyses were performed to assess relationships between social support and neighborhood perceptions with HIV management biomarkers. The majority of the sample was male (68.8%) and African American (72.3%), with a mean age of 43.1 years. Overall, 78% were receiving combination antiretroviral therapy (cART) prescriptions, with 69% being virally suppressed. Fear of neighborhood activities was independently associated with receiving current cART. Reports of social support and neighborhood perceptions were highly correlated. Findings suggest that supportive home environments likely would improve perceptions of social support.
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Affiliation(s)
- Enbal Shacham
- 1 Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Julia D López
- 1 Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Nur F Önen
- 2 Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Edgar T Overton
- 3 Division of Infectious Diseases, Department of Medicine, University of Alabama, Birmingham, AL, USA
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Abstract
Regardless of medical advancements, new HIV infections persist. Young adults are most often newly infected, thus research is needed to assess medication adherence barriers specific to young adults with HIV. The data were abstracted from medical charts to include both self-reported behavioral and psychological distress data and HIV parameters in 2013 among patients aged 18-30 years. Descriptive and logistic regression analyses were conducted to identify factors related to viral suppression and sexually transmitted infection (STI) status. A total of 335 individuals presented for care during a 12-month period at a single clinic. The majority were African American and had a mean age of 25.6 years. Nearly all had current prescriptions of antiretroviral therapy (ART). Among those receiving ART, almost three-quarters were virally suppressed, as measured by 200 copies/mL. STI tests are conducted annually and by assessed need; 30% of this sample had at least 1 bacterial STI diagnosis within the last year. Psychological distress symptoms were more common among individuals who were not virally suppressed, compared to those who were virally suppressed. Women and individuals with moderate to severe symptoms of depression had higher odds of having unsuppressed viral loads. The independent factors associated with having any STIs were being African American or other minorities and having two or more sex partners. Our findings related to how young adults are managing their HIV care suggest that increased efforts aimed to prevent additional STIs and manage psychological distress will likely reduce transmission risks.
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Affiliation(s)
- Enbal Shacham
- a Department of Behavioral Science and Health Education , College for Public Health and Social Justice, Saint Louis University , St. Louis , MO , USA
| | - Amy L Estlund
- a Department of Behavioral Science and Health Education , College for Public Health and Social Justice, Saint Louis University , St. Louis , MO , USA
| | - Amanda E Tanner
- b Department of Public Health Education , School of Health & Human Sciences, University of North Carolina Greensboro , Greensboro , NC , USA
| | - Rachel Presti
- c Division of Infectious Diseases, Department of Medicine , Washington University School of Medicine , St. Louis , MO , USA
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Zucker J, Mittal J, Jen SP, Cheng L, Cennimo D. Impact of Stewardship Interventions on Antiretroviral Medication Errors in an Urban Medical Center: A 3-Year, Multiphase Study. Pharmacotherapy 2016; 36:245-51. [PMID: 26833760 DOI: 10.1002/phar.1716] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 11/05/2022]
Abstract
BACKGROUND There is a high prevalence of HIV infection in Newark, New Jersey, with University Hospital admitting approximately 600 HIV-infected patients per year. Medication errors involving antiretroviral therapy (ART) could significantly affect treatment outcomes. The goal of this study was to evaluate the effectiveness of various stewardship interventions in reducing the prevalence of prescribing errors involving ART. METHODS This was a retrospective review of all inpatients receiving ART for HIV treatment during three distinct 6-month intervals over a 3-year period. During the first year, the baseline prevalence of medication errors was determined. During the second year, physician and pharmacist education was provided, and a computerized order entry system with drug information resources and prescribing recommendations was implemented. Prospective audit of ART orders with feedback was conducted in the third year. Analyses and comparisons were made across the three phases of this study. RESULTS Of the 334 patients with HIV admitted in the first year, 45% had at least one antiretroviral medication error and 38% had uncorrected errors at the time of discharge. After education and computerized order entry, significant reductions in medication error rates were observed compared to baseline rates; 36% of 315 admissions had at least one error and 31% had uncorrected errors at discharge. While the prevalence of antiretroviral errors in year 3 was similar to that of year 2 (37% of 276 admissions), there was a significant decrease in the prevalence of uncorrected errors at discharge (12%) with the use of prospective review and intervention. CONCLUSIONS Interventions, such as education and guideline development, can aid in reducing ART medication errors, but a committed stewardship program is necessary to elicit the greatest impact.
