1
|
Haas AD, Kusejko K, Cavassini M, Günthard H, Stöckle M, Calmy A, Bernasconi E, Schmid P, Egger M, Wandeler G. Late Re-Engagement Into HIV Care Among Adults in the Swiss HIV Cohort Study. J Acquir Immune Defic Syndr 2025; 98:491-500. [PMID: 39748160 DOI: 10.1097/qai.0000000000003597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Accepted: 11/21/2024] [Indexed: 01/04/2025]
Abstract
INTRODUCTION Little is known about the clinical status of persons with HIV who re-engage in care after an interruption. We evaluated the immunologic and clinical characteristics of individuals re-engaging in care within the Swiss HIV Cohort Study. METHODS Participants who re-engaged in care after an interruption >14 months with a viral load ≥100 copies/mL were classified as having interrupted antiretroviral therapy (ART). We defined late re-engagement as re-engaging with a CD4 cell count of <350 cells/µL or a new Centers for Disease Control and Prevention stage C disease. Linear and logistic regression models with restricted cubic splines were used to estimate the mean CD4 cell count at re-engagement and the probability of late re-engagement as a function of care interruption duration. RESULTS Of 14,864 participants with a median follow-up of 10.2 years (interquartile range 4.7-17.2 years), 2768 (18.6%) interrupted care, of whom 1489 (53.8%) re-engaged. Among those re-engaging, 62.3% had interrupted ART. For participants who interrupted ART, the mean CD4 count declined from 374 cells/µL [95% confidence interval (CI): 358 to 391 cells/µL] before the interruption to 250 cells/µL (95% CI: 221 to 281 cells/µL) among those re-engaging after 14 months, and to 185 cells/µL (95% CI: 160 to 212 cells/µL) among those re-engaging after 60 months. The estimated risk of late re-engagement in care was 68.6% (95% CI: 62.3% to 74.4%) for participants who interrupted ART for 14 months and 75.2% (95% CI: 68.9% to 80.6%) for those who interrupted ART for 60 months. CONCLUSIONS Although HIV care interruptions are not very common in Switzerland, most persons with HIV re-engaging after interrupting ART return with late-stage HIV.
Collapse
Affiliation(s)
- Andreas D Haas
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Katharina Kusejko
- Department of Infectious Diseaes and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Matthias Cavassini
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Huldrych Günthard
- Department of Infectious Diseaes and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Marcel Stöckle
- Division of Infectious Diseases, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases, Ente Ospedaliero Cantonale Lugano, University of Geneva and University of Southern Switzerland, Lugano, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gilles Wandeler
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; and
| |
Collapse
|
2
|
Nankya I, Natukunda E, Rutebarika D, Matama C, Basiimwa R, Arikod P, Muwabe F, Otike C, Kityo C. High prevalence of low-level viremia among infants initiated on antiretroviral drugs following mother-to-child transmission of HIV. AIDS Res Ther 2025; 22:34. [PMID: 40069769 PMCID: PMC11899026 DOI: 10.1186/s12981-025-00701-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 01/07/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND With the current elimination of mother to child transmission (EMTCT) of HIV, the number of HIV-positive newborns has greatly reduced. Some countries have successfully eliminated HIV infections among newborn babies. METHODS This study was nested within the DRIBS (Drug Resistance testing among Infants at Baseline Study), which enrolled 100 infants at the time of treatment initiation between 2017 and 2023. Infants were followed for two years. Viral load (VL) was measured every six months and after completion of the three sessions of intensified adherence counseling (IAC). IAC and HIV drug resistance testing were performed for VL greater than 1000 copies/ml. RESULTS The median age at diagnosis was 79 (IQR, 57.75;140.75) days, with 4% of patients diagnosed within 6 weeks after delivery. The median age at the initiation of therapy was 110.5 (IQR, 87.0-162.0) days. The median baseline %CD4 was 26 (IQR, 18.75;32), with 9% of the babies being severely immunosuppressed (%CD4 < 15%). The median baseline log viral load was 4.44 (IQR, 3.19-5.58). At six months, 30% and 60% of the patients had a VL < 50 and < 1000 copies/ml, respectively. At 12 months, 36% and 69% of patients had a VL < 50 and < 1000 copies/ml, respectively. At 24 months, 63% and 83% had VL < 50 and < 1000 copies/ml, respectively. Post-IAC VL revealed that 35% of the children had low-level viremia (LLV) compared to mothers 11.5%. Kaplan-Meyer survival estimates showed that while it took 72 weeks for 50% of the mothers and infants to attain a VL less than 1000 copies/ml, it took 96 weeks for the infants to attain a VL < 50 copies/ml. CONCLUSION A Viral load < 1000 copies/ml is achieved much more slowly in pediatric patients, implying that it might take longer for babies to achieve the third 95 (95% virally suppressed) of the UNAIDS targets. Furthermore, the greater prevalence of LLV in pediatric patients than in mothers has important implications for the response to therapy.
Collapse
Affiliation(s)
- Immaculate Nankya
- Joint Clinical Research Center, Plot 101 Lubowa Hill, Kampala, Uganda.
- Center for AIDS Research, Joint Clinical Research Centre, Plot 101 Lubowa Hill, Kampala, Uganda.
