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Kanyemba R, Govender K, Dzomba A, Mashamba TP, Mantell JE. HIV Focused Sexual Risk-Reduction Interventions Targeting Adolescent Boys and Young Men in Sub-Saharan Africa: A Scoping Review. AIDS Behav 2023; 27:3356-3391. [PMID: 37405621 PMCID: PMC10516779 DOI: 10.1007/s10461-023-04054-8] [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] [Accepted: 03/29/2023] [Indexed: 07/06/2023]
Abstract
Adolescent girls and young women's exceptionalism with HIV interventions has left adolescent boys and young men (ABYM) trailing behind, thus becoming a marginalized and underserved population. The scoping review aimed to provide an overview of interventions that have targeted sexual risk behaviors in ABYM in Sub-Saharan Africa (SSA) over the previous 21 years with critical insights on 'what works' in preventing the sexual transmission of HIV. A scoping review guided by Arksey and O'Malley's (in Int J Soc Res Methodol 8(1):19-32, 16) framework and the 2015 Johanna Briggs Institute's guidelines was conducted. A search of literature published between 2000 and 2020 was reviewed and twenty nine interventions from nine Sub Saharan African countries that met the eligibility criteria were reviewed. The review provides evidence on the successes and the limitations of sexual risk behavior interventions for ABYM in SSA. There is clear and consistent evidence that interventions reduce sexual risk behaviors in adolescent boys and young men. Their efficiency seems to grow with the length and intensity of the intervention. Positive effects were generally observed in condom use and on measures of HIV knowledge, attitudes and sexual behaviors as well as uptake of HIV tests and voluntary male circumcision. This review shows that sexual-risk interventions engaging men and boys in SSA are promising and warrant further rigorous development in terms of conceptualization, design and evaluation.
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Affiliation(s)
- Roselyn Kanyemba
- Health Economics and AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa.
- School of Social Sciences, University of KwaZulu Natal, Durban, South Africa.
| | - Kaymarlin Govender
- Health Economics and AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa
| | - Armstrong Dzomba
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tivani P Mashamba
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
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Kwena ZA, Amico RK, Masvawure TB, Ngure KK, Bukusi EA, Remien RH, Ochwal PO, Nguyen N, Mantell JE. Barriers to linkage and retention in HIV care still persist among adolescent girls and young women in western Kenya. Afr J AIDS Res 2023:1-14. [PMID: 37337818 DOI: 10.2989/16085906.2023.2197879] [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] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Adolescent girls and young women (AGYW) in sub-Saharan Africa experience delayed linkage to and poor retention in HIV care. Identifying and addressing specific barriers in HIV care programming is important to achieving the upgraded UNAIDS 95-95-95 targets and epidemic control. We examined these challenges among 103 HIV-positive AGYW in and out of HIV care in communities around Lake Victoria in western Kenya as part of a larger qualitative study to identify drivers of HIV testing and HIV care utilisation in key populations. We used the social-ecological model to guide development of interview guides. Individual-level barriers included denial and forgetfulness and gendered household responsibilities, medication side effects, especially if taken without food, pills being too big and difficult to swallow and the burden of a daily medication-taking regimen. Interpersonal barriers included troubled family relationships and pervasive fears of stigma and discrimination by friends and family. Communitylevel barriers were stigmatising attitudes toward people living with HIV. Health-system barriers included negative provider attitudes and confidentiality breaches. At the structural level, participants noted high costs due to long travel times to facilities, long clinic waiting times, household food insecurity and school and work commitments. AGYW's limited decision-making autonomy due to age and gender norms, including their reliance on the authority of older adults, makes these barriers especially troubling. Innovative treatment approaches that take into account the unique vulnerabilities of AGYW are urgently needed.
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Affiliation(s)
- Zachary A Kwena
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rivet K Amico
- Department of Health Behavior and Health Education, University of Michigan, Michigan, USA
| | - Tsitsi B Masvawure
- Health Studies, Center for Interdisciplinary Studies, College of the Holy Cross, Worcester, Massachusetts, USA
| | - Kenneth K Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Thika, Kenya
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Robert H Remien
- New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Perez O Ochwal
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Nadia Nguyen
- New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Joanne E Mantell
- New York State Psychiatric Institute and Columbia University, New York, New York, USA
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Hoffman S, Jamison K, Pathela P, Gonzalez-Argoti T, Rivera A, Leu CS, Hubbard S, Castro M, Borges C, Gandhi A, Edelstein Z, Myers J, Mantell JE, Bauman LJ. Health Care Provider Decisions to Initiate Oral HIV Preexposure Prophylaxis in New York City Public Sexual Health Clinics. Sex Transm Dis 2023; 50:386-394. [PMID: 36749905 PMCID: PMC10838661 DOI: 10.1097/olq.0000000000001782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Oral HIV preexposure prophylaxis (PrEP) is safe and effective but underutilized. Health care providers' beliefs about PrEP and attitudes toward people who could benefit may affect PrEP access. METHODS This mixed-methods study (2016-2018) was conducted in 8 New York City public sexual health clinics that implemented a PrEP program. Data included 32 in-depth qualitative interviews with clinicians, quantitatively coded to reflect their PrEP beliefs; a provider questionnaire; and 6 months of medical record visit data for these providers. Among patients with a PrEP indication, we examined the odds of a patient being initiated on PrEP associated with providers' PrEP beliefs and demographic characteristics, and patient characteristics. RESULTS Providers reported strong support for offering PrEP to eligible patients. The majority denied concerns about possible development of drug-resistant viral strains, giving PrEP to people who might not benefit, and PrEP toxicity. Nevertheless, about one-third agreed with each of these concerns, and 55% thought PrEP use might limit condom use. Of 2176 patients with a PrEP indication, 20% were initiated. Providers with more restrictive PrEP beliefs did not have lower odds of initiating patients on PrEP. Women as well as Black and Latinx patients were less likely to be initiated on PrEP. CONCLUSIONS Contrary to our hypotheses, providers' negative PrEP beliefs did not seem to reduce initiation of PrEP for eligible patients. This may be attributable to clear clinical protocols, strong staff support, and training on implementing PrEP in this setting. Racial and gender disparities in PrEP uptake urgently require attention.
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Affiliation(s)
- Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, NYS
Psychiatric Institute and Columbia University Irving Medical Center, New York, NY
10032
- Department of Epidemiology, Columbia University Mailman
School of Public Health, New York, NY 10032
| | - Kelly Jamison
- Bureau of Sexually Transmitted Infections, New York City
Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Preeti Pathela
- Bureau of Sexually Transmitted Infections, New York City
Department of Health and Mental Hygiene, Long Island City, NY, USA
| | | | - Angelic Rivera
- Albert Einstein College of Medicine, Department of
Pediatrics Bronx, NY, USA
| | - Cheng-Shiun Leu
- Department of Biostatistics, Columbia University Mailman
School of Public Health, New York, NY 10032
| | - Stephanie Hubbard
- Bureau of Sexually Transmitted Infections, New York City
Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Michael Castro
- Bureau of Sexually Transmitted Infections, New York City
Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Christine Borges
- Bureau of Sexually Transmitted Infections, New York City
Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Anisha Gandhi
- Bureau of HIV, New York City Department of Health and
Mental Hygiene, Long Island City, NY, USA
| | - Zoe Edelstein
- Bureau of HIV, New York City Department of Health and
Mental Hygiene, Long Island City, NY, USA
| | - Julie Myers
- Bureau of HIV, New York City Department of Health and
Mental Hygiene, Long Island City, NY, USA
| | - Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, NYS
Psychiatric Institute and Columbia University Irving Medical Center, New York, NY
10032
| | - Laurie J. Bauman
- Albert Einstein College of Medicine, Department of
Pediatrics Bronx, NY, USA
- Albert Einstein College of Medicine; Department of
Psychiatry and Behavioral Sciences, Bronx NY, USA
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Mantell JE, Zech JM, Masvawure TB, Assefa T, Molla M, Block L, Duguma D, Yirsaw Z, Rabkin M. Implementing six multi-month dispensing of antiretroviral therapy in Ethiopia: perspectives of clients and healthcare workers. BMC Health Serv Res 2023; 23:563. [PMID: 37259098 DOI: 10.1186/s12913-023-09549-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/14/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Multi-month dispensing (MMD) of antiretroviral therapy (ART) is an integral component of differentiated HIV service delivery for people living with HIV (PLHIV). Although many countries have scaled up ART dispensing to 3-month intervals, Ethiopia was the first African country to implement six-month dispensing (6-MMD) at scale, introducing its Appointment Spacing Model (ASM) for people doing well on ART in 2017. As of June 2021, 51.4% (n = 215,101) of PLHIV on ART aged ≥ 15 years had enrolled in ASM. Since little is known about the benefits and challenges of ASM perceived by Ethiopian clients and their healthcare workers (HCWs), we explored how the ASM was being implemented in Ethiopia's Oromia region in September 2019. METHODS Using a parallel convergent mixed-methods study design, we conducted 6 focus groups with ASM-eligible enrolled clients, 6 with ASM-eligible non-enrolled clients, and 22 in-depth interviews with HCWs. Data were audio-recorded, transcribed and translated into English. We used thematic analysis, initially coding deductively, followed by inductive coding of themes that emerged from the data, and compared the perspectives of ASM-enrolled and non-enrolled clients and their HCWs. RESULTS Participants enrolled in ASM and HCWs perceived client-level ASM benefits to include time and cost-savings, fewer work disruptions, reduced stigma due to fewer clinic visits, better medication adherence and improved overall health. Perceived health system-level benefits included improved quality of care, decongested facilities, reduced provider workloads, and improved record-keeping. Although non-enrolled participants anticipated many of the same benefits, their reasons for non-enrollment included medication storage challenges, concerns over less frequent health monitoring, and increased stress due to the large quantities of medicines dispensed. Enrolled participants and HCWs identified similar challenges, including client misunderstandings about ASM and initial ART stock-outs. CONCLUSIONS ASM with 6-MMD was perceived to have marked benefits for clients and health systems. Clients enrolled in the ASM and their HCWs had positive experiences with the model, including perceived improvements in efficiency, quality and convenience of HIV treatment services. The concerns of non-ASM enrolled participants suggest the need for enhanced client education about the model and more discreet and efficiently packaged ART and highlight that ASM is not ideal for all clients.
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Affiliation(s)
- Joanne E Mantell
- New York State Psychiatric Institute and Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, Gender, Sexuality and Health Area, Columbia University Irving Medical Center, New York, New York, United States of America.
| | - Jennifer M Zech
- ICAP at Columbia University, New York, NY, United States of America
| | - Tsitsi B Masvawure
- Health Studies Program, Center for Interdisciplinary Studies, College of the Holy Cross, Worcester, MA, United States of America
| | | | | | - Laura Block
- ICAP at Columbia University, New York, NY, United States of America
| | | | | | - Miriam Rabkin
- ICAP at Columbia University, New York, NY, United States of America
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, NY, United States of America
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Rael CT, Sandfort TGM, Gichangi P, Lafort Y, Mantell JE. Condom Use Among Male Sex Workers With Their Male Clients in Mombasa, Kenya: Results of a Sub-analysis of a Pilot, Multilevel, Structural, HIV Risk-Reduction Intervention. J Assoc Nurses AIDS Care 2023; 34:248-258. [PMID: 37129476 PMCID: PMC10754228 DOI: 10.1097/jnc.0000000000000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
ABSTRACT Despite the advent of preexposure prophylaxis, consistent condom use continues to be recommended because preexposure prophylaxis does not prevent sexually transmitted infections. This is important for high-risk populations (e.g., male sex workers; MSW) in low-resource, high-HIV/sexually transmitted infection prevalence settings, such as the Mombasa region in Kenya. This study aimed to examine the relationship between MSW's condom use, and their knowledge, beliefs, and attitudes about condoms. MSW (N = 158) completed surveys on their sexual behaviors/practices/attitudes. We used multiple regressions to identify associations between condom use, HIV knowledge/attitudes, and self-efficacy. Three quarters of participants reported always using condoms in the past week, and 64.3% reported always using condoms in the past month with male clients. Mean scores for knowledge and attitudes/self-efficacy toward condoms/safer sex were positively associated with condom use. Interventions to build self-efficacy, such as condom negotiation, and/or bringing up condom use with clients may be useful for Kenyan MSW.
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Affiliation(s)
- Christine Tagliaferri Rael
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Theo G M Sandfort
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Peter Gichangi
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Yves Lafort
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Joanne E Mantell
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
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Kelvin EA, Romo ML, George G, Mantell JE, Mwai E, Kinyanjui S, Nyaga EN, Odhiambo JO, Govender K. Evaluating effect modification by HIV testing history to understand the mechanisms behind the impact of announcing HIV self-testing availability in a clinic system in Kenya. Front Public Health 2023; 10:880070. [PMID: 36684866 PMCID: PMC9853377 DOI: 10.3389/fpubh.2022.880070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 11/24/2022] [Indexed: 01/09/2023] Open
Abstract
Background In sub-Saharan Africa, truckers and female sex workers (FSWs) have high HIV risk and face challenges accessing HIV testing. Adding HIV self-testing (HIVST) to standard of care (SOC) programs increases testing rates. However, the underlying mechanisms are not fully understood. HIVST may decrease barriers (inconvenient clinic hours, confidentiality concerns) and thus we would expect a greater impact among those not accessing SOC testing (barriers prevented previous testing). As a new biomedical technology, HIVST may also be a cue to action (the novelty of a new product motivates people to try it), in which case we might expect the impact to be similar by testing history. Methods We used data from two randomized controlled trials evaluating the announcement of HIVST availability via text-message to male truckers (n = 2,260) and FSWs (n = 2,196) in Kenya. Log binomial regression was used to estimate the risk ratio (RR) for testing ≤ 2 months post-announcement in the intervention vs. SOC overall and by having tested in the previous 12-months (12m-tested); and we assessed interaction between the intervention and 12m-tested. We also estimated risk differences (RD) per 100 and tested additive interaction using linear binomial regression. Results We found no evidence that 12m-tested modified the HIVST impact. Among truckers, those in the intervention were 3.1 times more likely to test than the SOC (p < 0.001). Although testing was slightly higher among those not 12m-tested (RR = 3.5, p = 0.001 vs. RR = 2.7, p = 0.020), the interaction was not significant (p = 0.683). Among FSWs, results were similar (unstratified RR = 2.6, p < 0.001; 12m-tested: RR = 2.7, p < 0.001; not 12m-tested: RR = 2.5, p < 0.001; interaction p = 0.795). We also did not find significant interaction on the additive scale (truckers: unstratified RD = 2.8, p < 0.001; 12m-tested RD = 3.8, p = 0.037; not 12m-tested RD = 2.5, p = 0.003; interaction p = 0.496. FSWs: unstratified RD = 9.7, p < 0.001; 12m-tested RD = 10.7, p < 0.001, not 12m-tested RD = 9.1, p < 0.001; interaction p = 0.615). Conclusion The impact of HIVST was not significantly modified by 12m-tested among truckers and FSWs on the multiplicative or additive scales. Announcing the availability of HIVST likely served primarily as a cue to action and testing clinics might maximize the HIVST benefits by holding periodic HIVST events to maintain the cue to action impact rather than making HIVST continually available.