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Affiliation(s)
- Jason Zucker
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Jaimie Mittal
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Shin-Pung Jen
- Pharmaceutical Care Division, University Hospital, Newark, New Jersey
| | - Lucy Cheng
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York
| | - David Cennimo
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
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Mapp F, Hutchinson J, Estcourt C. A systematic review of contemporary models of shared HIV care and HIV in primary care in high-income settings. Int J STD AIDS 2015; 26:991-7. [PMID: 25804421 DOI: 10.1177/0956462415577496] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 10/06/2014] [Accepted: 02/19/2015] [Indexed: 11/15/2022]
Abstract
HIV shared care is uncommon in the UK although shared care could be a beneficial model of care. We review the literature on HIV shared care to determine current practice and clinical, economic and patient satisfaction outcomes. We searched MEDLINE, EMBASE, NICE Evidence, Cochrane collaboration, Google and websites of the British HIV Association, Aidsmap, Public Health England, World Health Organization and Terrence Higgins Trust using relevant search terms in August 2014. Studies published after 2000, from healthcare settings comparable to the UK that described links between primary care and specialised HIV services were included and compared using principles of the Critical Appraisal Skills Programme and Authority, Accuracy, Coverage, Objectivity, Date, Significance frameworks. Three of the nine included models reported clinical or patient satisfaction outcomes but data collection and analyses were inadequate. None reported economic outcomes although some provided financial costings. Facilitators of shared care included robust clinical protocols, training and timely communication. Few published examples of HIV shared care exist and quality of evidence is poor. There is no consistent association with improved clinical outcomes, cost effectiveness or acceptability. Models are context specific, driven by local need, although some generalisable features could inform novel service delivery. Further evaluative research is needed to determine optimal components of shared HIV care.
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Affiliation(s)
- Fiona Mapp
- London School of Hygiene & Tropical Medicine, Social & Environmental Health Research, London, UK
| | - Jane Hutchinson
- Barts & The London School of Medicine & Dentistry, Blizard Institute, London, UK
| | - Claudia Estcourt
- Barts & The London School of Medicine & Dentistry, Blizard Institute, London, UK
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Shacham E, Önen NF, Donovan MF, Rosenburg N, Overton ET. Psychiatric Diagnoses among an HIV-Infected Outpatient Clinic Population. J Int Assoc Provid AIDS Care 2014; 15:126-30. [PMID: 25348798 DOI: 10.1177/2325957414553846] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
As individuals with HIV infection are living longer, the management of psychiatric disorders has increasingly been incorporated into comprehensive care. Individuals were recruited from an outpatient HIV clinic to assess the prevalence and related associations of current psychiatric disorders and biomarkers. Of the 201 participants who completed the interviews, the median age was 43.5 years, and the majority was male and African American. Most were receiving HIV therapy and 78% of those had achieved virologic suppression. Prevalent psychiatric diagnoses included major depressive disorder, generalized anxiety, and agoraphobia. Alcohol and cocaine/crack abuse and dependence were common substance use disorders. Current receipt of HIV therapy was less common among those diagnosed with generalized anxiety disorder. Agoraphobia was the only disorder associated with unsuppressed viral load. Psychiatric and substance use disorders are highly prevalent among an urban HIV clinic population, although we identified few associations between psychiatric diagnoses and HIV diseases status.