| | - Eva Natukunda
- Joint Clinical Research Center, Plot 101 Lubowa Hill, Kampala, Uganda
| | - Diana Rutebarika
- Joint Clinical Research Center, Plot 101 Lubowa Hill, Kampala, Uganda
| | - Christine Matama
- Joint Clinical Research Center, Plot 101 Lubowa Hill, Kampala, Uganda
| | - Roy Basiimwa
- Joint Clinical Research Center, Plot 101 Lubowa Hill, Kampala, Uganda
| | - Paul Arikod
- Joint Clinical Research Center, Plot 101 Lubowa Hill, Kampala, Uganda
| | - Faryad Muwabe
- Joint Clinical Research Center, Plot 101 Lubowa Hill, Kampala, Uganda
| | - Caroline Otike
- Joint Clinical Research Center, Plot 101 Lubowa Hill, Kampala, Uganda
| | - Cissy Kityo
- Joint Clinical Research Center, Plot 101 Lubowa Hill, Kampala, Uganda
| |
Collapse
|
3
|
Mutyambizi C, Rees K, Grimsrud A, Ndou R, Wilkinson LS. The heterogeneity among people re-engaging in antiretroviral therapy highlights the need for a differentiated approach: results from a cross-sectional study in Johannesburg, South Africa. J Int AIDS Soc 2024; 27:e26395. [PMID: 39648158 PMCID: PMC11625505 DOI: 10.1002/jia2.26395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 11/07/2024] [Indexed: 12/10/2024] Open
Abstract
INTRODUCTION Disengagement and re-engagement with antiretroviral therapy (ART) are common in South Africa, but routine monitoring is insufficient to inform policy development. To address this gap, Anova implemented the 2020 National Adherence Guidelines' re-engagement standard operating procedure (re-engagement SOP) and collected additional data to describe the characteristics of re-engagement visits to inform HIV programmes. METHODS Between July and December 2022, we conducted a study at nine primary healthcare facilities in Johannesburg. Staff were trained on the re-engagement SOP and provided with job aides to support implementation. Administration clerks categorized visits based on the time elapsed since the missed appointment: ≤14days and >14 days, with the latter identified as re-engaging. For these clients, clinicians filled out "re-engagement clinical assessment forms" that included visit dates, both clinician-assessed and self-reported treatment interruptions, and clinical details. Data on missed appointments and previous viral loads were extracted from medical records. The information was entered into REDCap. We present data from three out of the nine facilities, selected for their comprehensive data collection and high coverage of all re-engaging clients. RESULTS A total of 2342 clients returned following a missed scheduled appointment. The majority, 1523 (65%), missed their appointments by ≤ 14 days, while 819 (35%) were >14 days late (re-engaging). Among those re-engaging, 635 (78%) re-engagement clinical assessment forms were completed. A missed appointment date was available for 623 with 25% (n = 161) returning 2-4 weeks late, 47% (n = 298) 4-12 weeks and 26% (n = 164) >12 weeks late. Self-reported ART interruption, available for 89% (567/635), indicated the majority (54%, n = 304) experienced no interruption. Clinical concerns were identified in 65 (10%) cases. A majority (79%, 504/635) had prior viral load results, with 73% (370/504) below 50 copies/ml. CONCLUSIONS Clients frequently return to care shortly after missed appointments. Despite missing scheduled ART refill dates, many report not interrupting treatment, either having treatment on hand or sourcing ART elsewhere. Most re-engaging clients were adherent prior to disengagement, and clinical concerns are rare. A differentiated service delivery approach, prioritizing flexibility and reduced healthcare burden, is required to support client's needs and preferences at re-engagement.
Collapse
Affiliation(s)
| | - Kate Rees
- Anova Health InstituteJohannesburgSouth Africa
- Department of Community HealthSchool of Public Health, University of the WitwatersrandJohannesburgSouth Africa
| | | | | | - Lynne S. Wilkinson
- International AIDS SocietyCape TownSouth Africa
- Centre for Infectious Epidemiology and Research, Faculty of Health Sciences, University of Cape TownCape TownSouth Africa
| |
Collapse
|
4
|
MOOLLA H, DAVIES MA, DAVIES C, EUVRARD J, PROZESKY HW, FOX MP, ORRELL C, VON GROOTE P, JOHNSON LF, International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) Collaboration. The effect of care interruptions on mortality in adults resuming antiretroviral therapy. AIDS 2024; 38:1198-1205. [PMID: 38814712 PMCID: PMC11141523 DOI: 10.1097/qad.0000000000003859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To estimate the relative rate of all-cause mortality amongst those on antiretroviral treatment (ART) with a history of interruptions compared with those with no previous interruptions in care. DESIGN Retrospective cohort study. METHODS We used data from four South African cohorts participating in the International epidemiology Databases to Evaluate AIDS Southern Africa collaboration. We included adults who started ART between 2004 and 2019. We defined a care interruption as a gap in contact longer than 180 days. Observation time prior to interruption was allocated to a 'no interruption' group. Observation time after interruption was allocated to one of two groups based on whether the first interruption started before 6 months of ART ('early interruption') or later ('late interruption'). We used Cox regression to estimate hazard ratios. RESULTS Sixty-three thousand six hundred and ninety-two participants contributed 162 916 person-years of observation. There were 3469 deaths. Most participants were female individuals (67.4%) and the median age at ART initiation was 33.3 years (interquartile range: 27.5-40.7). Seventeen thousand and eleven (26.7%) participants experienced care interruptions. Those resuming ART experienced increased mortality compared with those with no interruptions: early interrupters had a hazard ratio of 4.37 (95% confidence interval (CI) 3.87-4.95) and late interrupters had a hazard ratio of 2.74 (95% CI 2.39-3.15). In sensitivity analyses, effect sizes were found to be proportional to the length of time used to define interruptions. CONCLUSION Our findings highlight the need to improve retention in care, regardless of treatment duration. Programmes to encourage return to care also need to be strengthened.
Collapse
Affiliation(s)
- Haroon MOOLLA
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann DAVIES
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Claire DAVIES
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Jonathan EUVRARD
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Hans W. PROZESKY
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Matthew P. FOX
- Department of Epidemiology and Department of Global Health, Boston University, Boston, Massachusetts, USA
| | | | - Per VON GROOTE
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Leigh F. JOHNSON
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | | |
Collapse
|
5
|
Wilkinson L, Grimsrud A. Enabling effective differentiated service delivery transitions for people on antiretroviral treatment. AIDS 2024; 38:615-622. [PMID: 38170470 PMCID: PMC10942239 DOI: 10.1097/qad.0000000000003826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Lynne Wilkinson
- IAS –International AIDS Society
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | |
Collapse
|
6
|
Mody A, Sohn AH, Iwuji C, Tan RKJ, Venter F, Geng EH. HIV epidemiology, prevention, treatment, and implementation strategies for public health. Lancet 2024; 403:471-492. [PMID: 38043552 DOI: 10.1016/s0140-6736(23)01381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/28/2023] [Accepted: 06/29/2023] [Indexed: 12/05/2023]
Abstract
The global HIV response has made tremendous progress but is entering a new phase with additional challenges. Scientific innovations have led to multiple safe, effective, and durable options for treatment and prevention, and long-acting formulations for 2-monthly and 6-monthly dosing are becoming available with even longer dosing intervals possible on the horizon. The scientific agenda for HIV cure and remission strategies is moving forward but faces uncertain thresholds for success and acceptability. Nonetheless, innovations in prevention and treatment have often failed to reach large segments of the global population (eg, key and marginalised populations), and these major disparities in access and uptake at multiple levels have caused progress to fall short of their potential to affect public health. Moving forward, sharper epidemiologic tools based on longitudinal, person-centred data are needed to more accurately characterise remaining gaps and guide continued progress against the HIV epidemic. We should also increase prioritisation of strategies that address socio-behavioural challenges and can lead to effective and equitable implementation of existing interventions with high levels of quality that better match individual needs. We review HIV epidemiologic trends; advances in HIV prevention, treatment, and care delivery; and discuss emerging challenges for ending the HIV epidemic over the next decade that are relevant for general practitioners and others involved in HIV care.