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Affiliation(s)
- Elizabeth A. Kelvin
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
| | - Matthew L. Romo
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
| | - Gavin George
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
- Division of Social Medicine and Global Health, Lund University, Lund, Sweden
| | - Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, Gender, Sexuality and Health Area, Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Eva Mwai
- North Star Alliance, Nairobi, Kenya
| | | | | | | | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
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Ayton S, Schwitters A, Mantell JE, Nuwagaba-Biribonwoha H, Hakim A, Hoffman S, Biraro S, Philip N, Wiesner L, Gummerson E, Brown K, Nyogea D, Barradas D, Nzima M, Fischer-Walker C, Payne D, Mulenga L, Mgomella G, Kirungi WL, Maile L, Aibo D, Musuka G, Mugurungi O, Low A. Male partner age, viral load, and HIV infection in adolescent girls and young women: evidence from eight sub-Saharan African countries. AIDS 2023; 37:113-123. [PMID: 36129107 PMCID: PMC11000148 DOI: 10.1097/qad.0000000000003388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/13/2022]
Abstract
OBJECTIVE We aimed to elucidate the role of partnerships with older men in the HIV epidemic among adolescent girls and young women (AGYW) aged 15-24 years in sub-Saharan Africa. DESIGN Analysis of Population-based HIV Impact Assessments in Eswatini, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia, and Zimbabwe. METHODS We examined associations between reported partner age and recent HIV infection among AGYW, incorporating male population-level HIV characteristics by age-band. Recent HIV infection was defined using the LAg avidity assay algorithm. Viremia was defined as a viral load of more than 1000 copies/ml, regardless of serostatus. Logistic regression compared recent infection in AGYW with older male partners to those reporting younger partners. Dyadic analysis examined cohabitating male partner age, HIV status, and viremia to assess associations with AGYW infection. RESULTS Among 17 813 AGYW, increasing partner age was associated with higher odds of recent infection, peaking for partners aged 35-44 (adjusted odds ratio = 8.94, 95% confidence interval: 2.63-30.37) compared with partners aged 15-24. Population-level viremia was highest in this male age-band. Dyadic analyses of 5432 partnerships confirmed the association between partner age-band and prevalent HIV infection (male spousal age 35-44-adjusted odds ratio = 3.82, 95% confidence interval: 2.17-6.75). Most new infections were in AGYW with partners aged 25-34, as most AGYW had partners in this age-band. CONCLUSION These results provide evidence that men aged 25-34 drive most AGYW infections, but partners over 9 years older than AGYW in the 35-44 age-band confer greater risk. Population-level infectiousness and male age group should be incorporated into identifying high-risk typologies in AGYW.
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Affiliation(s)
- Sarah Ayton
- ICAP at Columbia University, New York
- Department of Epidemiology, Mailman School of Public Health, New York, New York, USA
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, Mexico
| | - Amee Schwitters
- US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Joanne E. Mantell
- Department of Psychiatry, HIV Center for Clinical and Behavioral, Studies, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York
| | | | - Avi Hakim
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susie Hoffman
- Department of Epidemiology, Mailman School of Public Health, New York, New York, USA
- Department of Psychiatry, HIV Center for Clinical and Behavioral, Studies, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York
| | | | | | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Kristin Brown
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | | | - Danielle Payne
- US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Lloyd Mulenga
- Department of Infectious Diseases, Zambia Ministry of Health and University Teaching Hospital, Lusaka, Zambia
| | - George Mgomella
- US Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | | | - Limpho Maile
- Family Health Division, Ministry of Health, Maseru, Lesotho
| | | | | | - Owen Mugurungi
- AIDS and TB Programme, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Andrea Low
- ICAP at Columbia University, New York
- Department of Epidemiology, Mailman School of Public Health, New York, New York, USA
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Mantell JE, Khalifa A, Christian SN, Romo ML, Mwai E, George G, Strauss M, Govender K, Kelvin EA. Preferences, beliefs, and attitudes about oral fluid and blood-based HIV self-testing among truck drivers in Kenya choosing not to test for HIV. Front Public Health 2022; 10:911932. [PMID: 36438254 PMCID: PMC9682285 DOI: 10.3389/fpubh.2022.911932] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 10/03/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Clinical trials in sub-Saharan Africa support that HIV self-testing (HIVST) can increase testing rates in difficult-to-reach populations. However, trials mostly evaluate oral fluid HIVST only. We describe preferences for oral fluid vs. blood-based HIVST to elucidate prior trial results and inform testing programs. Methods Participants were recruited from a HIVST randomized controlled trial in Nakuru County, Kenya, which aimed to test the effect of choice between oral HIVST and facility-based testing compared to standard-of-care on HIV testing among truck drivers. We conducted in-depth interviews (IDIs) with purposively sampled trial participants who declined HIV testing at baseline or who were offered access to oral fluid HIVST and chose not to pick up the kit during follow-up. IDIs were conducted with all consenting participants. We first describe IDI participants compared to the other study participants, assessing the statistical significance of differences in characteristics between the two samples and then describe preferences, beliefs, and attitudes about HIVST biospecimen type expressed in the IDIs. Results The final sample consisted of 16 men who refused HIV testing at baseline and 8 men who did not test during follow-up. All IDI participants had tested prior to study participation; mean number of years since last HIV test was 1.55, vs. 0.98 among non-IDI participants (p = 0.093). Of the 14 participants who answered the question about preferred type of HIVST, nine preferred blood-based HIVST, and five, oral HIVST. Preference varied by study arm with four of five participants who answered this question in the Choice arm and five of nine in the SOC arm preferring blood-based HIVST. Six key themes characterized truckers' views about test type: (1) Rapidity of return of test results. (2) Pain and fear associated with finger prick. (3) Ease of use. (4) Trust in test results; (5) fear of infection by contamination; and (6) Concerns about HIVST kit storage and disposal. Conclusion We found no general pattern in the themes for preference for oral or blood-based HIVST, but if blood-based HIVST had been offered, some participants in the Choice arm might have chosen to self-test. Offering choices for HIVST could increase testing uptake.
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Affiliation(s)
- Joanne E. Mantell
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States,*Correspondence: Joanne E. Mantell
| | - Aleya Khalifa
- ICAP at Columbia University, New York, NY, United States,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Stephanie N. Christian
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States
| | - Matthew L. Romo
- Department of Epidemiology and Biostatistics and Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Eva Mwai
- The North Star Alliance, Nairobi, Kenya
| | - Gavin George
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa,Division of Social Medicine and Global Health, Lund University, Lund, Sweden
| | - Michael Strauss
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Kaymarlin Govender
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Elizabeth A. Kelvin
- Department of Epidemiology and Biostatistics and Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
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Mantell JE, Masvawure TB, Zech JM, Reidy W, Msukwa M, Glenshaw M, Grund J, Williams D, Pitt B, Rabkin M. "They are our eyes outside there in the community": Implementing enhanced training, management and monitoring of South Africa’s ward-based primary healthcare outreach teams. PLoS One 2022; 17:e0266445. [PMID: 36018854 PMCID: PMC9417004 DOI: 10.1371/journal.pone.0266445] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/22/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
In 2018, South Africa’s National Department of Health provided additional resources for ward-based primary healthcare outreach teams (OT) with support from the U.S. President’s Emergency Plan for AIDS Relief. The intervention package included a new training curriculum, enhanced staffing, revised management and supervisory structures, and more intensive monitoring and evaluation (M&E). The goal was to strengthen OT and their impact on both primary healthcare and HIV-specific services. We conducted a process evaluation of this intervention package during its second year and examined implementation successes and challenges.
Methods
We conducted a mixed-methods evaluation at 20 purposively selected facilities in Bojanala and City of Tshwane districts, including surveys with 222 community health workers (CHWs) and outreach team leaders (OTLs); key informant interviews and online surveys with 28 policy and program stakeholders; 70 in-depth interviews with health facility staff; 20 focus group discussions with 194 CHWs; 20 structured health facility assessments; directly-observed time-motion studies; and review of program documents.
Results
Most participants highlighted the hiring and training of CHWs and OTLs as a key implementation success because this had partially alleviated staffing shortages and helped clarify CHWs’ and OTLs’ responsibilities and supervisory structures. The new monitoring tools were welcomed for their potential to improve data collection and program tracking. However, participants highlighted many program challenges: short-lived gains in CHWs’ knowledge and skills due to lack of ongoing training and mentoring; insufficient integration of OT into health facility management structures; persistent shortages of equipment, supplies, transportation, and workspace for CHWs; and insufficient remuneration for staff.
Conclusion
Strengthening and expanding CHW programs, such as OT, requires intensive support and continuous investments. To sustain improvements in training, supervision, and job satisfaction, CHWs must be equipped with needed resources, provided with ongoing supportive supervision, and strengthened by optimized program management, monitoring and processes.
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Affiliation(s)
- Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, Gender, Sexuality and Health Area, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, United States of America
- * E-mail:
| | - Tsitsi B. Masvawure
- Health Studies Program, Center for Interdisciplinary Studies, College of the Holy Cross, Worcester, Massachusetts, United States of America
| | - Jennifer M. Zech
- ICAP at Columbia University, New York, New York, United States of America
| | - William Reidy
- ICAP at Columbia University, New York, New York, United States of America
| | | | - Mary Glenshaw
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Center for Global Health, Pretoria, South Africa
| | - Jonathan Grund
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Center for Global Health, Pretoria, South Africa
| | - Daniel Williams
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Center for Global Health, Pretoria, South Africa
| | - Blanche Pitt
- Health Studies Program, Center for Interdisciplinary Studies, College of the Holy Cross, Worcester, Massachusetts, United States of America
| | - Miriam Rabkin
- ICAP at Columbia University, New York, New York, United States of America
- Departments of Medicine and Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
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10
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Khalifa A, Findley S, Gummerson E, Mantell JE, Hakim AJ, Philip NM, Ginindza C, Hassani AS, Hong SY, Jalloh MF, Kirungi WL, Maile L, Mgomella GS, Miller LA, Minchella P, Mutenda N, Njau P, Schwitters A, Ward J, Low A. Associations Between Mobility, Food Insecurity, and Transactional Sex Among Women in Cohabitating Partnerships: An Analysis From 6 African Countries 2016-2017. J Acquir Immune Defic Syndr 2022; 90:388-398. [PMID: 35389376 PMCID: PMC9909688 DOI: 10.1097/qai.0000000000002995] [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: 12/14/2021] [Accepted: 03/16/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mobile women are at risk of HIV infection in sub-Saharan Africa, although we lack evidence for HIV risk among women in mobile partnerships, especially in the context of household food insecurity, a growing concern in the region. SETTING Women aged 15-59 years with a cohabitating male partner who participated in population-based HIV impact assessment surveys in Eswatini, Lesotho, Namibia, Tanzania, Uganda, and Zambia. METHODS We evaluated the association between women's and their partner's mobility (being away from home for more than 1 month or staying elsewhere) and transactional sex (selling sex or receiving money or goods in exchange for sex). We examined associations for effect measure modification by food insecurity level in the household in the past month. We used survey-weighted logistic regression, pooled and by country, adjusting for individual, partner, and household-level variables. RESULTS Among women with a cohabitating male partner, 8.0% reported transactional sex, ranging from 2.7% in Lesotho to 13.4% in Uganda. Women's mobility [aOR 1.35 (95% CI: 1.08 to 1.68)], but not their partner's mobility [aOR 0.91 (0.74-1.12)], was associated with transactional sex. Food insecurity was associated with transactional sex independent of mobility [aOR 1.29 (1.10-1.52)]. Among those who were food insecure, mobility was not associated with increased odds of transactional sex. CONCLUSION Food insecurity and women's mobility each increased the odds of transactional sex. Because transactional sex is associated with HIV risk, prevention programs can address the needs of mobile and food-insecure women, including those in cohabitating relationships.
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Affiliation(s)
- Aleya Khalifa
- ICAP at Columbia University, New York USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York USA
| | - Sally Findley
- Population & Family Health Department, Mailman School of Public Health, Columbia University, New York USA
| | | | - Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center
| | - Avi J. Hakim
- Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | - Ahmed Saadani Hassani
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, USA
| | - Steven Y. Hong
- Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | | | | | | | | | | | - Prosper Njau
- National AIDS Control Programme, Dar es Salaam, Tanzania
| | | | - Jennifer Ward
- Centers for Disease Control and Prevention, Kampala, Uganda
| | - Andrea Low
- ICAP at Columbia University, New York USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York USA
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11
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Faro EZ, Mantell JE, Gonzalez-Argoti T, Hoffman S, Edelstein Z, Tsoi B, Bauman LJ. Implementing PrEP Services in Diverse Health Care Settings. J Acquir Immune Defic Syndr 2022; 90:S114-S128. [PMID: 35703763 PMCID: PMC9204802 DOI: 10.1097/qai.0000000000002971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Uptake of pre-exposure prophylaxis (PrEP) in the US has been limited. Evidence for why and how PrEP has been successfully integrated into some clinical settings, but not in others is minimal. To address this gap, we conducted a qualitative study to identify contextual factors that facilitated and challenged the implementation of PrEP services. SETTING In partnership with the NYC Department of Health, we convened a planning committee with expertise with groups highly affected by the HIV epidemic employed in diverse health care settings, to guide the project. Representatives from programs within New York were targeted for participation initially and subsequently expanded nationally to enhance diversity in program type. METHODS Using an interview guide informed by the Consolidated Framework for Implementation Research, we conducted 20 interviews with participants who successfully implemented PrEP programs in different settings (eg, primary care, emergency department, sexual health clinics), using different delivery models. We used template and matrix analysis to identify and characterize contextual determinants and implementation strategies. RESULTS Participants frequently described determinants and strategies fluidly and conceptualized them in context-specific terms. Commonly discussed Consolidated Framework for Implementation Research constructs included implementation climate (tension for change, compatibility, relatively priority), stakeholders' knowledge (or lack thereof) and beliefs about PrEP, and costs associated with PrEP implementation. CONCLUSION Our work identifies patterns in PrEP program implementation, describing how organizations dealt with determinants in their own context. Our research points to the need to connect rigorous implementation research with how frontline implementers conceptualize their work to inform and improve PrEP implementation.
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Affiliation(s)
- Elissa Z Faro
- Department of Internal Medicine, University of Iowa, Iowa City, IA
| | - Joanne E Mantell
- Department of Psychiatry, Columbia University Irving Medical Center and the New York State Psychiatric Institute, New York, NY
| | - Tatiana Gonzalez-Argoti
- Departments of Pediatrics and Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Bronx, NY
| | - Susie Hoffman
- Department of Psychiatry, Columbia University Irving Medical Center and the New York State Psychiatric Institute, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; and
| | - Zoe Edelstein
- New York City Department of Health and Mental Hygiene, Queens, NY
| | - Benjamin Tsoi
- New York City Department of Health and Mental Hygiene, Queens, NY
| | - Laurie J Bauman
- Departments of Pediatrics and Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Bronx, NY
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12
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Hirsch-Moverman Y, Howard AA, Yuengling KA, Lebelo L, Frederix K, Hesseling AC, Nachman S, Maama LB, El-Sadr WM, Mantell JE. Effectiveness of a community-based intervention to prevent childhood TB in Lesotho. Int J Tuberc Lung Dis 2022; 26:612-622. [PMID: 35768915 DOI: 10.5588/ijtld.21.0558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Child contact management (CCM) is a recognized strategy to prevent TB; however, implementation is suboptimal. PREVENT was a cluster-randomized trial that evaluated the effectiveness and acceptability of a community-based intervention (CBI) to improve CCM in Lesotho.METHODS: Ten health facilities (HFs) were randomized to CBI or standard-of-care (SOC). CBI included nurse training/mentorship, health education by village health workers (VHW), adherence support, and multidisciplinary team meetings. Information on TB cases registered from February 2016 to June 2018 and their child contacts was abstracted. Outcomes were TB preventive treatment (TPT) initiation, TPT completion, and CBI acceptability. Generalized linear mixed models were used to test for differences between study arms and qualitative interview thematic analysis for acceptability.RESULTS: Among 547 registered children (CBI: n = 399; SOC: n = 148) of 426 adult TB patients, 46% were <2 years, 48% female, and 3% HIV-exposed/positive, with no significant differences between study arms. A total of 501 children initiated TPT-98% at CBI and 88% at SOC HFs (P < 0.0001). TPT completion was 82% in CBI vs. 59% in SOC sites (P = 0.048). Caregivers and providers reported that CBI was acceptable.CONCLUSION: The CBI was acceptable and significantly improved TPT initiation and completion in Lesotho, offering the opportunity to mitigate the threat of TB among children.