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Affiliation(s)
- Enbal Shacham
- Department of Behavioral Sciences and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Nur F Önen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | | | - Neal Rosenburg
- Nevada State College, School of Nursing, Henderson, NV, USA
| | - E Turner Overton
- Division of Infectious Diseases, Department of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
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Abstract
Despite advancements in the public's understanding of HIV infection, felt stigma towards individuals living with HIV persists. Stigma has been associated with adverse health outcomes, including poor adherence to care, and increased participation in HIV transmission risk behaviours. We evaluated the level of felt stigma and its relationship to other psychosocial and medical factors among a sample of 201 individuals with HIV engaged in care. The overall mean stigma score, as measured by the Reece Stigma Scale, was 21.7 (SD 8.7). In univariate analysis, felt stigma scores were higher among women, African Americans, younger participants, and individuals with less education. Higher felt stigma scores were also found among individuals who reported having fair to poor overall health, moderate to severe symptoms of depression and anxiety, and those with a current diagnosis of alcohol dependence, generalised anxiety disorder, agoraphobia, pain disorder, and current smokers. Higher felt stigma scores were independently associated with individuals with anxiety symptoms. These analyses highlight that stigma persists among individuals with HIV and may play an important role in HIV care. The relationship between psychiatric disorders and psychosocial factors highlights an opportunity to develop interventions that will address these common comorbidities and reduce stigma.
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Affiliation(s)
- Enbal Shacham
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Neal Rosenburg
- School of Nursing, Nevada State College, Henderson, NV, USA
| | - Nur F Önen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | | | - E Turner Overton
- Division of Infectious Diseases, Department of Medicine, University of Alabama, Birmingham, AL, USA
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Abstract
Family-based interventions are efficacious for human immunodeficiency virus (HIV) detection, prevention, and care, but they are not broadly diffused. Understanding intervention adaptation and translation processes can support evidence-based intervention (EBI) diffusion processes. This paper provides a narrative review of a series of EBI for families affected by HIV (FAH) that were adapted across five randomized controlled trials in the US, Thailand, and South Africa over 15 years. The FAH interventions targeted parents living with HIV and their children or caregiver supports. Parents with HIV were primarily mothers infected through sexual transmission. The EBIs for FAH are reviewed with attention to commonalities and variations in risk environments and intervention features. Frameworks for common and robust intervention functions, principles, practice elements, and delivery processes are utilized to highlight commonalities and adaptations for each location, time period, and intervention delivery settings. Health care, housing, food, and financial security vary dramatically in each risk environment. Yet, all FAH face common health, mental health, transmission, and relationship challenges. The EBIs efficaciously addressed these common challenges and were adapted across contexts with fidelity to robust intervention principles, processes, factors, and practices. Intervention adaptation teams have a series of structural decision points: mainstreaming HIV with other local health priorities or not; selecting an optimal delivery site (clinics, homes, community centers); and how to translate intervention protocols to local contexts and cultures. Replication of interventions with fidelity must occur at the level of standardized functions and robust principles, processes, and practices, not manualized protocols. Adopting a continuous quality improvement paradigm will enhance rapid and global diffusion of EBI for FAH.
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Affiliation(s)
- Mary Jane Rotheram-Borus
- Center for HIV Identification, Prevention, and Treatment Services, AIDS Institute, University of California, Los Angeles, Los Angeles, CA USA
| | - Dallas Swendeman
- Center for HIV Identification, Prevention, and Treatment Services, AIDS Institute, University of California, Los Angeles, Los Angeles, CA USA
| | - Sung-Jae Lee
- Center for HIV Identification, Prevention, and Treatment Services, AIDS Institute, University of California, Los Angeles, Los Angeles, CA USA
| | - Li Li
- Center for HIV Identification, Prevention, and Treatment Services, AIDS Institute, University of California, Los Angeles, Los Angeles, CA USA
| | - Bita Amani
- Center for HIV Identification, Prevention, and Treatment Services, AIDS Institute, University of California, Los Angeles, Los Angeles, CA USA
| | - Myralyn Nartey
- Center for HIV Identification, Prevention, and Treatment Services, AIDS Institute, University of California, Los Angeles, Los Angeles, CA USA
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