Collapse
Affiliation(s)
- Aaloke Mody
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.
| | - Annette H Sohn
- TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | - Collins Iwuji
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK; Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Rayner K J Tan
- University of North Carolina Project-China, Guangzhou, China; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Elvin H Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
7
|
Ntinga X, Musiello F, Pita T, Mabaso N, Celum C, Szpiro A, van Rooyen H, Barnabas R, van Heerden A. People living with HIV's perspectives of acceptability of fee for home delivery of ART: a qualitative study. BMC Health Serv Res 2024; 24:88. [PMID: 38233824 PMCID: PMC10792944 DOI: 10.1186/s12913-023-10533-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/27/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Significant progress has been made in the HIV response in South Africa; however, gaps remain in ensuring engagement in care to support life-long medication adherence and viral suppression. The National Department of Health (NDoH) has introduced community-based and clinic-based HIV differentiated service delivery (DSD) models to tackle suboptimal adherence and retention in care. Nevertheless, differentiated care models require adaptation to better serve clients who struggle with adherence. There is limited research on the acceptability of fee for home delivery of ART in resource-constrained settings. The current study investigates the acceptability of fee for home delivery of ART among people living with HIV in South Africa. METHODS Two mixed-gender focus group discussions (FGDs) took place between June and November 2019, consisting of 10 participants in each group. A purposive sampling strategy was employed to identify and select 10 people living with HIV who were ART-eligible but not in care, and 10 people living with HIV who were currently taking ART and in care. Participants were grouped according to their treatment status. A coding framework, informed by a priori categories and derived from topics in the interview guide, was developed and utilized to facilitate analysis. RESULTS Participants expressed enthusiasm for having ART home-delivered, as it would save the time spent waiting in long queues at the clinic. However, some participants raised concerns about potential payment difficulties due to high unemployment rates in the community. Some participants believed this would be acceptable, as patients already incur costs for travel and food when visiting the clinic. Participants in both FGDs expressed strong concerns about home delivery of their ART based on fear of accidental disclosure, especially for those who have not disclosed to their immediate families and partners. CONCLUSION Our study suggests that charging a fee for home delivery is an acceptable and innovative approach to supporting PLHIV in maintaining adherence to their medication and remaining in care.
Collapse
Affiliation(s)
- Xolani Ntinga
- Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, Sweetwaters, Pietermaritzburg, KZN, 3201, South Africa.
| | - Franco Musiello
- Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, Sweetwaters, Pietermaritzburg, KZN, 3201, South Africa
| | - Thembelihle Pita
- Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, Sweetwaters, Pietermaritzburg, KZN, 3201, South Africa
| | - Nomagugu Mabaso
- Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, Sweetwaters, Pietermaritzburg, KZN, 3201, South Africa
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, WA, USA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Adam Szpiro
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Heidi van Rooyen
- Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, Sweetwaters, Pietermaritzburg, KZN, 3201, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ruanne Barnabas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Alastair van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, Sweetwaters, Pietermaritzburg, KZN, 3201, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
8
|
Dovel K, Balakasi K, Hubbard J, Phiri K, Nichols BE, Coates TJ, Kulich M, Chikuse E, Phiri S, Long LC, Hoffman RM, Choko AT. Identifying efficient linkage strategies for men (IDEaL): a study protocol for an individually randomised control trial. BMJ Open 2023; 13:e070896. [PMID: 37438067 PMCID: PMC10347494 DOI: 10.1136/bmjopen-2022-070896] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/03/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Men in sub-Saharan Africa are less likely than women to initiate antiretroviral therapy (ART) and more likely to have longer cycles of disengagement from ART programmes. Treatment interventions that meet the unique needs of men are needed, but they must be scalable. We will test the impact of various interventions on 6-month retention in ART programmes among men living with HIV who are not currently engaged in care (never initiated ART and ART clients with treatment interruption). METHODS AND ANALYSIS We will conduct a programmatic, individually randomised, non-blinded, controlled trial. 'Non-engaged' men will be randomised 1:1:1 to either a low-intensity, high-intensity or stepped arm. The low-intensity intervention includes one-time male-specific counseling+facility navigation only. The high-intensity intervention offers immediate outside-facility ART initiation+male-specific counselling+facility navigation for follow-up ART visits. In the stepped arm, intervention activities build in intensity over time for those who do not re-engage in care with the following steps: (1) one-time male-specific counselling+facility navigation→(2) ongoing male mentorship+facility navigation→(3) outside-facility ART initiation+male-specific counselling+facility navigation for follow-up ART visits. Our primary outcome is 6-month retention in care. Secondary outcomes include cost-effectiveness and rates of adverse events. The primary analysis will be intention to treat with all eligible men in the denominator and all men retained in care at 6 months in the numerator. The proportions achieving the primary outcome will be compared with a risk ratio, corresponding 95% CI and p value computed using binomial regression accounting for clustering at facility level. ETHICS AND DISSEMINATION The Institutional Review Board of the University of California, Los Angeles and the National Health Sciences Research Council in Malawi have approved the trial protocol. Findings will be disseminated rapidly in national and international forums and in peer-reviewed journals and are expected to provide urgently needed information to other countries and donors. TRIAL REGISTRATION NUMBER NCT05137210. DATE AND VERSION 5 May 2023; version 3.
Collapse
Affiliation(s)
- Kathryn Dovel
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Implementation Science, Partners in Hope, Lilongwe, Malawi
| | - Kelvin Balakasi
- Department of Implementation Science, Partners in Hope, Lilongwe, Malawi
| | - Julie Hubbard
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Khumbo Phiri
- Department of Implementation Science, Partners in Hope, Lilongwe, Malawi
| | - Brooke E Nichols
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Medical Microbiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Thomas J Coates
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Global Health Institute, University of California, San Francisco, California, USA
| | - Michal Kulich
- Department of Probability and Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czechia
| | - Elijah Chikuse
- Department of Implementation Science, Partners in Hope, Lilongwe, Malawi
| | - Sam Phiri
- Department of Implementation Science, Partners in Hope, Lilongwe, Malawi
| | - Lawrence C Long
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Risa M Hoffman
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Augustine T Choko
- Clinical Research Programme, Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
9
|
Rose AL, Ochieng YA, Jack HE, Sangraula A, Ciya N, Jacobs Y, Ndamase S, Regenauer KS, Brown I, Hines AC, Johnson K, Bassett IV, Joska JA, Magidson JF, Myers B. Patient and stakeholder perspectives on impacts of the COVID-19 pandemic on HIV and mental health care delivery in South Africa. Int J STD AIDS 2023; 34:525-531. [PMID: 36943694 PMCID: PMC10031273 DOI: 10.1177/09564624231160581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/13/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND The COVID-19 pandemic had a global impact on health systems and the delivery of health services, including for chronic conditions such as HIV. In South Africa, impacts on HIV services have widely been quantitatively described. Across different health settings, patients have also qualitatively described numerous negative impacts to their HIV care. However, patient perspectives on COVID-19 impacts to HIV care in South Africa, the largest HIV care system in the world, have been little explored to date. METHODS We conducted 29 semi-structured individual interviews with people living with HIV (n = 24) and providers (n = 5) in Cape Town, South Africa. RESULTS While most patient participants reported continued access to HIV treatment during the pandemic, many described perceiving that the quality of their care declined. Increased structural barriers were described as one contributing factor to this change. Additionally, patients described that reduced privacy in clinical interactions was a key factor negatively influencing their experience of receiving care. CONCLUSION Findings underscore the importance of ensuring patient privacy for HIV services even during the rearrangement of services in emergencies. It is also important to continue developing models to integrate community mental health services within HIV care delivery in South Africa.