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Affiliation(s)
- Y Hirsch-Moverman
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - A A Howard
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - K A Yuengling
- ICAP at Columbia University, Mailman School of Public Health, New York, NY
| | - L Lebelo
- ICAP at Columbia University, Maseru, Lesotho
| | - K Frederix
- ICAP at Columbia University, Maseru, Lesotho
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - S Nachman
- Pediatric Infectious Diseases, State University of New York Stony Brook, Stony Brook, NY, USA
| | - L B Maama
- Lesotho Ministry of Health National Tuberculosis Programme, Maseru, Lesotho
| | - W M El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - J E Mantell
- HIV Center for Clinical & Behavioral Studies, Gender, Sexuality and Health Area, at the New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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13
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Low A, Wright C, Platt J, Chang C, Mantell JE, Romero E, Hoos D, Mannheimer S, Greenleaf A, Castor D, El-Sadr WM. COVID-19 vaccine uptake and factors associated with being unvaccinated among lesbian, gay, bisexual, transgender, queer, and other sexual identities (LGBTQ+) New Yorkers. Open Forum Infect Dis 2022; 9:ofac260. [PMID: 35855958 PMCID: PMC9129197 DOI: 10.1093/ofid/ofac260] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 03/30/2022] [Accepted: 05/18/2022] [Indexed: 11/18/2022] Open
Abstract
Routine data on vaccine uptake are not disaggregated by lesbian, gay, bisexual, transgender, queer, and other sexual identities (LGBTQ+) populations, despite higher risk of infection and severe disease. We found comparable vaccination uptake patterns among 1032 LGBTQ+ New Yorkers and the general population. We identified critical socioeconomic factors that were associated with vaccine hesitancy in this economically vulnerable population.
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Affiliation(s)
- Andrea Low
- ICAP at Columbia, Mailman School of Public Health, New York, NY USA
- Department of Epidemiology, Mailman School of Public Health, New York, NY USA
| | - Connor Wright
- ICAP at Columbia, Mailman School of Public Health, New York, NY USA
| | - Joey Platt
- ICAP at Columbia, Mailman School of Public Health, New York, NY USA
| | - Christiana Chang
- ICAP at Columbia, Mailman School of Public Health, New York, NY USA
| | - Joanne E. Mantell
- Department of Epidemiology, Mailman School of Public Health, New York, NY USA
- HIV Center for Clinical and Behavioral Studies, Gender, Sexuality and Health Area, New York State Psychiatric Institute and Columbia University Department of Psychiatry, New York, NY USA
| | - Emily Romero
- ICAP at Columbia, Mailman School of Public Health, New York, NY USA
| | - David Hoos
- ICAP at Columbia, Mailman School of Public Health, New York, NY USA
| | - Sharon Mannheimer
- ICAP at Columbia, Mailman School of Public Health, New York, NY USA
- Division of Infectious Diseases, Department of Medicine, Harlem Hospital Center, New York, NY USA
| | - Abigail Greenleaf
- ICAP at Columbia, Mailman School of Public Health, New York, NY USA
- Department of Population and Family Health, Mailman School of Public Health, New York, NY USA
| | - Delivette Castor
- Department of Epidemiology, Mailman School of Public Health, New York, NY USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY USA
| | - Wafaa M. El-Sadr
- ICAP at Columbia, Mailman School of Public Health, New York, NY USA
- Department of Epidemiology, Mailman School of Public Health, New York, NY USA
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14
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Restar AJ, Valente PK, Ogunbajon A, Masvawure TB, Sandfort T, Gichangi P, Lafort Y, Mantell JE. Solidarity, support and competition among communities of female and male sex workers in Mombasa, Kenya. Cult Health Sex 2022; 24:627-641. [PMID: 33666535 PMCID: PMC8556737 DOI: 10.1080/13691058.2021.1876248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Female and male sex workers are at elevated risk for HIV infection, psychological distress and other adverse health outcomes. It is therefore important to understand how sex workers' social relationships with one another might inform psychosocial support services for this population. We conducted semi-structured interviews to examine the formation and nature of social networks of 25 female and 25 male sex workers recruited from bars and clubs in Mombasa, Kenya. Relationships between and among female and male participants were often formed based on a mutual understanding of the challenging nature of sex work. Both groups described their relationships in terms of friendship and brotherhood/sisterhood and highlighted the following benefits of sex worker social networks: economic benefits, access to information about HIV/STIs and protection, and support against violence from clients and law enforcement agents. Social networks were often threatened by competition for clients and hence could result in conflict. However, sex workers explained that their sense of solidarity and reliance on one another for health, protection and economic well-being helped minimise conflict. The social networks of sex workers could therefore be used to leverage or optimise access to HIV prevention and care.
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Affiliation(s)
- Arjee J. Restar
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
- Corresponding Author: Arjee Restar
| | - Pablo K. Valente
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA
| | - Adedotun Ogunbajon
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Tsitsi Beatrice Masvawure
- Health Studies Program, Center for Interdisciplinary Studies, College of the Holy Cross, Worcester, MA, USA
| | - Theo Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA
| | - Peter Gichangi
- Technical University of Mombasa, Mombasa, Kenya
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
- Department of Anatomy, University of Nairobi, Nairobi, Kenya
| | - Yves Lafort
- KEMRI, Wellcome Trust Research Programme, Kilifi, Kenya
| | - Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA
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15
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Murphy EC, Danvers A, Zamudio AR, Avila K, Proehl M, Gonzalez-Argoti T, Mantell JE, Bauman LJ, Dolan SM. "Being able to do whatever you wanna do as a woman is important:" a qualitative exploration of contraception as a frame of reference for HIV prevention with PrEP. Reprod Health 2022; 19:92. [PMID: 35392943 PMCID: PMC8991476 DOI: 10.1186/s12978-022-01393-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Use of HIV PrEP (pre-exposure prophylaxis) is a strategic tool in the effort to end the HIV epidemic. 20% of new HIV infections in the US are among cis-gender women, yet they comprise only 5% of all PrEP users. Black women disproportionately bear the burden of new HIV acquisition and accounted for almost 60% of new HIV diagnoses among women in 2018. Increasing understanding and uptake of PrEP among women at risk of HIV acquisition in alignment with their reproductive values and preferences is key to increasing PrEP uptake and decreasing HIV burden in this population. Objective This study examines how experiences with contraception among women of color shape their perceptions and preferences regarding HIV PrEP to inform counseling that aligns with their reproductive values. Methods Women aged 18–45 who self-identified as Black or Latina were recruited at an academic medical center in the Bronx from June 2018 to July 2019. We enrolled 30 participants seeking family planning care (10), prenatal care (10), or care for sexually transmitted infections (10). Participants completed a brief written survey assessing their risk of HIV acquisition. Semi-structured, face-to-face interviews were then audio-recorded, transcribed, and entered into Dedoose. Grounded theory and constant comparison approaches were used to analyze the data. Results Twenty-one participants (70%) screened positive for HIV acquisition risk. Four had received information on PrEP from a medical provider prior to the interview. Three themes emerged from the qualitative analysis: (1) Similar to oral contraception, women conceptualized PrEP as a “daily pill” to support their reproductive health; (2) Women perceived PrEP as a tool to support autonomy and pleasure in their sexual health; (3) Like birth control, women desired multiple delivery options for HIV prophylaxis. Conclusions Contraception may serve as a frame of reference when counseling about PrEP among cis-women at risk of acquiring HIV. Our study suggests that this approach re-contextualizes counseling on PrEP within a sex-positive framework that prioritizes pleasure, safety, and autonomy as integral to sexual and reproductive wellness. Consideration of historically marginalized women’s experiences with contraception and reproductive values may facilitate their use of PrEP. PrEP (pre-exposure prophylaxis) is a medicine taken daily by people at risk of getting HIV from sex or injection drug use. Although PrEP is a safe and effective medication for women, the use of PrEP remains exceedingly low among cis-gender women at risk of HIV in the US. This study examines how experiences with contraception among women of color, who disproportionately bear the burden of HIV acquisition, shape their perceptions and preferences regarding PrEP. We interviewed 30 women who self-identified as Black or Latina at an academic medical center in the Bronx. Similar to oral contraception, women in this study conceptualized PrEP as a “daily pill” to support their reproductive health. This report details how women’s experiences with contraception may serve as the foundation to re-contextualize conversations on PrEP within a sex-positive framework that prioritizes pleasure, safety, and autonomy as integral to sexual and reproductive wellness.
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Affiliation(s)
- Emma Chew Murphy
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Antoinette Danvers
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrés Ramírez Zamudio
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai and Mount Sinai Health System, New York, NY, USA
| | - Karina Avila
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Meghan Proehl
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai and Mount Sinai Health System, New York, NY, USA
| | - Tatiana Gonzalez-Argoti
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, Gender, Sexuality and Health Area, Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Laurie J Bauman
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Siobhan M Dolan
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai and Mount Sinai Health System, New York, NY, USA. .,Icahn School of Medicine at Mount Sinai and Mount Sinai Health System, 1176 Fifth Avenue, 9th Floor, Box 1170, New York, NY, 10029, USA.
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16
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Miller SS, Mantell JE, Parmley LE, Musuka G, Chingombe I, Mapingure M, Rogers JH, Wu Y, Hakim AJ, Mugurungi O, Samba C, Harris TG. Stigma, Social Cohesion, and HIV Risk Among Sexual and Gender Minorities in Two Cities in Zimbabwe. AIDS Behav 2022; 26:2994-3007. [PMID: 35304904 PMCID: PMC9372004 DOI: 10.1007/s10461-022-03622-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/24/2022]
Abstract
Though stigma is a recognized contributor to the disproportionate HIV burden among sexual and gender minorities (SGM) in sub-Saharan Africa, data describing this association among Zimbabwean SGM are limited. We examined relationships between SGM stigma and HIV and the potential for social cohesion to moderate the association among Zimbabwean men who have sex with men, transgender women, and genderqueer individuals. Consenting participants (n = 1511) recruited through respondent-driven sampling for a biobehavioral survey in Harare and Bulawayo completed structured interviews and received HIV testing. Reported SGM stigma was common (68.9% in Harare and 65.3% in Bulawayo) and associated with HIV infection in Harare (adjusted prevalence ratio [aPR] = 1.82, 95% confidence interval [CI] = 1.27–2.62) and Bulawayo (aPR = 1.51, 95% CI = 1.15–2.00) in relative risk regression. Social cohesion did not moderate these relationships. Findings demonstrate stigma’s association with HIV vulnerability among Zimbabwean SGM, highlighting the need for stigma-mitigation to reduce HIV transmission in this population.
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Affiliation(s)
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA
| | | | | | | | | | - John H Rogers
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Yingfeng Wu
- ICAP at Columbia University, New York, NY, USA
| | - Avi J Hakim
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Owen Mugurungi
- AIDS and TB Programme, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Tiffany G Harris
- ICAP at Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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17
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Danvers AA, Chew Murphy E, Avila K, Gonzalez-Argoti T, Edwards AR, Hoffman S, Mantell JE, Bauman LJ, Dolan SM. Women Trust Their OBGYNs to Provide Preexposure Prophylaxis: An Opportunity for HIV Prevention. Front Reprod Health 2022; 4:832287. [PMID: 36303639 PMCID: PMC9580770 DOI: 10.3389/frph.2022.832287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/15/2022] [Indexed: 12/05/2022] Open
Abstract
Objective The objective of this study was to understand how women perceive the role of their Obstetrician and Gynecologist (OBGYN) in screening for and providing preexposure prophylaxis (PrEP) for HIV prevention. Methods We recruited women ages 18–45 years receiving obstetric or gynecological care at an academic medical center in the Bronx, NY. Thirty participants were enrolled: 10 seeking care for family planning, 10 seeking prenatal care, and 10 seeking care for a sexually transmitted infection. We screened participants for HIV acquisition risk using a PrEP screening tool. We conducted face-to-face, semi-structured interviews, which were audio-recorded, transcribed, and entered into Dedoose for analysis of themes using a grounded theory approach. Results Sixty percent of the participants were Latinx and 33% African American. Seventy percent had one or more risk factors for HIV acquisition based on the PrEP screening tool, indicating they would benefit from a PrEP discussion. Three main themes emerged from the analysis of interview data. Participants viewed OBGYNs as experts in sexual and reproductive healthcare and believed they were experts in PrEP. Participants were concerned about “PrEP stigma”, being judged by their clinicians as being sexually promiscuous if they expressed a need for PrEP. Lastly, when participants trusted their OBGYN, that trust became a facilitator for women to consider PrEP and offset stigma as a barrier to identifying patients who are candidates for PrEP. Conclusion Women established in care with an OBGYN are enthusiastic about having access to PrEP services incorporated into their sexual and reproductive healthcare. A universal approach to HIV prevention would avert stigma surrounding HIV care and prevention.
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Affiliation(s)
- Antoinette A. Danvers
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
- *Correspondence: Antoinette A. Danvers
| | - Emma Chew Murphy
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Karina Avila
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Tatiana Gonzalez-Argoti
- Departments of Pediatrics and Psychiatry and Behavioral Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Angelic Rivera Edwards
- Montefiore School Health Program, Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Susie Hoffman
- Department of Epidemiology, Joseph L. Mailman School of Public Health at Columbia University, New York, NY, United States
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Joanne E. Mantell
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Laurie J. Bauman
- Departments of Pediatrics and Psychiatry and Behavioral Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Siobhan M. Dolan
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai and Mount Sinai Health System, New York, NY, United States
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18
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Valente PK, Edeza A, Masvawure TB, Sandfort TGM, Gichangi PB, Restar AJ, Tocco JU, Chabeda SV, Lafort Y, Mantell JE. Violence and Victimization in Interactions Between Male Sex Workers and Male Clients in Mombasa, Kenya. J Interpers Violence 2022; 37:NP1784-NP1810. [PMID: 32552195 PMCID: PMC7612270 DOI: 10.1177/0886260520922361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Male sex workers (MSWs) and male clients (MCMs) who engage their services face increased vulnerability to violence in Kenya, where same-sex practices and sex work are criminalized. However, little is known about how violence might arise in negotiations between MSWs and MCMs. This study explored the types of victimization experienced by MSWs and MCMs, the contexts in which these experiences occurred, and the responses to violence among these groups. We conducted in-depth interviews with 25 MSWs and 11 MCMs recruited at bars and clubs identified by peer sex worker educators as "hotspots" for sex work in Mombasa, Kenya. Violence against MSWs frequently included physical or sexual assault and theft, whereas MCMs' experiences of victimization usually involved theft, extortion, or other forms of economic violence. Explicitly negotiating the price for the sexual exchange before having sex helped avoid conflict and violence. For many participants, guesthouses that were tolerant of same-sex encounters were perceived as safer places for engaging in sex work. MSWs and MCMs rarely reported incidents of violence to the police due to fear of discrimination and arrests by law enforcement agents. Some MSWs fought back against violence enacted by clients or tapped into peer networks to obtain information about potentially violent clients as a strategy for averting conflicts and violence. Our study contributes to the limited literature examining the perspectives of MSWs and MCMs with respect to violence and victimization, showing that both groups are vulnerable to violence and in need of interventions to mitigate violence and protect their health. Future interventions should consider including existing peer networks of MSWs in efforts to prevent violence in the context of sex work. Moreover, decriminalizing same-sex practices and sex work in Kenya may inhibit violence against MSWs and MCMs and provide individuals with safer spaces for engaging in sex work.
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Affiliation(s)
- Pablo K. Valente
- Brown University, Providence, RI, USA
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA
| | | | | | - Theo G. M. Sandfort
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA
| | - Peter B. Gichangi
- Technical University of Mombasa, Mombasa, Kenya
- Ghent University, Ghent, Belgium
- University of Nairobi, Nairobi, Kenya
| | - Arjee J. Restar
- Brown University, Providence, RI, USA
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA
| | - Jack Ume Tocco
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA
| | | | | | - Joanne E. Mantell
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA
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19
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Gailloud L, Gonzalez-Argoti T, Philip S, Josephs LS, Mantell JE, Bauman LJ. 'How come they don't talk about it in school?' Identifying adolescent barriers to PrEP use. Health Educ Res 2022; 36:505-517. [PMID: 34467401 PMCID: PMC8793170 DOI: 10.1093/her/cyab030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/11/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
Although 21% of new human immunodeficiency virus (HIV) diagnoses in the United States are in youth aged 13-24 years, adolescent awareness and uptake of the HIV prevention medication pre-exposure prophylaxis (PrEP) are low. This study explores the attitudes and challenges that adolescents face while taking PrEP. Thirty interviews were conducted with Black and Latine (we use the gender-inclusive term Latine rather than Latinx for more appropriate Spanish pronunciation) students aged 15-17 who received care at school-based health centers (SBHCs) in the Bronx, NY. Transcripts were coded inductively and deductively using thematic analysis. Most participants were unaware of PrEP, but nearly all were enthusiastic when informed about it; a majority denied that they would feel any stigma when taking PrEP. Despite this high receptivity, multiple barriers were identified, particularly confidentiality from parents, low perceived need of PrEP and concerns about daily adherence and side effects. Adolescents overall were enthusiastic about the availability of PrEP and felt it empowered them to have control over their health. SBHCs were considered trusted sources of confidential, accessible care, and we believe that they can be uniquely positioned to mitigate barriers to PrEP distribution in the future.
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20
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Hirsch-Moverman Y, Strauss M, George G, Mutiti A, Mafukidze A, Shongwe S, Dube GS, El Sadr WM, Mantell JE, Howard AA. Paediatric tuberculosis preventive treatment preferences among HIV-positive children, caregivers and healthcare providers in Eswatini: a discrete choice experiment. BMJ Open 2021; 11:e048443. [PMID: 34686549 PMCID: PMC8543650 DOI: 10.1136/bmjopen-2020-048443] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 09/02/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Isoniazid preventive therapy initiation and completion rates are suboptimal among children. Shorter tuberculosis (TB) preventive treatment (TPT) regimens have demonstrated safety and efficacy in children and may improve adherence but are not widely used in high TB burden countries. Understanding preferences regarding TPT regimens' characteristics and service delivery models is key to designing services to improve TPT initiation and completion rates. We examined paediatric TPT preferences in Eswatini, a high TB burden country. DESIGN We conducted a sequential mixed-methods study utilising qualitative methods to inform the design of a discrete choice experiment (DCE) among HIV-positive children, caregivers and healthcare providers (HCP). Drug regimen and service delivery characteristics included pill size and formulation, dosing frequency, medication taste, treatment duration and visit frequency, visit cost, clinic wait time, and clinic operating hours. An unlabelled, binary choice design was used; data were analysed using fixed and mixed effects logistic regression models, with stratified models for children, caregivers and HCP. SETTING The study was conducted in 20 healthcare facilities providing TB/HIV care in Manzini, Eswatini, from November 2018 to December 2019. PARTICIPANTS Ninety-one stakeholders completed in-depth interviews to inform the DCE design; 150 children 10-14 years, 150 caregivers and 150 HCP completed the DCE. RESULTS Despite some heterogeneity, the results were fairly consistent among participants, with palatability of medications viewed as the most important TPT attribute; fewer and smaller pills were also preferred. Additionally, shorter waiting times and cost of visit were found to be significant drivers of choices. CONCLUSION Palatable medication, smaller/fewer pills, low visit costs and shorter clinic wait times are important factors when designing TPT services for children and should be considered as new paediatric TPT regimens in Eswatini are rolled out. More research is needed to determine the extent to which preferences drive TPT initiation, adherence and completion rates.
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Affiliation(s)
- Yael Hirsch-Moverman
- ICAP at Columbia University, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Michael Strauss
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Anthony Mutiti
- ICAP at Columbia University, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Arnold Mafukidze
- ICAP at Columbia University, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Siphesihle Shongwe
- ICAP at Columbia University, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Gloria Sisi Dube
- Eswatini National TB Control Programme, Eswatini Ministry of Health, Mbabane, Hhohho, Swaziland
| | - Wafaa M El Sadr
- ICAP at Columbia University, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Joanne E Mantell
- Department of Psychiatry, Gender, Sexuality and Health Area, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Andrea A Howard
- ICAP at Columbia University, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
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21
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Kelvin EA, George G, Romo ML, Mantell JE, Mwai E, Nyaga EN, Odhiambo JO, Govender K. The Impact on HIV Testing Over 6 Months When Free Oral HIV Self-Test Kits Were Available to Truck Drivers in Kenya: A Randomized Controlled Trial. Front Public Health 2021; 9:635907. [PMID: 34660501 PMCID: PMC8514766 DOI: 10.3389/fpubh.2021.635907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Studies suggest that offering HIV self-testing (HIVST) increases short-term HIV testing rates, but few have looked at long-term outcomes. Methods: We conducted a randomized controlled trial (RIDIE 55847d64a454f) on the impact of offering free oral HIVST to 305 truck drivers recruited from two clinics in Kenya. We previously reported that those offered HIVST were more likely to accept testing. Here we report on the 6-month follow-up during which intervention participants could pick-up HIVST kits from eight clinics. Results: There was no difference in HIV testing during 6-month follow-up between participants in the intervention and the standard of care (SOC) arms (OR = 1.0, p = 0.877). The most common reasons given for not testing were lack of time (69.6%), low risk (27.2%), fear of knowing HIV status (20.8%), and had tested recently (8.0%). The null association was not modified by having tested at baseline (interaction p = 0.613), baseline risk behaviors (number of partners in past 6 months, interaction p = 0.881, had transactional sex in past 6 months, interaction p = 0.599), nor having spent at least half of the past 30 nights away from home for work (interaction p = 0.304). Most participants indicated a preference for the characteristics associated with the SOC [preference for blood-based tests (69.4%), provider-administered testing (74.6%) testing in a clinic (70.1%)]. However, those in the intervention arm were more likely to prefer an oral swab test than those in the SOC (36.6 vs. 24.6%, p = 0.029). Conclusions: Offering HIVST kits to truck drivers through a clinic network had little impact on testing rates over the 6-month follow-up when participants had to return to the clinic to access HIVST. Clinic-based distribution of HIVST kits may not address some major barriers to testing, such as lack of time to go to a clinic, fear of knowing one's status and low risk perception. Preferred HIV testing attributes were consistent with the SOC for most participants, but oral swab preference was higher among those in the intervention arm, who had seen the oral HIVST and had the opportunity to try it. This suggests that preferences may change with exposure to different testing modalities.
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Affiliation(s)
- Elizabeth A. Kelvin
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
| | - Gavin George
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Matthew L. Romo
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
| | - Joanne E. Mantell
- Gender, Sexuality and Health Area, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, Columbia University Irving Medical Center, New York, NY, United States
| | - Eva Mwai
- North Star Alliance, Nairobi, Kenya
| | | | | | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
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22
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Harris TG, Flören S, Mantell JE, Nkambule R, Lukhele NG, Malinga BP, Chekenyere R, Kidane A. HIV and aging among adults aged 50 years and older on antiretroviral therapy in Eswatini. Afr J AIDS Res 2021; 20:107-115. [PMID: 33685372 DOI: 10.2989/16085906.2021.1887301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Antiretroviral therapy (ART) has decreased HIV-related morbidity and mortality and increased life expectancy of people living with HIV (PLHIV). Globally, the number of older PLHIV (OPLHIV; ≥50 years) is growing and predicted to increase substantially in coming years. In sub-Saharan Africa, where the majority of OPLHIV reside, there are limited data on the health and well-being of OPLHIV.Methods: We conducted an exploratory descriptive study that included structured interviews with 50 OPLHIV receiving ART at an outpatient HIV clinic in Eswatini and in-depth qualitative interviews (IDIs) with a sub-set of ten participants to elicit their experiences of living with HIV as an older adult, including quality of life, physical health, and mental health. Quantitative analyses were performed to obtain both descriptive statistics and cross-tabulations. A thematic analysis of IDI narratives was conducted based on three levels of the socio-ecological model to identify sub-themes and response patterns.Results: All study participants were virally suppressed. Self-reported non-communicable disease (NCD) risk factors and markers were common, with 40% (n = 20) reporting being current or former smokers, 0% consuming the recommended servings of fruits and vegetables per day, and 57% (n = 28 of 49 reporting screening) reporting having hypertension. However, the majority (88%; 44 of 50) had sufficient physical activity; most of the activity was in the work domain. Slightly more than one-third (38%; 13 of 34 tested) had a high random blood sugar level. Barriers to living with HIV were primarily structural (food insecurity, unemployment, access to transportation and health care).Conclusions: OPLHIV should be screened for NCDs, and services for NCDs should ideally be integrated with HIV services. While all participants had controlled HIV, this study highlights the need for strategies that facilitate OPLHIV's HIV service utilisation. With the increasing numbers of OPLHIV, these issues cannot be ignored.
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Affiliation(s)
| | | | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, USA
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23
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Hirsch-Moverman Y, Howard AA, Mantell JE, Lebelo L, Frederix K, Wills A, Hesseling AC, Nachman S, Maama LB, El-Sadr WM. Improving child tuberculosis contact identification and screening in Lesotho: Results from a mixed-methods cluster-randomized implementation science study. PLoS One 2021; 16:e0248516. [PMID: 34014956 PMCID: PMC8136650 DOI: 10.1371/journal.pone.0248516] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 03/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background Child tuberculosis (TB) contact management is recommended for preventing TB in children but its implementation is suboptimal in high TB/HIV-burden settings. The PREVENT Study was a mixed-methods, clustered-randomized implementation study that evaluated the effectiveness and acceptability of a community-based intervention (CBI) to improve child TB contact management in Lesotho, a high TB burden country. Methods Ten health facilities were randomized to CBI or standard of care (SOC). CBI holistically addressed the complex provider-, patient-, and caregiver-related barriers to prevention of childhood TB. Routine TB program data were abstracted from TB registers and cards for all adult TB patients aged >18 years registered during the study period, and their child contacts. Primary outcome was yield (number) of child contacts identified and screened per adult TB patient. Generalized linear mixed models tested for differences between study arms. CBI acceptability was assessed via semi-structured in-depth interviews with a purposively selected sample of 20 healthcare providers and 28 caregivers. Qualitative data were used to explain and confirm quantitative results. We used thematic analysis to analyze the data. Results From 01/2017-06/2018, 973 adult TB patients were recorded, 490 at CBI and 483 at SOC health facilities; 64% male, 68% HIV-positive. At CBI and SOC health facilities, 216 and 164 child contacts were identified, respectively (p = 0.16). Screening proportions (94% vs. 62%, p = 0.13) were similar; contact yield per TB case (0.40 vs. 0.20, p = 0.08) was higher at CBI than SOC health facilities, respectively. CBI was acceptable to caregivers and healthcare providers. Conclusion Identification and screening for TB child contacts were similar across study arms but yield was marginally higher at CBI compared with SOC health facilities. CBI scale-up may enhance the ability to reach and engage child TB contacts, contributing to efforts to improve TB prevention among children.
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Affiliation(s)
- Yael Hirsch-Moverman
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- * E-mail:
| | - Andrea A. Howard
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Joanne E. Mantell
- Division of Gender, Sexuality and Health, at the New York State Psychiatric Institute and Department of Psychiatry, HIV Center for Clinical & Behavioral Studies, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Limakatso Lebelo
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Koen Frederix
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Aprielle Wills
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Anneke C. Hesseling
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Sharon Nachman
- Pediatric Infectious Diseases, SUNY Stony Brook, Stony Brook, New York, United States of America
| | - Llang B. Maama
- Lesotho Ministry of Health National Tuberculosis Program, Maseru, Lesotho
| | - Wafaa M. El-Sadr
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
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24
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Mantell JE, Franks J, Lahuerta M, Omollo D, Zerbe A, Hawken M, Wu Y, Odera D, El-Sadr WM, Agot K. Life in the Balance: Young Female Sex Workers in Kenya Weigh the Risks of COVID-19 and HIV. AIDS Behav 2021; 25:1323-1330. [PMID: 33389320 PMCID: PMC7778484 DOI: 10.1007/s10461-020-03140-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic has had serious health, economic and psychosocial consequences. Marginalized populations including female sex workers face the stark choice of risking exposure to SARS-CoV-2 as they engage with clients or prioritizing their health at the cost of losing a primary source of income. As part of an ongoing open-label, randomized controlled trial providing daily oral pre-exposure prophylaxis and adherence support, we interviewed 193 of 200 enrolled young female sex workers (18–24 years) in Kisumu, Kenya, about COVID-19 awareness and precautions, access to health services, and sex work during Kenya’s pandemic-related lockdown. Nearly all participants were aware of COVID-19 and reported taking protective measures, but only half reported concerns about acquiring SARS-CoV-2. Night curfews and bar closures adversely affected participants’ sex work business, reducing the number of clients and payment amounts from clients. Nearly 15% experienced violence from a client or regular, non-paying sex partner during the lockdown period. Participants’ access to healthcare services was not disrupted.
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Affiliation(s)
- Joanne E. Mantell
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, NY USA
| | - Julie Franks
- Mailman School of Public Health, ICAP at Columbia University, New York, NY USA
| | - Maria Lahuerta
- Mailman School of Public Health, ICAP at Columbia University, New York, NY USA
| | - Dan Omollo
- IMPACT Research and Development Organization, Kisumu, Kenya
| | - Allison Zerbe
- Mailman School of Public Health, ICAP at Columbia University, New York, NY USA
| | - Mark Hawken
- Mailman School of Public Health, ICAP at Columbia University, New York, NY USA
| | - Yingfeng Wu
- Mailman School of Public Health, ICAP at Columbia University, New York, NY USA
| | - Doris Odera
- Mailman School of Public Health, ICAP at Columbia University, New York, NY USA
| | - Wafaa M. El-Sadr
- Mailman School of Public Health, ICAP at Columbia University, New York, NY USA
| | - Kawango Agot
- IMPACT Research and Development Organization, Kisumu, Kenya
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Mantell JE, Exner TM, Bai D, Leu CS, Beksinska M, Mabude Z, Hoffman S, Smit JA. Perceived male partner attitudes toward the female condom predict female university students' use of the female condom. Int J STD AIDS 2021; 31:753-762. [PMID: 32631211 DOI: 10.1177/0956462420912986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Female and male condoms are the only methods that prevent both sexually transmitted infections (STIs), including HIV, and unintended pregnancy. Despite continuing high STI rates, few studies investigate factors predicting whether women initiating female condom (FC) use sustain use. Using data from a randomized trial, we examined predictors of sustained FC use at five-month follow-up (FU2) among female university students in South Africa who participated in either a one-session, information-only, group-delivered Minimal Intervention or a two-session, group-delivered Enhanced Intervention. In the final multiple logistic regression model, believing one's partner holds positive attitudes toward the FC (aOR = 1.40; p = 0.028), and greater FC use for vaginal sex at previous assessment (aOR) = 1.19; p = 0.008) were associated with greater odds of FC use at FU2. Excluding number of FC-protected occasions at FU1 from the analysis, discussing FC use with partner (aOR = 2.89; p = 0.071) and believing one's partner holds positive attitudes toward the FC (aOR = 1.63; p < 0.001) were associated with greater odds of use at FU2. The FC empowers women to protect themselves from both STIs and unintended pregnancy, but targeted interventions are needed to address men's negative attitudes toward the device. Engaging men as FC champions to support and promote FC use, along with marketing campaigns targeted to men, may expand FC coverage and enhance uptake.