Collapse
Affiliation(s)
- Alexandra L Rose
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Yvonne A Ochieng
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Helen E Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Anu Sangraula
- Department of Behavioral and Community Health, University of Maryland, College Park, MD, USA
| | - Nonceba Ciya
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa
| | - Yuche Jacobs
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa
| | - Sibabalwe Ndamase
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa
| | | | - Imani Brown
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Abigail C Hines
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa
| | - Ingrid V Bassett
- Division of Infectious Diseases, Medical Practice Evaluation Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - John A Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa
- Curtin EnAble Institute, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
10
|
Zhou Y, Li Y, Xiao X, Qian HZ, Wang H. Perceptions toward antiretroviral therapy and delayed ART initiation among people living with HIV in Changsha, China: mediating effects of treatment willingness. Front Public Health 2023; 11:1105208. [PMID: 37383264 PMCID: PMC10294673 DOI: 10.3389/fpubh.2023.1105208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/11/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction Delayed antiretroviral therapy (ART) initiation is associated with poor HIV outcomes and a higher likelihood of HIV transmission. Methods This cross-sectional study assessed the proportion of delayed ART initiation which was defined as initiating ART after 30 days of HIV diagnosis, and evaluated the pathways influencing ART initiation among adult PLWH in Changsha, China who were diagnosed between 2014 and 2022. Results Of 518 participants, 37.8% delayed in initiating ART. Based on the theory of reasoned action (TRA), delayed initiation was indirectly associated with perceptions toward ART through the mediating pathway of patients' treatment willingness, with treatment willingness significantly being the full mediator. Discussion The findings may guide the development of interventions to improve timely uptake of ART in people who are newly diagnosed with HIV.
Collapse
Affiliation(s)
- Yaqin Zhou
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yixuan Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xueling Xiao
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Han-Zhu Qian
- School of Public Health, Yale University, New Haven, CT, United States
| | - Honghong Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| |
Collapse
|
11
|
Dovel KL, Hariprasad S, Hubbard J, Cornell M, Phiri K, Choko A, Abbott R, Hoffman R, Nichols B, Gupta S, Long L. Strategies to improve antiretroviral therapy (ART) initiation and early engagement among men in sub-Saharan Africa: A scoping review of interventions in the era of universal treatment. Trop Med Int Health 2023; 28:454-465. [PMID: 37132119 PMCID: PMC10354296 DOI: 10.1111/tmi.13880] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVES Men in sub-Saharan Africa (SSA) have lower rates of antiretroviral therapy (ART) initiation and higher rates of early default than women. Little is known about effective interventions to improve men's outcomes. We conducted a scoping review of interventions aimed to increase ART initiation and/or early retention among men in SSA since universal treatment policies were implemented. METHODS Three databases, HIV conference databases and grey literature were searched for studies published between January 2016 to May 2021 that reported on initiation and/or early retention among men. Eligibility criteria included: participants in SSA, data collected after universal treatment policies were implemented (2016-2021), quantitative data on ART initiation and/or early retention for males, general male population (not exclusively focused on key populations), intervention study (report outcomes for at least one non-standard service delivery strategy), and written in English. RESULTS Of the 4351 sources retrieved, 15 (reporting on 16 interventions) met inclusion criteria. Of the 16 interventions, only two (2/16, 13%) exclusively focused on men. Five (5/16, 31%) were randomised control trials (RCT), one (1/16, 6%) was a retrospective cohort study, and 10 (10/16, 63%) did not have comparison groups. Thirteen (13/16, 81%) interventions measured ART initiation and six (6/16, 37%) measured early retention. Outcome definitions and time frames varied greatly, with seven (7/16, 44%) not specifying time frames at all. Five types of interventions were represented: optimising ART services at health facilities, community-based ART services, outreach support (such as reminders and facility escort), counselling and/or peer support, and conditional incentives. Across all intervention types, ART initiation rates ranged from 27% to 97% and early retention from 47% to 95%. CONCLUSIONS Despite years of data of men's suboptimal ART outcomes, there is little high-quality evidence on interventions to increase men's ART initiation or early retention in SSA. Additional randomised or quasi-experimental studies are urgently needed.
Collapse
Affiliation(s)
- Kathryn L Dovel
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
- Partners in Hope Medical Center, Lilongwe, Malawi
| | - Santhi Hariprasad
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Julie Hubbard
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
- Partners in Hope Medical Center, Lilongwe, Malawi
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Khumbo Phiri
- Partners in Hope Medical Center, Lilongwe, Malawi
| | | | - Rachel Abbott
- Division of HIV, Infections Diseases & Global Medicine, University of California San Francisco, San Francisco, California, USA
| | - Risa Hoffman
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Brooke Nichols
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Sundeep Gupta
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Lawrence Long
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
12
|
Dringus S, Davis K, Simms V, Bernays S, Redzo N, Bandason T, Chikodzore R, Sibanda E, Webb K, Ncube G, Kranzer K, Ferrand RA, Dziva Chikwari C. Delivery of index-linked HIV testing for children: learnings from a qualitative process evaluation of the B-GAP study in Zimbabwe. BMC Infect Dis 2023; 23:262. [PMID: 37101147 PMCID: PMC10131435 DOI: 10.1186/s12879-023-08088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 02/16/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Index-linked HIV testing for children, whereby HIV testing is offered to children of individuals living with HIV, has the potential to identify children living with undiagnosed HIV. The "Bridging the Gap in HIV Testing and Care for Children in Zimbabwe" (B-GAP) study implemented and evaluated the provision of index-linked HIV testing for children aged 2-18 years in Zimbabwe. We conducted a process evaluation to understand the considerations for programmatic delivery and scale-up of this strategy. METHODS We used implementation documentation to explore experiences of the field teams and project manager who delivered the index-linked testing program, and to describe barriers and facilitators to index-linked testing from their perspectives. Qualitative data were drawn from weekly logs maintained by the field teams, monthly project meeting minutes, the project coordinator's incident reports and WhatsApp group chats between the study team and the coordinator. Data from each of the sources was analysed thematically and synthesised to inform the scale-up of this intervention. RESULTS Five main themes were identified related to the implementation of the intervention: (1) there was reduced clinic attendance of potentially eligible indexes due to community-based differentiated HIV care delivery and collection of HIV treatment by proxy individuals; (2) some indexes reported that they did not live in the same household as their children, reflecting the high levels of community mobility; (3) there were also thought to be some instances of 'soft refusal'; (4) further, delivery of HIV testing was limited by difficulties faced by indexes in attending health facilities with their children for clinic-based testing, stigma around community-based testing, and the lack of familiarity of indexes with caregiver provided oral HIV testing; (5) and finally, test kit stockouts and inadequate staffing also constrained delivery of index-linked HIV testing. CONCLUSIONS There was attrition along the index-linked HIV testing cascade of children. While challenges remain at all levels of implementation, programmatic adaptations of index-linked HIV testing approaches to suit patterns of clinic attendance and household structures may strengthen implementation of this strategy. Our findings highlight the need to tailor index-linked HIV testing to subpopulations and contexts to maximise its effectiveness.