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Affiliation(s)
- Joanne E Mantell
- Department of Psychiatry, Division of Gender, Sexuality and HIV, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA
| | - Theresa M Exner
- Department of Psychiatry, Division of Gender, Sexuality and HIV, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA
| | - Dan Bai
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Cheng-Shiun Leu
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mags Beksinska
- MRU (MatCH Research Unit), Department of Obstetrics & Gynaecology, The University of the Witwatersrand, Durban, South Africa
| | - Zonke Mabude
- MRU (MatCH Research Unit), Department of Obstetrics & Gynaecology, The University of the Witwatersrand, Durban, South Africa
| | - Susie Hoffman
- Department of Psychiatry, Division of Gender, Sexuality and HIV, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jennifer A Smit
- MRU (MatCH Research Unit), Department of Obstetrics & Gynaecology, The University of the Witwatersrand, Durban, South Africa
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Sy KTL, Tariq S, Ramjee G, Blanchard K, Leu CS, Kelvin EA, Exner TM, Gandhi AD, Lince-Deroche N, Mantell JE, O’Sullivan LF, Hoffman S. Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study. PLoS One 2021; 16:e0246744. [PMID: 33606712 PMCID: PMC7895397 DOI: 10.1371/journal.pone.0246744] [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: 06/13/2020] [Accepted: 01/25/2021] [Indexed: 01/08/2023] Open
Abstract
Despite expanded antiretroviral therapy (ART) eligibility in South Africa, many people diagnosed with HIV do not initiate ART promptly, yet understanding of the reasons is limited. Using data from an 8-month prospective cohort interview study of women and men newly-diagnosed with HIV in three public-sector primary care clinics in the eThekwini (Durban) region, South Africa, 2010-2014, we examined if theoretically-relevant social-structural, social-cognitive, psychosocial, and health status indicators were associated with time to ART initiation. Of 459 diagnosed, 350 returned to the clinic for their CD4+ test results (linkage); 153 (33.3%) were ART-eligible according to treatment criteria at the time; 115 (75.2% of those eligible) initiated ART (median = 12.86 weeks [95% CI: 9.75, 15.97] after linkage). In adjusted Cox proportional hazard models, internalized stigma was associated with a 65% decrease in the rate of ART initiation (Adjusted hazard ratio [AHR] 0.35, 95% CI: 0.19-0.80) during the period less than four weeks after linkage to care, but not four or more weeks after linkage to care, suggesting that stigma-reduction interventions implemented shortly after diagnosis may accelerate ART uptake. As reported by others, older age was associated with more rapid ART initiation (AHR for 1-year age increase: 1.04, 95% CI: 1.01-1.07) and higher CD4+ cell count (≥300μL vs. <150μL) was associated with a lower rate of initiation (AHR 0.38, 95% CI: 0.19-0.80). Several other factors that were assessed prior to diagnosis, including stronger belief in traditional medicine, higher endorsement of stigma toward people living with HIV, food insecurity, and higher psychological distress, were found to be in the expected direction of association with ART initiation, but confidence intervals were wide and could not exclude a null finding.
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Affiliation(s)
- Karla Therese L. Sy
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
| | - Shema Tariq
- Institute for Global Health, University College London, London, United Kingdom
| | - Gita Ramjee
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Kelly Blanchard
- Ibis Reproductive Health, Cambridge, Massachusetts and Johannesburg, South Africa
| | - Cheng-Shiun Leu
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Elizabeth A. Kelvin
- Department of Epidemiology & Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, New York, United States of America
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, New York, United States of America
| | - Theresa M. Exner
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
| | - Anisha D. Gandhi
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
| | - Naomi Lince-Deroche
- Ibis Reproductive Health, Cambridge, Massachusetts and Johannesburg, South Africa
| | - Joanne E. Mantell
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
| | | | - Susie Hoffman
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
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Strauss M, George G, Mantell JE, Mapingure M, Masvawure TB, Lamb MR, Zech JM, Musuka G, Chingombe I, Msukwa M, Boccanera R, Gwanzura C, Apollo T, Rabkin M. Optimizing Differentiated HIV Treatment Models in Urban Zimbabwe: Assessing Patient Preferences Using a Discrete Choice Experiment. AIDS Behav 2021; 25:397-413. [PMID: 32812124 PMCID: PMC7846512 DOI: 10.1007/s10461-020-02994-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Differentiated service delivery holds great promise for streamlining the delivery of health services for HIV. This study used a discrete choice experiment to assess preferences for differentiated HIV treatment delivery model characteristics among 500 virally suppressed adults on antiretroviral therapy in Harare, Zimbabwe. Treatment model characteristics included location, consultation type, healthcare worker cadre, operation times, visit frequency and duration, and cost. A mixed effects logit model was used for parameter estimates to identify potential preference heterogeneity among participants, and interaction effects were estimated for sex and age as potential sources of divergence in preferences. Results indicated that participants preferred health facility-based services, less frequent visits, individual consultations, shorter waiting times, lower cost and, delivered by respectful and understanding healthcare workers. Some preference heterogeneity was found, particularly for location of service delivery and group vs. individual models; however, this was not fully explained by sex and age characteristics of participants. In urban areas, facility-based models, such as the Fast Track model requiring less frequent clinic visits, are likely to better align with patient preferences than some of the other community-based or group models that have been implemented. As Zimbabwe scales up differentiated treatment models for stable patients, a clear understanding of patient preferences can help in designing services that will ensure optimal utilization and improve the efficiency of service delivery.
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Affiliation(s)
- Michael Strauss
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa.
| | - Gavin George
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa
| | - Joanne E Mantell
- Department of Psychiatry, Division of Gender, Sexuality and Health, The New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA
| | | | - Tsitsi B Masvawure
- Health Studies Program, Center for Interdisciplinary Studies, College of the Holy Cross, Worcester, MA, USA
| | - Matthew R Lamb
- ICAP at Columbia University, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | | | | | | | - Rodrigo Boccanera
- Health Resources and Services Administration (HRSA), Rockville, MD, USA
| | - Clorata Gwanzura
- HIV/AIDS and STIs Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Tsitsi Apollo
- HIV/AIDS and STIs Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Miriam Rabkin
- ICAP at Columbia University, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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Christian SN, Mantell JE, Romo ML, Grov C, George G, Mwai E, Nyaga E, Odhiambo JO, Govender K, Kelvin EA. Applying a social-ecological lens to opinions about HIV self-testing among Kenyan truckers who declined to test: a qualitative study. Afr J AIDS Res 2020; 19:147-155. [PMID: 32780676 DOI: 10.2989/16085906.2020.1764070] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
HIV prevalence among truckers in Africa is high and testing rates suboptimal. With numerous African countries having approved HIV self-testing kits, more information on how to design acceptable and accessible self-testing programs for high-risk populations is necessary. We explored views about self-testing via in-depth interviews with 24 truckers participating in a randomised controlled trial who refused HIV testing. A social-ecological lens was used to guide data analysis and frame study findings. While most participants said that they would use an HIV self-test, perceived barriers and facilitators were identified at multiple levels. Many participants noted lack of time to test or obtain a self-test kit as a major barrier (intrapersonal) and varied in their views about self-testing with a partner (interpersonal). Participants offered programmatic/policy recommendations, suggesting that they preferred accessing self-test kits in settings where training could be provided. Participants believed they should be able to pick up multiple test kits at the same time and that the test kits should be free or low cost. These study findings will help guide the design of self-testing programs for truckers and other mobile populations.
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Affiliation(s)
- Stephanie N Christian
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, USA
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health, New York State Psychiatric Institute & Columbia University, New York, USA
| | - Matthew L Romo
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, USA.,CUNY Institute for Implementation Science in Population Health, City University of New York, New York, USA
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, USA.,CUNY Institute for Implementation Science in Population Health, City University of New York, New York, USA
| | - Gavin George
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Eva Mwai
- North Star Alliance, Nairobi, Kenya
| | | | | | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Elizabeth A Kelvin
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, USA
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Beksinska M, Nkosi P, Mabude Z, Mantell JE, Zulu B, Milford C, Smit JA. Lessons from the evaluation of the South African National Female Condom Programme. PLoS One 2020; 15:e0236984. [PMID: 32790677 PMCID: PMC7425948 DOI: 10.1371/journal.pone.0236984] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 07/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Understanding of the facilitators and challenges to female condom (FC) uptake has been limited due to lack of evaluation of national FC programmes. SETTING The FC has been an integral component of South Africa's (SA) HIV prevention programme for 20 years and is the largest government-funded FC programme worldwide. METHODS The national FC evaluation used a mixed-methods approach and consisted of key informant interviews and a telephone survey in a national sample of public and non-public sites. A sub-sample of sites participated in client and provider interviews, and a self-administered client survey. A review of distribution statistics from South Africa's District Health Information System was also conducted. RESULTS All 256 public-sector and 28 non-public-sector facilities reported having ever distributed FCs. Less than 5% of these facilities reported stock-outs and less than 3% reported they had a supply of expired female condoms. Systems for male condom (MC) and FC distribution were complementary, with similar ordering, delivery and reporting processes. FC promotion by providers (n = 278) varied with regard to FC training, whether attitudes about FCs influenced providers offer of FCs, and how they counselled clients about FCs. Of the 4442 self-administered client surveys in 133 facilities, similar proportions of women (15.4%) and men (15.2%) had ever used FCs. Although FCs were available at almost all sites surveyed, only two-thirds of clients were aware of their availability. CONCLUSION Data highlight the role of providers as gatekeepers to FC access in public and non-public sectors and provide support for further FC programme expansion in SA and globally.
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Affiliation(s)
- Mags Beksinska
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Phumla Nkosi
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zonke Mabude
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joanne E. Mantell
- Division of Gender, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, Sexuality and Health, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, United States of America
| | - Bongiwe Zulu
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cecilia Milford
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jennifer A. Smit
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Hirsch-Moverman Y, Mantell JE, Lebelo L, Howard AA, Hesseling AC, Nachman S, Frederix K, Maama LB, El-Sadr WM. Provider attitudes about childhood tuberculosis prevention in Lesotho: a qualitative study. BMC Health Serv Res 2020; 20:461. [PMID: 32450858 PMCID: PMC7249694 DOI: 10.1186/s12913-020-05324-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 05/14/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The World Health Organization estimated that 1.12 million children developed tuberculosis (TB) in 2018, and at least 200,000 children died from TB. Implementation of effective child contact management is an important strategy to prevent childhood TB but these practices often are not prioritized or implemented, particularly in low- and middle-income countries. This study aimed to explore attitudes of healthcare providers toward TB prevention and perceived facilitators and challenges to child contact management in Lesotho, a high TB burden country. Qualitative data were collected via group and individual in-depth interviews with 12 healthcare providers at five health facilities in one district and analyzed using a thematic framework. RESULTS Healthcare providers in our study were interested and committed to improve child TB contact management and identified facilitators and challenges to a successful childhood TB prevention program. Facilitators included: provider understanding of the importance of TB prevention and enhanced provider training on child TB contact management, with a particular focus on ruling out TB in children and addressing side effects. Challenges identified by providers were at multiple levels -- structural, clinic, and individual and included: [1] access to care, [2] supply-chain issues, [3] identification and screening of child contacts, and [4] adherence to isoniazid preventive therapy. CONCLUSIONS Given the significant burden of TB morbidity and mortality in young children and the recent requirement by the WHO to report IPT initiation in child contacts, prioritization of child TB contact management is imperative and should include enhanced provider training on childhood TB and mentorship as well as strategies to eliminate challenges. Strategies that enable more efficient child TB contact management delivery include creating standardized tools that facilitate the implementation, tracking, and monitoring of child TB contact management coupled with guidance and mentorship from the district health management team. To tackle access to care challenges, we propose delivering intensive community health education, conducting community screening more efficiently using standardized tools, and facilitating access to services in the community.
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Affiliation(s)
- Yael Hirsch-Moverman
- ICAP at Columbia University, Mailman School of Public Health, 722 West 168th Street, MSPH Box 18, New York, NY 10032 USA
- Department of Epidemiology, Columbia University, New York, NY USA
| | - Joanne E. Mantell
- HIV Center for Clinical & Behavioral Studies, Division of Gender, Sexuality and Health, at the New York State Psychiatric Institute and Columbia University Irving Medical Center, Department of Psychiatry, New York, NY USA
| | - Limakatso Lebelo
- ICAP at Columbia University, Mailman School of Public Health, 722 West 168th Street, MSPH Box 18, New York, NY 10032 USA
| | - Andrea A. Howard
- ICAP at Columbia University, Mailman School of Public Health, 722 West 168th Street, MSPH Box 18, New York, NY 10032 USA
- Department of Epidemiology, Columbia University, New York, NY USA
| | - Anneke C. Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Sharon Nachman
- Pediatric Infectious Diseases, SUNY Stony Brook, Stony Brook, NY USA
| | - Koen Frederix
- ICAP at Columbia University, Mailman School of Public Health, 722 West 168th Street, MSPH Box 18, New York, NY 10032 USA
| | | | - Wafaa M. El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, 722 West 168th Street, MSPH Box 18, New York, NY 10032 USA
- Department of Epidemiology, Columbia University, New York, NY USA
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31
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Hoffman S, Leu CS, Ramjee G, Blanchard K, Gandhi AD, O'Sullivan L, Kelvin EA, Exner TM, Mantell JE, Lince-Deroche N. Linkage to Care Following an HIV Diagnosis in Three Public Sector Clinics in eThekwini (Durban), South Africa: Findings from a Prospective Cohort Study. AIDS Behav 2020; 24:1181-1196. [PMID: 31677039 DOI: 10.1007/s10461-019-02688-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Linkage to care following an HIV diagnosis remains an important HIV care continuum milestone, even in the era of universal ART eligibility. In an 8-month prospective cohort study among 459 (309 women, 150 men) newly-diagnosed HIV-positive individuals in three public-sector clinics in Durban metropolitan region, South Africa, from 2010 to 2013, median time to return to clinic for CD4+ results (linkage) was 10.71 weeks (95% CI 8.52-12.91), with 54.1% 3-month cumulative incidence of linkage. At study completion (9.23 months median follow-up), 26.2% had not linked. Holding more positive outcome-beliefs about enrolling in care was associated with more rapid linkage [adjusted hazard ratio (AHR)each additional belief 1.31; 95% CI 1.05-1.64] and lower odds of never linking [adjusted odds ratio (AOR) 0.50; 95% CI 0.33-0.75]. Holding positive ARV beliefs was strongly protective against never linking to care. Age over 30 years (AHR 1.59; 95% CI 1.29-1.97) and disclosing one's HIV-positive status within 30 days of diagnosis (AHR 1.52; 95% CI 1.10-2.10) were associated with higher linkage rates and lower odds of never linking. Gender was not associated with linkage and did not alter the effect of other predictors. Although expanded access to ART has reduced some linkage barriers, these findings demonstrate that people's beliefs and social relations also matter. In addition to structural interventions, consistent ART education and disclosure support, and targeting younger individuals for linkage are high priorities.
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Affiliation(s)
- Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., Unit 15, New York, NY, 10032, USA.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., Unit 15, New York, NY, 10032, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Kelly Blanchard
- Ibis Reproductive Health, Cambridge, MA, USA
- Ibis Reproductive Health, Johannesburg, South Africa
| | - Anisha D Gandhi
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., Unit 15, New York, NY, 10032, USA
| | - Lucia O'Sullivan
- Department of Psychology, University of New Brunswick, Fredericton, Canada
| | - Elizabeth A Kelvin
- Epidemiology & Biostatistics Program, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Theresa M Exner
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., Unit 15, New York, NY, 10032, USA
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., Unit 15, New York, NY, 10032, USA
| | - Naomi Lince-Deroche
- Ibis Reproductive Health, Cambridge, MA, USA
- Ibis Reproductive Health, Johannesburg, South Africa
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32
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Valente PK, Mantell JE, Masvawure TB, Tocco JU, Restar AJ, Gichangi P, Chabeda SV, Lafort Y, Sandfort TG. "I Couldn't Afford to Resist": Condom Negotiations Between Male Sex Workers and Male Clients in Mombasa, Kenya. AIDS Behav 2020; 24:925-937. [PMID: 31321637 DOI: 10.1007/s10461-019-02598-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Male sex workers in Kenya face a disproportionate burden of HIV and often engage in condomless sex with their commercial partners, yet little is known about how condom negotiations between male sex workers and clients take place. We conducted semi-structured interviews with 25 male sex workers and 11 male clients of male sex workers in Mombasa, Kenya, to examine barriers and facilitators to condom use and how condom use negotiation takes place in these interactions. Participants reported positive attitudes toward condom use and perceived condom use to be a health-promoting behavior. Barriers to condom use included extra-payment for condomless sex, low perceived HIV/STI risk with some sexual partners, perceived reduced pleasure associated with using condoms, alcohol use, and violence against male sex workers by clients. Future interventions should address individual- and structural-level barriers to condom use to promote effective condom use negotiation between male sex workers and male clients.
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Rabkin M, Strauss M, Mantell JE, Mapingure M, Masvawure TB, Lamb MR, Zech JM, Musuka G, Chingombe I, Msukwa M, Boccanera R, Gwanzura C, George G, Apollo T. Optimizing differentiated treatment models for people living with HIV in urban Zimbabwe: Findings from a mixed methods study. PLoS One 2020; 15:e0228148. [PMID: 31990930 PMCID: PMC6986745 DOI: 10.1371/journal.pone.0228148] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/09/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Zimbabwe is scaling up HIV differentiated service delivery (DSD) to improve treatment outcomes and health system efficiencies. Shifting stable patients into less-intensive DSD models is a high priority in order to accommodate the large numbers of newly-diagnosed people living with HIV (PLHIV) needing treatment and to provide healthcare workers with the time and space needed to treat people with advanced HIV disease. DSD is also seen as a way to improve service quality and enhance retention in care. National guidelines support five differentiated antiretroviral treatment models (DART) for stable HIV-positive adults, but little is known about patient preferences, a critical element needed to guide DART scale-up and ensure person-centered care. We designed a mixed-methods study to explore treatment preferences of PLHIV in urban Zimbabwe. METHODS The study was conducted in Harare, and included 35 health care worker (HCW) key informant interviews (KII); 8 focus group discussions (FGD) with 54 PLHIV; a discrete choice experiment (DCE) in which 500 adult DART-eligible PLHIV selected their preferences for health facility (HF) vs. community location, individual vs. group meetings, provider cadre and attitude, clinic operation times, visit frequency, visit duration and cost to patient; and a survey with the 500 DCE participants exploring DART knowledge and preferences. RESULTS Patient preferences were consistent in the FGDs, DCE and survey. Participants strongly preferred respectful HCWs, HF-based services, individual DART models, and less costly services. Patients also preferred less frequent visits and shorter wait times. They were indifferent to variations in HCW cadre and distances from home to HF. These preferences were mostly homogenous, with only minor differences between male vs. female and older vs. younger patients. HCWs in the KII correctly characterized facility-based individual models as the one most favored by patients; HCWs also preferred this model, which they felt decongested HFs and reduced their workload. CONCLUSIONS DART-eligible PLHIV in Harare found it relatively easy to access HFs, and preferred attributes associated with facility-based individual models. Prioritizing these for scale-up in urban areas may be the most efficient way to sustain positive patient outcomes and increase health system performance.
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Affiliation(s)
- Miriam Rabkin
- ICAP at Columbia University, New York, New York, United States of America
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
- * E-mail:
| | - Michael Strauss
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa
| | - Joanne E. Mantell
- Department of Psychiatry, Division of Gender, Sexuality and Health, Columbia University, New York, New York, United States of America
- The New York State Psychiatric Institute, New York, New York, United States of America
| | | | - Tsitsi B. Masvawure
- Department of Sociology and Anthropology, College of the Holy Cross, Worcester, Massachusetts, United States of America
| | - Matthew R. Lamb
- ICAP at Columbia University, New York, New York, United States of America
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Jennifer M. Zech
- ICAP at Columbia University, New York, New York, United States of America
| | | | | | | | - Rodrigo Boccanera
- Health Resources and Services Administration (HRSA), Bethesda, Maryland, United States of America
| | - Clorata Gwanzura
- Ministry of Health and Child Care, HIV/AIDS and STIs Unit, Harare, Zimbabwe
| | - Gavin George
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa
| | - Tsitsi Apollo
- Ministry of Health and Child Care, HIV/AIDS and STIs Unit, Harare, Zimbabwe
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Bockting W, MacCrate C, Israel H, Mantell JE, Remien RH. Engagement and Retention in HIV Care for Transgender Women: Perspectives of Medical and Social Service Providers in New York City. AIDS Patient Care STDS 2020; 34:16-26. [PMID: 31846348 DOI: 10.1089/apc.2019.0067] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Transgender women are less likely to engage in HIV care and adhere to antiretroviral medications than other at-risk populations. Health care and social service providers, in addition to consumers, have experiences that can elucidate barriers and facilitators to care and inform interventions. Guided by the social/ecological model, we conducted interviews with 19 providers working with transgender women. At the health systems level, perceived barriers included lack of care accessibility and security, providers' misunderstanding of the transgender community, and lack of cultural competency of information systems and staff. At the community level, barriers included HIV stigma. At the family level, barriers included rejection and housing instability. At the individual level, barriers included conflicts between HIV- and transgender care, medication side effects, competing priorities, mental health issues and substance abuse, and low health literacy. Facilitators included provider competence in transgender health, improved access to care, and patient empowerment. Findings indicate the need for an integrated care model.
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Affiliation(s)
- Walter Bockting
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
| | - Caitlin MacCrate
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
| | - Hayley Israel
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
| | - Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
| | - Robert H. Remien
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
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Mantell JE, Masvawure TB, Mapingure M, Apollo T, Gwanzura C, Block L, Bennett E, Preko P, Musuka G, Rabkin M. Engaging men in HIV programmes: a qualitative study of male engagement in community-based antiretroviral refill groups in Zimbabwe. J Int AIDS Soc 2019; 22:e25403. [PMID: 31686432 PMCID: PMC6829354 DOI: 10.1002/jia2.25403] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/05/2019] [Accepted: 09/25/2019] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Suboptimal male engagement in HIV programmes is a persistent challenge, leading to lower coverage of HIV testing, prevention and treatment services, and to worse outcomes for men. Differentiated service delivery models, such as peer-led community antiretroviral refill groups (CARGs), offer the opportunity to enhance patient satisfaction, retention and treatment outcomes. We conducted an exploratory qualitative study to identify facilitators and barriers to CARG participation by HIV-positive men, with inputs from recipients of HIV care, community members, healthcare workers (HCWs), donors and policymakers. METHODS Between July and October 2017, we conducted 20 focus group discussions (FGDs) with 147 adults living with HIV, including men and women enrolled in CARGs and men not enrolled in CARGs, and 46 key informant interviews (KIIs) with policymakers, donors, HCWs and community members. FGDs and KIIs were recorded, transcribed and translated. A constant comparison approach was used to triangulate findings and identify themes related to male engagement in CARGs in rural Zimbabwe. RESULTS CARG participants, policymakers, donors, HCWs, and community members noted many advantages to CARG participation, including convenience, efficiency, solidarity and mutual psychosocial support. Although those familiar with CARGs reported that these groups decreased HIV-related stigma, concerns about stigma and privacy were perceived to be the primary reason for men's non-participation. Other important barriers to male enrolment included lack of awareness of CARGs, misunderstanding of how CARGs operate, few perceived benefits and lack of flexibility in CARG implementation. CONCLUSIONS More effective educational and awareness campaigns, community-based anti-stigma campaigns, more flexible CARG designs, and provision of financial and/or in-kind support to CARG members could mitigate many of the barriers to male enrolment in CARGs. Men may also prefer alternative differentiated service delivery models that are facility-based and/or do not require group participation.
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Affiliation(s)
- Joanne E Mantell
- Division of GenderSexuality and HealthDepartment of PsychiatryColumbia UniversityNew York State Psychiatric InstituteNew YorkNYUSA
| | - Tsitsi B Masvawure
- Center for Interdisciplinary StudiesCollege of the Holy CrossWorcesterMAUSA
| | | | - Tsitsi Apollo
- HIV/AIDS and STIs UnitMinistry of Health and Child CareHarareZimbabwe
| | - Clorata Gwanzura
- HIV/AIDS and STIs UnitMinistry of Health and Child CareHarareZimbabwe
| | | | - Eleanor Bennett
- Division of GenderSexuality and HealthDepartment of PsychiatryColumbia UniversityNew York State Psychiatric InstituteNew YorkNYUSA
| | | | | | - Miriam Rabkin
- ICAP at Columbia UniversityNew YorkNYUSA
- Departments of Medicine & EpidemiologyColumbia University Mailman School of Public HealthNew YorkNYUSA
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Hirsch-Moverman Y, Mantell JE, Lebelo L, Wynn C, Hesseling AC, Howard AA, Nachman S, Frederix K, Maama LB, El-Sadr WM. Tuberculosis preventive treatment preferences among care givers of children in Lesotho: a pilot study. Int J Tuberc Lung Dis 2019; 22:858-862. [PMID: 29991393 DOI: 10.5588/ijtld.17.0809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Shorter-duration regimens for preventing drug-susceptible tuberculosis (TB) have been shown to be safe and efficacious in children, and may improve acceptability, adherence, and treatment completion. While these regimens have been used in children in low TB burden countries, they are not yet widely used in high TB burden countries. SETTING Five health facilities in one district in Lesotho, a high TB burden country. OBJECTIVE Assess the preventive treatment preferences of care givers of child TB contacts. DESIGN Qualitative data were collected using in-depth interviews with 12 care givers whose children completed preventive treatment, and analyzed using grounded theory. FINDINGS Care givers were interested in being involved in the children's treatment decisions. Pill burden, treatment duration and related frequency of dosing were identified as important factors that influenced preventive treatment preferences among care givers. CONCLUSION Understanding care giver preferences and involving them in treatment decisions may facilitate efforts to implement successful preventive treatment for TB among children in high TB burden countries.
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Affiliation(s)
- Y Hirsch-Moverman
- ICAP at Columbia University, Mailman School of Public Health, New York, Department of Epidemiology, Columbia University, New York
| | - J E Mantell
- HIV Center for Clinical & Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Columbia University, Department of Psychiatry, New York
| | - L Lebelo
- ICAP at Columbia University, Mailman School of Public Health, New York
| | - C Wynn
- Department of Sociomedical Sciences, Columbia University, New York, New York, USA
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A A Howard
- ICAP at Columbia University, Mailman School of Public Health, New York, Department of Epidemiology, Columbia University, New York
| | - S Nachman
- Pediatric Infectious Diseases, State University of New York Stony Brook, Stony Brook, New York, USA
| | - K Frederix
- ICAP at Columbia University, Mailman School of Public Health, New York
| | - L B Maama
- Lesotho Ministry of Health National Tuberculosis Program, Maseru, Lesotho
| | - W M El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, New York, Department of Epidemiology, Columbia University, New York
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Romo ML, George G, Mantell JE, Mwai E, Nyaga E, Strauss M, Odhiambo JO, Govender K, Kelvin EA. Depression and sexual risk behavior among long-distance truck drivers at roadside wellness clinics in Kenya. PeerJ 2019; 7:e7253. [PMID: 31355055 PMCID: PMC6642802 DOI: 10.7717/peerj.7253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/05/2019] [Indexed: 11/20/2022] Open
Abstract
Background Truck drivers in sub-Saharan Africa are at high risk for both mental health disorders and sexually transmitted infections. We sought to determine the prevalence of depression among a sample of long-distance truck drivers seeking services at roadside wellness clinics in Kenya and explore the relationship between depression and sexual risk behavior. Methods We used data from an interviewer-administered questionnaire from 284 truck drivers in Kenya who participated in a randomized controlled trial evaluating whether offering oral HIV self-testing could increase HIV test uptake. Depression was categorized based on the Patient Health Questionnaire-9 score, with a score ≥10 indicative of probable major depressive disorder (MDD). Sexual risk behavior was operationalized as the number of condomless sex partners in the past 6 months. Results The mean participant age was 36.9 years, 83.0% were married, and 37.0% had a secondary school education or higher. Overall, 24% of participants had probable MDD, and 58.2% reported having one condomless sex partner in the past 6 months, whereas 27.3% reported having had two or more. In a multivariable Poisson regression model adjusted for demographic and other relevant variables, including number of sex partners, MDD was significantly associated with a greater number of condomless sex partners (adjusted prevalence ratio 1.63, 95% confidence interval [1.25–2.12], p < 0.001). General self-efficacy significantly mediated the association between MDD and number of condomless sex partners. Conclusions The high prevalence of depression highlights the need to test the feasibility and acceptability of mental healthcare interventions for this population, possibly integrated with HIV prevention services. Future research is needed to better understand the association between depression and sexual risk behavior, as well as the role of self-efficacy.
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Affiliation(s)
- Matthew L Romo
- Department of Epidemiology and Biostatistics & Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.,School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Gavin George
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute & Columbia University Medical Center, New York, NY, USA
| | - Eva Mwai
- North Star Alliance, Nairobi, Kenya
| | | | - Michael Strauss
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | | | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Elizabeth A Kelvin
- Department of Epidemiology and Biostatistics & Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
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Kelvin EA, George G, Kinyanjui S, Mwai E, Romo ML, Oruko F, Odhiambo JO, Nyaga EN, Mantell JE, Govender K. Announcing the availability of oral HIV self-test kits via text message to increase HIV testing among hard-to-reach truckers in Kenya: a randomized controlled trial. BMC Public Health 2019; 19:7. [PMID: 30606161 PMCID: PMC6318910 DOI: 10.1186/s12889-018-6345-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 07/23/2018] [Accepted: 12/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Truckers in sub-Saharan Africa are at higher risk of contracting HIV than the general population. HIV self-testing may be a way to increase testing rates in this high-risk population. The objective of this randomized controlled trial was to assess whether informing truckers who do not test for HIV regularly about the availability of HIV self-testing kits at roadside wellness centers in Kenya using text messages would increase HIV testing rates compared to the current program in which they are sent text messages about the availability of HIV testing in general. Methods A sample of 2262 male truckers registered in the North Star Alliance electronic health record system who, based on these records, were not testing for HIV regularly were randomized to one of three study groups in which they were sent text messages about the availability of (1) oral HIV self-test kits at all 8 North Star Alliance Kenya clinics that was sent three times (intervention), (2) HIV testing in general (not self-testing) at all North Star Alliance clinics sent three times (enhanced standard of care [SOC]), or (3) HIV testing in general (not self-testing) at all North Star Alliance clinics sent one time (SOC). We looked at HIV testing over a 2-month study period following the first text. Results Truckers in the intervention group were significantly more likely to test for HIV compared to those in the enhanced SOC (OR = 2.7, p = 0.009). There was no difference in HIV testing between those in the enhanced SOC and the SOC groups. Of those in the intervention group who tested, 64.5% chose the self-test and 35.5% chose the standard provider-administered blood-based HIV test. Although the intervention more than doubled HIV testing rates, because HIV testing rates were so low in this population (by design as we selected irregular testers), even in the intervention group more than 96% of participants did not test. Conclusions Announcing the availability of HIV self-testing via text message increased HIV testing rates among truckers who were not regularly accessing HIV testing. However, self-testing is only a partial solution to increasing testing rates in this hard to reach population. Trial registration This trial was registered prior to enrollment at the Registry for International Impact Evaluations (RIDIE STUDY ID: 582a2462ae2ab): http://ridie.3ieimpact.org/index.php?r=search/detailView&id=492. It was also registered after completion at ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT03662165): https://clinicaltrials.gov/ct2/show/NCT03662165?term=NCT03662165&type=Intr&cond=HIV&rank=1.