Collapse
Affiliation(s)
- Stefanie Dringus
- Public Health, Environments and Society Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
| | - Katherine Davis
- MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
| | - Victoria Simms
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Sarah Bernays
- Global Health Department, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, University of Sydney, Sydney, Australia
| | - Nicol Redzo
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rudo Chikodzore
- Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| | - Edwin Sibanda
- City Health Department, Bulawayo City Council, Bulawayo, Zimbabwe
| | - Karen Webb
- Organization for Public Health Interventions and Development, Harare, Zimbabwe
| | - Getrude Ncube
- Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| | - Katharina Kranzer
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Division of Infectious and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - Rashida A Ferrand
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| |
Collapse
|
13
|
Kherghehpoush S, McKeirnan KC. The role of community pharmacies in the HIV and HCV care continuum. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100215. [PMID: 36938123 PMCID: PMC10017415 DOI: 10.1016/j.rcsop.2022.100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction In 2019, there were over 1.1 million people living with human immunodeficiency virus (HIV) and 2.4 million people living with hepatitis C virus (HCV) in the United States. One in seven (14%) are unaware of their HIV infection and almost half of all HCV infections are undiagnosed. People with unstable housing are disproportionately affected by HIV and HCV. The present study will evaluate interventions by community pharmacists that may reduce HIV and HCV transmission and promote linkage to care. Methods This study was conducted in an independent community pharmacy in Spokane, Washington. Eligible study participants were walk-in patients of the pharmacy, over the age of 18, and experiencing homelessness. Pharmacy patients were excluded if they had a history of HIV or HCV diagnosis, received a screening for HIV or HCV in the last six months or were unable to give informed consent. The intervention included administration of HIV and HCV point-of-care testing (POCT) using a blood sample, risk determination interview, comprehensive HIV and HCV education, and personalized post-test and risk mitigation counseling followed by referral to partnering health clinics. Results Fifty participants were included in the final data analysis. Twenty-two participants (44%) had a reactive HCV POCT, and one participant had a reactive HIV POCT. Of the 94% of participants who reported illicit drug use, 74% reported injection drug use. Seventy-six percent (n = 38) qualified for PrEP. Pharmacist referrals were made for 28 participants and 71% were confirmed to have established care. Conclusion Individuals experiencing homelessness are at an increased risk for acquiring HIV and HCV due to risky sexual behaviors and substance misuse. PrEP is underutilized in the U.S. and pharmacist involvement in the HIV and HCV care continuum may have a significant impact in improving linkage and retention in care of difficult to treat populations.
Collapse
|
14
|
Van Heerden A, Humphries H, Geng E. Whole person HIV services: a social science approach. Curr Opin HIV AIDS 2023; 18:46-51. [PMID: 36440805 PMCID: PMC9799045 DOI: 10.1097/coh.0000000000000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Globally, approximately 38.4 million people who are navigating complex lives, are also living with HIV, while HIV incident cases remain high. To improve the effectiveness of HIV prevention and treatment service implementation, we need to understand what drives human behaviour and decision-making around HIV service use. This review highlights current thinking in the social sciences, emphasizing how understanding human behaviour can be leveraged to improve HIV service delivery. RECENT FINDINGS The social sciences offer rich methodologies and theoretical frameworks for investigating how factors synergize to influence human behaviour and decision-making. Social-ecological models, such as the Behavioural Drivers Model (BDM), help us conceptualize and investigate the complexity of people's lives. Multistate and group-based trajectory modelling are useful tools for investigating the longitudinal nature of peoples HIV journeys. Successful HIV responses need to leverage social science approaches to design effective, efficient, and high-quality programmes. SUMMARY To improve our HIV response, implementation scientists, interventionists, and public health officials must respond to the context in which people make decisions about their health. Translating biomedical efficacy into real-world effectiveness is not simply finding a way around contextual barriers but rather engaging with the social context in which communities use HIV services.
Collapse
Affiliation(s)
- Alastair Van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg
| | - Hilton Humphries
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg
- Department of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Elvin Geng
- Centre for Dissemination and Implementation, Institute of Public Health, Division of Infectious Diseases, Department of Medicine, School of Medicine at Washington University in St. Louis, St. Louis, Missouri, USA
| |
Collapse
|
15
|
Olislagers Q, van Leth F, Shabalala F, Dlamini N, Simelane N, Masilela N, Gomez GB, Pell C, Vernooij E, Reis R, Molemans M. Reasons for, and factors associated with, positive HIV retesting: a cross-sectional study in Eswatini. AIDS Care 2022:1-8. [PMID: 36449635 DOI: 10.1080/09540121.2022.2142930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Eswatini has a high HIV prevalence but has made progress towards improving HIV-status awareness, ART uptake and viral suppression. However, there is still a delay in ART initiation, which could partly be attributed to positive HIV-retesting. This study examines reasons for, and factors associated with, positive HIV-retesting among MaxART participants in Eswatini. Data from 601 participants is included in this cross-sectional study. Descriptive statistics and logistic regressions were used. Of the participants, 32.8% has ever retested after a previous positive result. Most participants who retested did this because they could not accept their results (61.9% of all retesters). Other main reasons are related to external influences, gender or the progression of their HIV infection (respectively 18.3%, 10.2%, and 6.1% of all retesters). Participants without a current partner and participants with less time since their first positive test have lower odds of retesting. To decrease retesting and reduce the delay in ART initiation resulting from it, efforts could be made on increasing the acceptance of positive HIV results. Providing more information on the process of testing and importance of early ART initiation, could be part of the solution.