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Affiliation(s)
- Elizabeth A Kelvin
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, New York, NY, 10027, USA. .,CUNY Institute for Implementation Science in Population Health, City University of New York, 55 West 125th Street, New York, NY, 10027, USA.
| | - Gavin George
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Westville Campus, J block, Level 4, University Road, Durban, South Africa
| | | | - Eva Mwai
- North Star Alliance, PO Box 165, Nairobi, 00202, Kenya
| | - Matthew L Romo
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, New York, NY, 10027, USA.,CUNY Institute for Implementation Science in Population Health, City University of New York, 55 West 125th Street, New York, NY, 10027, USA
| | - Faith Oruko
- North Star Alliance, PO Box 165, Nairobi, 00202, Kenya
| | | | - Eston N Nyaga
- North Star Alliance, PO Box 165, Nairobi, 00202, Kenya
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health, New York State Psychiatric Institute & Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Westville Campus, J block, Level 4, University Road, Durban, South Africa
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Strauss M, George G, Mantell JE, Romo ML, Mwai E, Nyaga EN, Odhiambo JO, Govender K, Kelvin EA. Stated and revealed preferences for HIV testing: can oral self-testing help to increase uptake amongst truck drivers in Kenya? BMC Public Health 2018; 18:1231. [PMID: 30400898 PMCID: PMC6219162 DOI: 10.1186/s12889-018-6122-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-distance truck drivers in Africa are particularly at risk of HIV acquisition and offering self-testing could help increase testing coverage in this hard-to-reach population. The aims of this study are twofold: (1) to examine the preference structures of truck drivers in Kenya regarding HIV testing service delivery models and what they mean for the roll-out of HIV self-testing, and (2) to compare the preference data collected from a hypothetical discrete choice experiment with the actual choices made by participants in the intervention arm of a randomised controlled trial (RCT) who were offered HIV testing choices. METHODS Using data from 150 truck drivers, this paper examines whether the stated preferences regarding HIV testing in a discrete choice experiment predict the actual test selected when offered HIV testing choices. Conditional logit models were used for main effects analysis and stratified models were run by HIV testing choices made in the trial to assess if the attributes preferred differed by test chosen. RESULTS The strongest driver of stated preference among all participants was cost. However, two preferences diverged between those who actually chose self-testing in the RCT and those who chose a provider administered test: the type of test (p < 0.001) and the type of counselling (p = 0.003). Self-testers preferred oral-testing to finger-prick testing (OR 1.26 p = 0.005), while non-self-testers preferred finger-prick testing (OR 0.56 p < 0.001). Non-self-testers preferred in-person counselling to telephonic counselling (OR 0.64 p < 0.001), while self-testers were indifferent to type of counselling. Preferences in both groups regarding who administered the test were not significant. CONCLUSIONS We found stated preference structures helped explain the actual choices participants made regarding the type of HIV testing they accepted. Offering oral testing may be an effective strategy for increasing willingness to test among certain groups of truck drivers. However, the importance of in-person counselling and support, and concern that an oral test cannot detect HIV infection may mean that continuing to offer finger-prick testing at roadside wellness centres will best align with the preferences of those already attending these facilities. More research is needed to explore whether who administers the HIV test (provider versus self) makes any difference. TRIAL REGISTRATION This trial is registered with the Registry for International Development Impact Evaluations ( RIDE ID#55847d64a454f ).
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Affiliation(s)
- Michael Strauss
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, 4th Floor J-Block, University of KwaZulu-Natal Westville Campus, University Drive, Durban, 4041 South Africa
| | - Gavin George
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, 4th Floor J-Block, University of KwaZulu-Natal Westville Campus, University Drive, Durban, 4041 South Africa
| | - Joanne E. Mantell
- Division of Gender, Sexuality and Health, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute & Columbia University, 1051 Riverside Drive, New York, NY 10032 USA
| | - Matthew L. Romo
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy and Institute for Implementation Science in Population Health, City University of New York, 55 West 125th Street, New York, NY 10027 USA
| | - Eva Mwai
- North Star Alliance, PO Box 165, Nairobi, 00202 Kenya
| | | | | | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, 4th Floor J-Block, University of KwaZulu-Natal Westville Campus, University Drive, Durban, 4041 South Africa
| | - Elizabeth A. Kelvin
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy and Institute for Implementation Science in Population Health, City University of New York, 55 West 125th Street, New York, NY 10027 USA
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Fifield J, O'Sullivan L, Kelvin EA, Mantell JE, Exner T, Ramjee G, Blanchard K, Hoffman S. Social Support and Violence-prone Relationships as Predictors of Disclosure of HIV Status Among Newly Diagnosed HIV-positive South Africans. AIDS Behav 2018; 22:3287-3295. [PMID: 29744766 DOI: 10.1007/s10461-018-2136-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/24/2022]
Abstract
Despite the salience of social support and violence as potential outcomes of disclosure, how pre-existing social support and relationship violence among people living with HIV shapes and influences HIV status disclosure has received limited attention. Following the Disclosure Process Model, this study investigated pre-disclosure support and violence-prone relationships as predictors of disclosure using data from a prospective study of 459 newly diagnosed South African women and men. Most (88%) disclosed their status to at least one person by their 8-month interview. Level of social support was unrelated to disclosure to a partner. However, those with higher levels of support had higher odds of disclosing to family and to others. Women in violence-prone relationships were more likely to report disclosure to a partner than were those not in such relationships, counter to expectations. The findings suggest that the same mechanisms may not explain processes of disclosure across all relationship types.
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Affiliation(s)
- Jocelyn Fifield
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA.
- Ariadne Labs, Brigham and Women's Hospital and Harvard School of Public Health, Boston, MA, USA.
- , 401 Park Drive, Boston, MA, 02115, USA.
| | - Lucia O'Sullivan
- Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
| | - Elizabeth A Kelvin
- Epidemiology & Biostatistics Program, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Theresa Exner
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Gita Ramjee
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | | | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Nyirenda M, Street R, Reddy T, Hoffman S, Dawad S, Blanchard K, Exner TM, Kelvin EA, Mantell JE, Ramjee G. Food insecurity, HIV status and prior testing at South African primary healthcare clinics. S AFR J SCI 2018. [DOI: 10.17159/sajs.2018/4407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
HIV and food insecurity are two prominent causes of morbidity and mortality in sub-Saharan Africa. Food insecurity has been associated with risky sexual practices and poor access to healthcare services. We describe the association between household food insecurity and previous HIV testing and HIV status. We used logistic regression to analyse the association between food insecurity and prior HIV counselling and testing (HCT) and testing HIV positive. A total of 2742 adults who presented for HCT at three primary healthcare clinics in KwaZulu-Natal, South Africa, participated in the study. The prevalence of household food insecurity was 35%. The prevalence of food insecurity was highest in adults who had incomplete high schooling (43%), were unemployed (39%), and whose primary source of income was government grants (50%). Individuals who were food insecure had significantly higher odds of testing HIV positive (adjusted odds ratio 1.41, 95% CI 1.16–1.71), adjusted for demographic and socio-economic variables. There was no association between food insecurity and prior HCT. The findings of this study highlight the important role food insecurity may play in HIV risk. Interventions to turn food-insecure into food-secure households are needed to reduce their household members’ vulnerability to HIV acquisition. The absence of such interventions is likely to severely impact ambitious global targets of ending AIDS by 2030 through the 90-90-90 targets and test-and-treat-all initiatives.
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Affiliation(s)
- Makandwe Nyirenda
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Renee Street
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
- Environment and Health Research Unit, South African Medical Research Council, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Susie Hoffman
- Department of Epidemiology, Columbia University, New York, New York, USA
- HIV Center for Clinical and Behavioural Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Suraya Dawad
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
- National Department of Health, Pretoria, South Africa
| | | | - Theresa M. Exner
- HIV Center for Clinical and Behavioural Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Elizabeth A. Kelvin
- Department of Epidemiology and Biostatistics, City University of New York, New York, New York, USA
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, New York, USA
| | - Joanne E. Mantell
- HIV Center for Clinical and Behavioural Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
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George G, Chetty T, Strauss M, Inoti S, Kinyanjui S, Mwai E, Romo ML, Oruko F, Odhiambo JO, Nyaga E, Mantell JE, Govender K, Kelvin EA. Costing analysis of an SMS-based intervention to promote HIV self-testing amongst truckers and sex workers in Kenya. PLoS One 2018; 13:e0197305. [PMID: 29979704 PMCID: PMC6034789 DOI: 10.1371/journal.pone.0197305] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 12/19/2017] [Accepted: 04/29/2018] [Indexed: 11/18/2022] Open
Abstract
Objective HIV testing rates in many sub-Saharan African countries have remained suboptimal, and there is an urgent need to explore strategic yet cost-effective approaches to increase the uptake of HIV testing, especially among high-risk populations. Methods A costing analysis was conducted for a randomized controlled trial (RCT) with male truckers and female sex workers (FSWs) registered in the electronic health record system (EHRS) of the North Star Alliance, which offers healthcare services at major transit hubs in Southern and East Africa. The RCT selected a sample of truckers and FSWs who were irregular HIV testers, according to the EHRS, and evaluated the effect of SMSs promoting the availability of HIV self-testing (HIVST) kits in Kenyan clinics (intervention program) versus a general SMS reminding clients to test for HIV (enhanced and standard program) on HIV testing rates. In this paper, we calculated costs from a provider perspective using a mixed-methods approach to identify, measure, and value the resources utilized within the intervention and standard programs. The results of the analysis reflect the cost per client tested. Results The cost of offering HIVST was calculated to be double that of routine facility-based testing (USD 10.13 versus USD 5.01 per client tested), primarily due to the high price of the self-test kit. In the two study arms that only offered provider-administered HIV testing in the clinic, only 1% of truckers and 6% of FSWs tested during the study period, while in the intervention arm, which also offered HST, approximately 4% of truckers and 11% of FSWs tested. These lower than expected outcomes resulted in relatively high cost per client estimates for all three study arms. Within the intervention arm, 65% of truckers and 72% of FSWs who tested chose the HIVST option. However, within the intervention arm, the cost per additional client tested was lower for FSWs than for truckers, at USD 0.15 per additional client tested versus USD 0.58 per additional client tested, driven primarily by the higher response rates. Conclusion Whilst the availability of HIVST increased HIV testing among both truckers and FSWs, the cost of providing HIVST is higher than that of a routine health facility-based test, driven primarily by the price of the HIV self-test kit. Future research needs to identify strategies which increase demand for HIVST, and determine whether these strategies and the subsequent increased demand for HIVST are cost-effective in relation to the conventional facility based testing currently available.
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Affiliation(s)
- Gavin George
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Taruna Chetty
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Michael Strauss
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | | | | | - Eva Mwai
- North Star Alliance, Nairobi, Kenya
| | - Matthew L. Romo
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, United States of America
- Institute for Implementation Science in Population Health, City University of New York, New York, United States of America
| | | | | | | | - Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health, New York State Psychiatric Institute & Columbia University, New York, New York, United States of America
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Elizabeth A. Kelvin
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, United States of America
- Institute for Implementation Science in Population Health, City University of New York, New York, United States of America
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Romo ML, George G, Mantell JE, Mwai E, Nyaga E, Odhiambo JO, Govender K, Kelvin EA. Psychosocial characteristics of primary care-seeking long-distance truck drivers in Kenya and associations with HIV testing. Afr J AIDS Res 2018; 17:119-128. [PMID: 29690829 PMCID: PMC6085082 DOI: 10.2989/16085906.2018.1449760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The 90-90-90 strategy from the Joint United Nations Programme on HIV/AIDS (UNAIDS) to end the AIDS epidemic by 2020 includes, as its first goal, to have 90% of all people living with HIV to know their status. Achieving this goal will depend on effectively reaching high risk populations, which include mobile populations such as truck drivers. This study aimed to characterise a sample of 305 truck drivers recruited from 2 roadside wellness clinics in Kenya in terms of anticipated HIV stigma, self-efficacy, fatalism, gender equity, sensation seeking, and self-esteem, and then determine the association of these psychosocial characteristics with HIV testing behaviour. Greater general self-efficacy was associated with higher income and more years working as a truck driver. Greater fatalism was associated with non-Christian religion, being married, and having a lower income. Greater gender equity was associated with completing high school, being married, and having higher income. Greater sensation seeking was associated with lower income and fewer years employed as a truck driver. In multivariable logistic regression adjusted for demographic variables, anticipated HIV stigma was negatively associated with having ever tested for HIV (adjusted odds ratio [aOR] = 0.79; 95% confidence interval [CI] = 0.63–0.98; p = 0.034) and self-esteem was positively associated with testing (aOR = 1.06; 95% CI = 1.00–1.12; p = 0.038). Associations with HIV testing behaviour were not significant for self-efficacy, fatalism, gender equity, or sensation seeking. Public health interventions aiming to reduce anticipated stigma and increase self-esteem may potentially increase the uptake of HIV testing among truck drivers. Further research is needed to better understand the influence of these psychosocial characteristics on HIV testing.
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Affiliation(s)
- Matthew L Romo
- a Department of Epidemiology and Biostatistics & Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy , City University of New York , New York , USA
| | - Gavin George
- b Health Economics and HIV and AIDS Research Division , University of KwaZulu-Natal , Durban , South Africa
| | - Joanne E Mantell
- d HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality, and Health , New York State Psychiatric Institute & Columbia University Medical Center , New York , USA
| | - Eva Mwai
- c North Star Alliance , Nairobi , Kenya
| | | | | | - Kaymarlin Govender
- b Health Economics and HIV and AIDS Research Division , University of KwaZulu-Natal , Durban , South Africa
| | - Elizabeth A Kelvin
- a Department of Epidemiology and Biostatistics & Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy , City University of New York , New York , USA
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Kelvin EA, George G, Mwai E, Nyaga EN, Mantell JE, Romo ML, Odhiambo JO, Govender K. Offering Self-administered Oral HIV Testing as a Choice to Truck Drivers in Kenya: Predictors of Uptake and Need for Guidance While Self-testing. AIDS Behav 2018; 22:580-592. [PMID: 28540563 PMCID: PMC5818565 DOI: 10.1007/s10461-017-1783-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We assessed predictors of choosing self-administered oral HIV testing in the clinic with supervision versus the standard provider-administered blood test when offered the choice among 149 Kenyan truck drivers, described the types of guidance participants needed during self-testing and predictors of needing guidance. Overall, 56.38% of participants chose the self-test, 23.49% the provider-administered test, and 20.13% refused testing. In the adjusted regression models, each additional unit on the fatalism and self-efficacy scales was associated with 0.97 (p = 0.003) and 0.83 (p = 0.008) times lower odds of choosing the self-test, respectively. Overall, 52.38% of self-testers did so correctly without questions, 47.61% asked questions, and 13.10% required unsolicited correction from the provider. Each additional unit on the fatalism scale was associated with 1.07 times higher odds of asking for guidance when self-testing (p < 0.001). Self-administered oral HIV testing seems to be acceptable and feasible among Kenyan truck drivers, especially if given the opportunity to ask questions.
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45
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Masvawure TB, Mantell JE, Tocco JU, Gichangi P, Restar A, Chabeda SV, Lafort Y, Sandfort TGM. Intentional and Unintentional Condom Breakage and Slippage in the Sexual Interactions of Female and Male Sex Workers and Clients in Mombasa, Kenya. AIDS Behav 2018; 22:637-648. [PMID: 28975484 DOI: 10.1007/s10461-017-1922-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We examined why male condoms broke or slipped off during commercial sex and the actions taken in response among 75 female and male sex workers and male clients recruited from 18 bars/nightclubs in Mombasa, Kenya. Most participants (61/75, 81%) had experienced at least one breakage or slippage during commercial sex. Many breakages were attributed to the direct actions of clients. Breakages and slippages fell into two main groups: those that were intentionally caused by clients and unintentional ones caused by inebriation, forceful thrusting during sex and incorrect or non-lubricant use. Participant responses included: stopping sex and replacing the damaged condoms, doing nothing, getting tested for HIV, using post-exposure prophylaxis and washing. Some sex workers also employed strategies to prevent the occurrence of condom breakages. Innovative client-oriented HIV prevention and risk-reduction interventions are therefore urgently needed. Additionally, sex workers should be equipped with skills to recognize and manage breakages.
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Affiliation(s)
- Tsitsi B Masvawure
- Department of Sociology and Anthropology, College of the Holy Cross, Worcester, MA, USA.