Collapse
Affiliation(s)
- Quint Olislagers
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Frank van Leth
- Department of health sciences, VU University, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Fortunate Shabalala
- Department of Community Health Nursing Sciences, Faculty of Health Sciences, University of Eswatini, Mbabane, Eswatini
| | - Njabuliso Dlamini
- National Emergency Response Council on HIV and AIDS (NERCHA), Mbabane, Eswatini
| | | | - Nelisiwe Masilela
- Department of Community Health Nursing Sciences, Faculty of Health Sciences, University of Eswatini, Mbabane, Eswatini
| | - Gabriela B. Gomez
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Pell
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Global Health Amsterdam, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
| | - Eva Vernooij
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands
| | - Ria Reis
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- The Children’s Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Marjan Molemans
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
16
|
Keene CM, Ragunathan A, Euvrard J, English M, McKnight J, Orrell C, the InCARE Stakeholder Group. Measuring patient engagement with HIV care in sub-Saharan Africa: a scoping study. J Int AIDS Soc 2022; 25:e26025. [PMID: 36285618 PMCID: PMC9597383 DOI: 10.1002/jia2.26025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Engagement with HIV care is a multi-dimensional, dynamic process, critical to maintaining successful treatment outcomes. However, measures of engagement are not standardized nor comprehensive. This undermines our understanding of the scope of challenges with engagement and whether interventions have an impact, complicating patient and programme-level decision-making. This study identified and characterized measures of engagement to support more consistent and comprehensive evaluation. METHODS We conducted a scoping study to systematically categorize measures the health system could use to evaluate engagement with HIV care for those on antiretroviral treatment. Key terms were used to search literature databases (Embase, PsychINFO, Ovid Global-Health, PubMed, Scopus, CINAHL, Cochrane and the World Health Organization Index Medicus), Google Scholar and stakeholder-identified manuscripts, ultimately including English evidence published from sub-Saharan Africa from 2014 to 2021. Measures were extracted, organized, then reviewed with key stakeholders. RESULTS AND DISCUSSION We screened 14,885 titles/abstracts, included 118 full-texts and identified 110 measures of engagement, categorized into three engagement dimensions ("retention," "adherence" and "active self-management"), a combination category ("multi-dimensional engagement") and "treatment outcomes" category (e.g. viral load as an end-result reflecting that engagement occurred). Retention reflected status in care, continuity of attendance and visit timing. Adherence was assessed by a variety of measures categorized into primary (prescription not filled) and secondary measures (medication not taken as directed). Active self-management reflected involvement in care and self-management. Three overarching use cases were identified: research to make recommendations, routine monitoring for quality improvement and strategic decision-making and assessment of individual patients. CONCLUSIONS Heterogeneity in conceptualizing engagement with HIV care is reflected by the broad range of measures identified and the lack of consensus on "gold-standard" indicators. This review organized metrics into five categories based on the dimensions of engagement; further work could identify a standardized, minimum set of measures useful for comprehensive evaluation of engagement for different use cases. In the interim, measurement of engagement could be advanced through the assessment of multiple categories for a more thorough evaluation, conducting sensitivity analyses with commonly used measures for more comparable outputs and using longitudinal measures to evaluate engagement patterns. This could improve research, programme evaluation and nuanced assessment of individual patient engagement in HIV care.
Collapse
Affiliation(s)
- Claire M. Keene
- Health Systems CollaborativeOxford Centre for Global Health ResearchNuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Ayesha Ragunathan
- Health Systems CollaborativeOxford Centre for Global Health ResearchNuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Jonathan Euvrard
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public Health and Family MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Mike English
- Health Systems CollaborativeOxford Centre for Global Health ResearchNuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Jacob McKnight
- Health Systems CollaborativeOxford Centre for Global Health ResearchNuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Catherine Orrell
- Department of MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | | |
Collapse
|
17
|
Keene CM, Ragunathan A, Euvrard J, English M, McKnight J, Orrell C, the InCARE Stakeholder Group. Measuring patient engagement with HIV care in sub-Saharan Africa: a scoping study. J Int AIDS Soc 2022; 25:e26025. [PMID: 36285618 PMCID: PMC9597383 DOI: 10.1002/jia2.26025/full|10.1002/jia2.26025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/27/2022] [Indexed: 05/22/2023] Open
Abstract
INTRODUCTION Engagement with HIV care is a multi-dimensional, dynamic process, critical to maintaining successful treatment outcomes. However, measures of engagement are not standardized nor comprehensive. This undermines our understanding of the scope of challenges with engagement and whether interventions have an impact, complicating patient and programme-level decision-making. This study identified and characterized measures of engagement to support more consistent and comprehensive evaluation. METHODS We conducted a scoping study to systematically categorize measures the health system could use to evaluate engagement with HIV care for those on antiretroviral treatment. Key terms were used to search literature databases (Embase, PsychINFO, Ovid Global-Health, PubMed, Scopus, CINAHL, Cochrane and the World Health Organization Index Medicus), Google Scholar and stakeholder-identified manuscripts, ultimately including English evidence published from sub-Saharan Africa from 2014 to 2021. Measures were extracted, organized, then reviewed with key stakeholders. RESULTS AND DISCUSSION We screened 14,885 titles/abstracts, included 118 full-texts and identified 110 measures of engagement, categorized into three engagement dimensions ("retention," "adherence" and "active self-management"), a combination category ("multi-dimensional engagement") and "treatment outcomes" category (e.g. viral load as an end-result reflecting that engagement occurred). Retention reflected status in care, continuity of attendance and visit timing. Adherence was assessed by a variety of measures categorized into primary (prescription not filled) and secondary measures (medication not taken as directed). Active self-management reflected involvement in care and self-management. Three overarching use cases were identified: research to make recommendations, routine monitoring for quality improvement and strategic decision-making and assessment of individual patients. CONCLUSIONS Heterogeneity in conceptualizing engagement with HIV care is reflected by the broad range of measures identified and the lack of consensus on "gold-standard" indicators. This review organized metrics into five categories based on the dimensions of engagement; further work could identify a standardized, minimum set of measures useful for comprehensive evaluation of engagement for different use cases. In the interim, measurement of engagement could be advanced through the assessment of multiple categories for a more thorough evaluation, conducting sensitivity analyses with commonly used measures for more comparable outputs and using longitudinal measures to evaluate engagement patterns. This could improve research, programme evaluation and nuanced assessment of individual patient engagement in HIV care.
Collapse
Affiliation(s)
- Claire M. Keene
- Health Systems CollaborativeOxford Centre for Global Health ResearchNuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Ayesha Ragunathan
- Health Systems CollaborativeOxford Centre for Global Health ResearchNuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Jonathan Euvrard
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public Health and Family MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Mike English
- Health Systems CollaborativeOxford Centre for Global Health ResearchNuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Jacob McKnight
- Health Systems CollaborativeOxford Centre for Global Health ResearchNuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Catherine Orrell
- Department of MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | | |
Collapse
|
18
|
Arora AK, Engler K, Lessard D, Kronfli N, Rodriguez-Cruz A, Huerta E, Lemire B, Routy JP, Wittmer R, Cox J, de Pokomandy A, Del Balso L, Klein M, Sebastiani G, Vedel I, Quesnel-Vallée A, ASAP Migrant Advisory Committee, Lebouché B. Experiences of Migrant People Living with HIV in a Multidisciplinary HIV Care Setting with Rapid B/F/TAF Initiation and Cost-Covered Treatment: The 'ASAP' Study. J Pers Med 2022; 12:1497. [PMID: 36143282 PMCID: PMC9503330 DOI: 10.3390/jpm12091497] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 11/21/2022] Open
Abstract
This study aimed to explore the experiences of migrant people living with HIV (MLWH) enrolled in a Montreal-based multidisciplinary HIV care clinic with rapid antiretroviral treatment (ART) initiation and cost-covered ART. Between February 2020 and March 2022, 32 interviews were conducted with 16 MLWH at three time-points (16 after 1 week of ART initiation, 8 after 24 weeks, 8 after 48 weeks). Interviews were analyzed via the Framework Method. Thirty categories were identified, capturing experiences across the HIV care cascade. At diagnosis, most MLWH described "initially experiencing distress". At linkage, almost all MLWH discussed "navigating the health system with difficulty". At treatment initiation, almost all MLWH expressed "being satisfied with treatment", particularly due to a lack of side effects. Regarding care retention, all MLWH noted "facing psychosocial or health-related challenges beyond HIV". Regarding ART adherence, most MLWH expressed "being satisfied with treatment" with emphasis on their taking control of HIV. At viral suppression, MLWH mentioned "finding more peace of mind since becoming undetectable". Regarding their perceived health-related quality of life, most MLWH indicated "being helped by a supportive social network". Efficient, humanizing, and holistic approaches to care in a multidisciplinary setting, coupled with rapid and free ART initiation, seemed to help alleviate patients' concerns, address their bio-psycho-social challenges, encourage their initial and sustained engagement with HIV care and treatment, and ultimately contribute to positive experiences.
Collapse
Affiliation(s)
- Anish K. Arora
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3S 1Z1, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, QC H4A 3S5, Canada
| | - Kim Engler
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, QC H4A 3S5, Canada
| | - David Lessard
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, QC H4A 3S5, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Adriana Rodriguez-Cruz
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3S 1Z1, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, QC H4A 3S5, Canada
| | - Edmundo Huerta
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, QC H4A 3S5, Canada
| | - Benoit Lemire
- Pharmacy Department, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Jean-Pierre Routy
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - René Wittmer
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - Joseph Cox
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3A 1A2, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3S 1Z1, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Lina Del Balso
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Marina Klein
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Giada Sebastiani
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3S 1Z1, Canada
| | - Amélie Quesnel-Vallée
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3A 1A2, Canada
- Department of Sociology, Faculty of Arts, McGill University, Montréal, QC H3A 0G5, Canada
| | - ASAP Migrant Advisory Committee
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3S 1Z1, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, QC H4A 3S5, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| |
Collapse
|
19
|
Musengimana G, Umugisha JP, Habinshuti P, Anderson T, Mukesharurema G, Remera E, Ndahimana JD, Barnhart DA. Characteristics and clinical outcomes of patients presenting with advanced HIV disease in the "treat all" era: a retrospective cohort study from rural Rwanda. BMC Infect Dis 2022; 22:706. [PMID: 36008786 PMCID: PMC9404671 DOI: 10.1186/s12879-022-07692-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background In 2016 Rwanda adopted “treat all” where all patients with HIV are immediately eligible for ART regardless of disease progression. Despite widespread availability of treatment, it is unknown whether presentation with advanced HIV persists. Methods We conducted a retrospective cohort among patients aged ≥ 15 who enrolled in care between July 2016 and July 2018 in three rural Rwandan districts. We estimated the prevalence of advanced HIV, defined as presenting with CD4 count < 200 cells/mm3 or WHO stage 3 or 4, and compared baseline characteristics of patients with and without advanced HIV. We compared cumulative incidences and time to events using Chi squared tests and Cox proportional hazards models, respectively, for (a) viral load tests; (b) viral suppression; (c) death; and (d) treatment failure (a composite of death, lost to follow up, or virologic failure). Results Among 957 patients, 105 (11.0%) presented with advanced HIV. These patients were significantly more likely to have low body mass index, come from Burera district, be older, and be identified through inpatient settings rather than through voluntary or prenatal testing. Patients with advanced HIV had significantly higher risks of death at 12-months (9.5% vs 1.5%, p < 0.001) and 18-months (10.5% vs 1.9%, p < 0.001) and significantly higher risk of treatment failure at 12-months (21.9% vs. 14.2%, p = 0.037). After adjusting for confounders, patients with advanced HIV had still higher rates of death (adjusted Hazard ratio [aHR] = 4.4, 95% CI: 1.9, 10.2, p < 0.001) and treatment failure (aHR = 1.7, 95% CI: 1.1, 2.5, p = 0.017), but no difference in viral load testing (aHR = 1.1, 95% CI: 0.8, 1.5, p = 0.442) or viral suppression (aHR = 1.0, 95% CI: 0.8, 1.4, p = 0.949). When allowing for the hazard ratio to vary over time, patients with advanced HIV experienced elevated rates of treatment failure in the first six of enrollment, but not after nine months. Conclusion Presenting with advanced HIV remains common and is still associated with poor patient outcomes. Sensitization of the community to the benefits of early ART initiation, identification of patients with advanced HIV, and holistic support programs for the first 6 months of treatment may be needed to improve outcomes.