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Jack Ume Tocco
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Peter Gichangi
- International Centre for Reproductive Health, Mombasa, Kenya
- International Centre for Reproductive Health-Ghent University, Ghent, Belgium
- Department of Anatomy, University of Nairobi, Nairobi, Kenya
| | - Arjee Restar
- Brown School of Public Health, Brown University, Providence, RI, USA
| | | | - Yves Lafort
- International Centre for Reproductive Health-Ghent University, Ghent, Belgium
| | - Theo G M Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
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Tariq S, Hoffman S, Ramjee G, Mantell JE, Phillip JL, Blanchard K, Lince-Deroche N, Exner TM. "I did not see a need to get tested before, everything was going well with my health": a qualitative study of HIV-testing decision-making in KwaZulu-Natal, South Africa. AIDS Care 2018; 30:32-39. [PMID: 28695750 PMCID: PMC5699939 DOI: 10.1080/09540121.2017.1349277] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/26/2017] [Indexed: 01/15/2023]
Abstract
Few studies have examined HIV-testing decision-making since the South African national HIV counseling and testing campaign in 2010-2011 and subsequent expansion in antiretroviral therapy (ART) eligibility in 2012. We describe HIV-testing decision-making and pathways to testing among participants in Pathways to Care, a cohort study of newly-diagnosed HIV-positive adults in KwaZulu-Natal. Our analysis is embedded within a theoretical framework informed by Arthur Kleinman's work on pluralistic healthcare systems, and the concept of diagnostic itineraries (i.e., the route taken to HIV testing). We conducted 26 semi-structured interviews in 2012, within one month of participants' diagnosis. Most (n = 22) deferred testing until they had developed symptoms, and then often sought recourse in non-biomedical settings. Of the eleven symptomatic participants who accessed professional medical services prior to testing, only three reported that a healthcare professional had offered or recommended an HIV test. Although ART emerged as an important motivator, offering hope of health and normalcy, fear of death and HIV-related stigma remained key barriers. Despite national policy changes in testing and treatment, health system and individual factors contributed to ongoing high levels of late diagnosis of HIV in this study population. Encouraging local health systems to direct clients toward HIV testing, and continuing to raise awareness of the benefits of routine testing remain important strategies to reduce delayed diagnoses.
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Affiliation(s)
- Shema Tariq
- a HIV Center for Clinical and Behavioral Studies , NYS Psychiatric Institute and Columbia University , New York , NY , USA
| | - Susie Hoffman
- a HIV Center for Clinical and Behavioral Studies , NYS Psychiatric Institute and Columbia University , New York , NY , USA
- b Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Gita Ramjee
- c South African Medical Research Council , HIV Prevention Research Unit , Durban , South Africa
- d Department of Global Health, School of Medicine , University of Washington , Seattle , WA , USA
| | - Joanne E Mantell
- a HIV Center for Clinical and Behavioral Studies , NYS Psychiatric Institute and Columbia University , New York , NY , USA
| | - Jessica L Phillip
- c South African Medical Research Council , HIV Prevention Research Unit , Durban , South Africa
| | - Kelly Blanchard
- e Ibis Reproductive Health , Cambridge , MA , USA
- f Ibis Reproductive Health , Johannesburg , South Africa
| | - Naomi Lince-Deroche
- e Ibis Reproductive Health , Cambridge , MA , USA
- f Ibis Reproductive Health , Johannesburg , South Africa
| | - Theresa M Exner
- a HIV Center for Clinical and Behavioral Studies , NYS Psychiatric Institute and Columbia University , New York , NY , USA
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Weintraub A, Mantell JE, Holt K, Street RA, Wilkey C, Dawad S, Masvawure TB, Hoffman S. 'These people who dig roots in the forests cannot treat HIV': Women and men in Durban, South Africa, reflect on traditional medicine and antiretroviral drugs. Glob Public Health 2018; 13:115-127. [PMID: 28793809 PMCID: PMC5698148 DOI: 10.1080/17441692.2017.1359326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/19/2022]
Abstract
Relatively few empirical investigations of the intersection of HIV biomedical and traditional medicine have been undertaken. As part of preliminary work for a longitudinal study investigating health-seeking behaviours among newly diagnosed individuals living with HIV, we conducted semi-structured interviews with 24 urban South Africans presenting for HIV testing or newly enrolled in HIV care; here we explored participants' views on African traditional medicine (TM) and biomedical HIV treatment. Notions of acceptance/non-acceptance were more nuanced than dichotomous, with participants expressing views ranging from favourable to reproachful, often referring to stories they had heard from others rather than drawing from personal experience. Respect for antiretrovirals and biomedicine was evident, but indigenous beliefs, particularly about the role of ancestors in healing, were common. Many endorsed the use of herbal remedies, which often were not considered TM. Given people's diverse health-seeking practices, biomedical providers need to recognise the cultural importance of traditional health practices and routinely initiate respectful discussion of TM use with patients.
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Affiliation(s)
- Amy Weintraub
- a HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health , New York State Psychiatric Institute and Columbia University , New York , NY , USA
| | - Joanne E Mantell
- a HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health , New York State Psychiatric Institute and Columbia University , New York , NY , USA
| | - Kelsey Holt
- b Women and Health Initiative , Harvard T.H. Chan School of Public Health , Boston , MA , USA
- c Ibis Reproductive Health , Cambridge , MA , USA
| | - Renée A Street
- d South African Medical Research Council , HIV Prevention Research Unit , Durban , South Africa
| | - Catriona Wilkey
- e Hornby Zeller Associates , Inc. , South Portland , ME , USA
| | - Suraya Dawad
- f The Presidency Republic of South Africa , Pretoria , South Africa
| | - Tsitsi B Masvawure
- g Department of Sociology and Anthropology , College of the Holy Cross , Worcester , MA , USA
| | - Susie Hoffman
- a HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health , New York State Psychiatric Institute and Columbia University , New York , NY , USA
- h Joseph Mailman School of Public Health, Department of Epidemiology , Columbia University , New York , NY , USA
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Hirsch-Moverman Y, Howard AA, Frederix K, Lebelo L, Hesseling A, Nachman S, Mantell JE, Lekhela T, Maama LB, El-Sadr WM. The PREVENT study to evaluate the effectiveness and acceptability of a community-based intervention to prevent childhood tuberculosis in Lesotho: study protocol for a cluster randomized controlled trial. Trials 2017; 18:552. [PMID: 29157275 PMCID: PMC5697438 DOI: 10.1186/s13063-017-2184-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 11/25/2016] [Accepted: 09/09/2017] [Indexed: 11/24/2022] Open
Abstract
Background Effective, evidence-based interventions to prevent childhood tuberculosis (TB) in high TB/HIV-burden, resource-limited settings are urgently needed. There is limited implementation of evidence-based contact management strategies, including isoniazid preventive therapy (IPT), for child contacts of TB cases in Lesotho. Methods/design This mixed-methods implementation science study utilizes a two-arm cluster-randomized trial design with randomization at the health facility level. The study aims to evaluate the effectiveness and acceptability of a combination community-based intervention (CBI) versus standard of care (SOC) for the management of child TB contacts. The study includes three phases: (I) exploratory phase; (II) intervention implementation and testing phase; (III) post-intervention explanatory phase. Healthcare provider interviews to inform intervention refinement (phase I) were completed in December 2015. In phase II, 10 health facilities were randomized to deliver the CBI or SOC, with stratification by facility type (i.e., hospital vs. health center). CBI holistically addresses the complex provider-related, patient-related, and caregiver-related barriers to prevention of childhood TB through nurse training and mentorship; health education for caregivers and patients by village health workers; adherence support using text messaging and village health workers; and multidisciplinary team meetings, where programmatic data are reviewed and challenges and solutions are discussed. SOC sites follow country guidelines for child TB contact management. Routine TB program data will be abstracted for all adult TB cases newly registered during the study period and their child contacts from TB registers and cards. The anticipated sample size is 1080 child contacts. Primary outcomes are yield (number) of child contacts, including children < 5 years of age and HIV-positive children < 15 years of age; IPT initiation; and IPT completion. Secondary outcomes include HIV testing; yield of active prevalent TB among child contacts; and acceptability and utilization of CBI components. Intervention implementation began in February 2016 and is ongoing. Post-intervention interviews with healthcare providers and caregivers (phase III) commenced in February 2017. Discussion The PREVENT study tests the effectiveness and acceptability of a novel combination CBI for child TB contact management in Lesotho. If effective, CBI will have important implications for addressing childhood TB in Lesotho and elsewhere. Trial registration ClinicalTrials.gov, NCT02662829. Registered on 15 January 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2184-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yael Hirsch-Moverman
- ICAP, Mailman School of Public Health, Columbia University, 722 West 168th St, MSPH Box 18, New York, NY, 10032, USA. .,Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th St, MSPH Box 18, New York, NY, USA.
| | - Andrea A Howard
- ICAP, Mailman School of Public Health, Columbia University, 722 West 168th St, MSPH Box 18, New York, NY, 10032, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th St, MSPH Box 18, New York, NY, USA
| | - Koen Frederix
- ICAP in Lesotho, Columbia University, Lancers Inn, Kingsway and Pioneer Road, Maseru, 100, Lesotho
| | - Limakatso Lebelo
- ICAP in Lesotho, Columbia University, Lancers Inn, Kingsway and Pioneer Road, Maseru, 100, Lesotho
| | - Anneke Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, PO Box 241, Cape Town, 8000, South Africa
| | - Sharon Nachman
- Pediatric Infectious Diseases, SUNY Stony Brook University, Stony Brook, NY, 11794, USA
| | - Joanne E Mantell
- HIV Center for Clinical & Behavioral Studies, Division of Gender, Sexuality and Health, at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Tsepang Lekhela
- National Tuberculosis Programme, The Ministry of Health, P.O. Box 514, Maseru, 100, Lesotho
| | - Llang Bridget Maama
- National Tuberculosis Programme, The Ministry of Health, P.O. Box 514, Maseru, 100, Lesotho
| | - Wafaa M El-Sadr
- ICAP, Mailman School of Public Health, Columbia University, 722 West 168th St, MSPH Box 18, New York, NY, 10032, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th St, MSPH Box 18, New York, NY, USA
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Strauss M, George G, Lansdell E, Mantell JE, Govender K, Romo M, Odhiambo J, Mwai E, Nyaga EN, Kelvin EA. HIV testing preferences among long distance truck drivers in Kenya: a discrete choice experiment. AIDS Care 2017; 30:72-80. [PMID: 28847156 PMCID: PMC5903847 DOI: 10.1080/09540121.2017.1367086] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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] [Indexed: 01/16/2023]
Abstract
Providing HIV testing services to truck drivers in Africa is crucial but has proven challenging. The introduction of HIV self-testing promises to provide expanded service delivery options for clients, potentially increasing demand for services and expanding coverage – especially important for high-risk and difficult-to-reach populations. This study examines the preferences regarding HIV testing service delivery models, among long distance truck drivers to identify testing services that would appeal to this population. Using a discrete choice experiment, this study examines the drivers of choice regarding HIV counselling and testing among 305 truck drivers recruited from two roadside wellness clinics along major trucking routes in Kenya. Participants made trade-offs between characteristics of HIV testing service delivery models by making hypothetical choices in a series of paired HIV testing scenarios. Conditional logit models were used to identify the HIV testing characteristics driving the selection of preferred scenarios, as well as determine whether preferences interact with individual characteristics – especially HIV testing history. Participants preferred free, provider-administered HIV testing at a roadside clinic, using a finger-prick test, with in-person counselling, undertaken in the shortest possible time. The strongest driver of choice was the cost of the test. Those who had never tested previously preferred oral testing and telephonic counselling, while those who were not regular testers favoured clinic based – over self-testing. The results of this study indicate that for the majority of participants – most of whom had tested before – the existing services offered at roadside clinics were the preferred service delivery model. The introduction of oral self-testing increases the options available to truck drivers and may even improve testing uptake for some, especially among those who have never tested before. However, these findings suggest the impact on HIV testing uptake of introducing oral self-testing may be limited in this population.
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Affiliation(s)
- Michael Strauss
- a Health Economics and HIV and AIDS Research Division (HEARD) , University of KwaZulu-Natal , Durban , South Africa
| | - Gavin George
- a Health Economics and HIV and AIDS Research Division (HEARD) , University of KwaZulu-Natal , Durban , South Africa
| | - Emma Lansdell
- a Health Economics and HIV and AIDS Research Division (HEARD) , University of KwaZulu-Natal , Durban , South Africa
| | - Joanne E Mantell
- b HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health , New York State Psychiatric Institute & Columbia University , New York , NY , USA
| | - Kaymarlin Govender
- a Health Economics and HIV and AIDS Research Division (HEARD) , University of KwaZulu-Natal , Durban , South Africa
| | - Matthew Romo
- c Department of Epidemiology and Biostatistics , CUNY Graduate School of Public Health and Health Policy, City University of New York , New York , NY , USA
| | | | - Eva Mwai
- d North Star Alliance , Nairobi , Kenya
| | | | - Elizabeth A Kelvin
- c Department of Epidemiology and Biostatistics , CUNY Graduate School of Public Health and Health Policy, City University of New York , New York , NY , USA
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Kelvin EA, George G, Mwai E, Nyaga E, Mantell JE, Romo ML, Odhiambo JO, Starbuck L, Govender K. Offering self-administered oral HIV testing to truck drivers in Kenya to increase testing: a randomized controlled trial. AIDS Care 2017; 30:47-55. [PMID: 28826229 PMCID: PMC5901679 DOI: 10.1080/09540121.2017.1360997] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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] [Indexed: 11/18/2022]
Abstract
We conducted a randomized controlled trial among 305 truck drivers from two North Star Alliance roadside wellness clinics in Kenya to see if offering HIV testing choices would increase HIV testing uptake. Participants were randomized to be offered (1) a provider-administered rapid blood (finger-prick) HIV test (i.e., standard of care [SOC]) or (2) a Choice between SOC or a self-administered oral rapid HIV test with provider supervision in the clinic. Participants in the Choice arm who refused HIV testing in the clinic were offered a test kit for home use with phone-based posttest counseling. We compared HIV test uptake using the Mantel Haenszel odds ratio (OR) adjusting for clinic. Those in the Choice arm had higher odds of HIV test uptake than those in the SOC arm (OR = 1.5), but the difference was not statistically significant (p = 0.189). When adding the option to take an HIV test kit for home use, the Choice arm had significantly greater odds of testing uptake (OR = 2.8, p = 0.002). Of those in the Choice arm who tested, 26.9% selected the SOC test, 64.6% chose supervised self-testing in the clinic, and 8.5% took a test kit for home use. Participants varied in the HIV test they selected when given choices. Importantly, when participants who refused HIV testing in the clinic were offered a test kit for home use, an additional 8.5% tested. Offering truck drivers a variety of HIV testing choices may increase HIV testing uptake in this key population.
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Affiliation(s)
- Elizabeth A Kelvin
- a Department of Epidemiology and Biostatistics & Institute for Implementation Science in Population Health , CUNY Graduate School of Public Health and Health Policy, City University of New York , New York , NY , USA
| | - Gavin George
- b Health Economics and HIV and AIDS Research Division , University of KwaZulu-Natal , Durban , South Africa
| | - Eva Mwai
- c North Star Alliance , Nairobi , Kenya
| | | | - Joanne E Mantell
- d HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health , New York State Psychiatric Institute & Columbia University , New York , NY , USA
| | - Matthew L Romo
- a Department of Epidemiology and Biostatistics & Institute for Implementation Science in Population Health , CUNY Graduate School of Public Health and Health Policy, City University of New York , New York , NY , USA
| | | | - Lila Starbuck
- a Department of Epidemiology and Biostatistics & Institute for Implementation Science in Population Health , CUNY Graduate School of Public Health and Health Policy, City University of New York , New York , NY , USA
| | - Kaymarlin Govender
- b Health Economics and HIV and AIDS Research Division , University of KwaZulu-Natal , Durban , South Africa
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