Collapse
Affiliation(s)
- Gentille Musengimana
- Division of HIV/AIDs, Rwanda Biomedical Center, STIs and Viral Hepatitis, City of Kigali, Rwanda.
| | - Jean Paul Umugisha
- Partners in Heath, Inshuti Mu Buzima, Infectious Disease Program, City of Kigali, Rwanda
| | - Placide Habinshuti
- Partners in Heath, Inshuti Mu Buzima, Infectious Disease Program, City of Kigali, Rwanda
| | - Todd Anderson
- Partners in Heath, Inshuti Mu Buzima, Infectious Disease Program, City of Kigali, Rwanda
| | | | - Eric Remera
- Division of HIV/AIDs, Rwanda Biomedical Center, STIs and Viral Hepatitis, City of Kigali, Rwanda
| | - Jean D'Amour Ndahimana
- Partners in Heath, Inshuti Mu Buzima, Infectious Disease Program, City of Kigali, Rwanda
| | - Dale A Barnhart
- Partners in Heath, Inshuti Mu Buzima, Infectious Disease Program, City of Kigali, Rwanda.,Department of Global Health and Social Medicine Boston, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
20
|
Christ B, van Dijk JH, Nyandoro TY, Reichmuth ML, Kunzekwenyika C, Chammartin F, Egger M, Wringe A, Ballif M. Availability and experiences of differentiated antiretroviral therapy delivery at HIV care facilities in rural Zimbabwe: a mixed-method study. J Int AIDS Soc 2022; 25:e25944. [PMID: 36008925 PMCID: PMC9411726 DOI: 10.1002/jia2.25944] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 05/20/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Zimbabwe adopted differentiated HIV care policies in 2015 to promote client-centred care and relieve strain on health facilities. We examined the availability, experiences and perceptions of differentiated antiretroviral therapy (ART) delivery in rural Zimbabwe following the policy adoption. METHODS We undertook a cross-sectional mixed methods study in all the 26 facilities providing HIV care in a rural district in Zimbabwe. We collected quantitative data about ART delivery and visit durations from 31 healthcare providers and a purposive stratified sample of 378 clients obtaining ART either through routine care or differentiated ART delivery models. We performed 26 semi-structured interviews among healthcare providers and seven focus group discussions (FGDs) among clients to elicit their perceptions and experiences of ART delivery. Data were collected in 2019, with one follow-up FGD in 2021. We analysed the transcripts thematically, with inductive coding, to identify emerging themes. RESULTS Twenty facilities (77%) offered at least one differentiated ART delivery models, including community ART refill groups (CARGs; 13 facilities, 50%), fast-track refill (8, 31%), family refill (6, 23%) or club refill (1, 4%). Thirteen facilities (50%) offered only one model. The median visit duration was 28 minutes (interquartile range [IQR]: 16-62). Participants in fast-track had the shortest visit durations (18 minutes, IQR: 11-24). Confidentiality and disclosure of HIV status, travelling long distances, travel costs and waiting times were the main issues influencing clients' views on differentiated ART delivery. Fast-track refill was perceived as the preferred model of clients for its limited involuntary disclosure and efficiency. In contrast, group- and community-based refill models reduced travel costs but were felt to be associated with involuntary disclosure of HIV status, which could discourage clients. Healthcare providers also experienced an additional workload when offering facility-based group models, such as CARGs. CONCLUSIONS Differentiated ART delivery models were widely available in this rural setting, but most facilities did not offer a choice of models to address clients' diverse preferences. A minority offered fast-track refills, although this model was often mentioned as desirable. Confidentiality, travel expenses and client waiting times are key elements to consider when planning and rolling out differentiated HIV care.
Collapse
Affiliation(s)
- Benedikt Christ
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | | | - Martina L Reichmuth
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | | | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Centre for Infectious Disease Research and Epidemiology, University of Cape Town, Cape Town, South Africa.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison Wringe
- London School of Hygiene and Tropical Medicine, London, UK
| | - Marie Ballif
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | |
Collapse
|
21
|
Odayar J, Chi BH, Phillips TK, Mukonda E, Hsiao NY, Lesosky M, Myer L. Transfer of Patients on Antiretroviral Therapy Attending Primary Health Care Services in South Africa. J Acquir Immune Defic Syndr 2022; 90:309-315. [PMID: 35298449 DOI: 10.1097/qai.0000000000002950] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/22/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients stable on antiretroviral therapy (ART) may require transfer between health care facilities to maintain continuous care, yet data on the frequency, predictors, and virologic outcomes of transfers are limited. METHODS Data for all viral load (VL) testing at public sector health facilities in the Western Cape Province (2011-2018) were obtained. Participant inclusion criteria were a first VL between 2011 and 2013, age >15 years at ART initiation, and >1 VL within 5 years of ART initiation, of which ≥1 was at a primary health care facility. Two successive VLs taken at different facilities indicated a transfer. We assessed predictors of transfer using generalized estimating equations with Poisson regression and the association between transfer and subsequent VL> 1000 copies/mL using generalized mixed effects. RESULTS Overall 84,814 participants (median age at ART initiation 34 years and 68% female) were followed up for up to 4.5 years after their first VL: 34% (n = 29,056) transferred at least once, and among these, 26% transferred twice and 11% transferred thrice or more. Female sex, age <30 years, and first VL > 1000 copies/mL were independently associated with an increased rate of transfer [adjusted rate ratio 1.24, 95% confidence interval (CI): 1.21 to 1.26; 1.34, 95% CI: 1.31 to 1.36; and 1.42, 95% CI: 1.38 to 1.45, respectively]. Adjusting for age, sex, and disengagement, transfer was associated with an increased relative odds of VL > 1000 copies/mL (odds ratio 1.35, 95% CI: 1.29 to 1.42). CONCLUSIONS Approximately one-third of participants transferred and virologic outcomes were poor post-transfer. Stable patients who transfer may require additional support to maintain adherence.
Collapse
Affiliation(s)
- Jasantha Odayar
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Benjamin H Chi
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; and
| | - Tamsin K Phillips
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Elton Mukonda
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Nei-Yuan Hsiao
- Division of Medical Virology, National Health Laboratory Service, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
22
|
Hubbard JA, Mphande M, Phiri K, Balakasi K, Hoffman RM, Daniels J, Choko A, Coates TJ, Dovel K. Improving ART initiation among men who use HIV self-testing in Malawi: a qualitative study. J Int AIDS Soc 2022; 25:e25950. [PMID: 35700027 PMCID: PMC9196890 DOI: 10.1002/jia2.25950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/24/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION HIV self-testing (HIVST) increases HIV testing uptake among men; however, the linkage to antiretroviral therapy (ART) among HIVST users is low. Innovative strategies for ART initiation are needed, yet little is known about the unique barriers to care experienced by male HIVST users, and what ART-related interventions men desire. METHODS We conducted semi-structured in-depth interviews with cisgender men (≥15 years) in Malawi who tested HIV positive using HIVST between 2018 and 2020, as well as interviews with their female partners (≥15 years) who distributed the HIVST kits. Medical records from seven facilities were used to identify respondents. We included men who received HIVST from a health facility (primary distribution) and from sexual partners (secondary distribution). Interview guides focused on unique barriers to ART initiation following HIVST and desired interventions to improve linkage and initiation. Interviews were audio recorded, translated and transcribed to English, and analysed using constant comparison methods in Atlas.ti v.8.4. Themes were compared by HIVST distribution strategy. Data were collected between 2019 and 2020. RESULTS Twenty-seven respondents were interviewed: eight male/female dyads (16 respondents), eight men without a female partner and three women who represented men who did not participate in the study. Among the 19 men represented (16 men interviewed in person, three represented by secondary report from female partners), seven received HIVST through primary distribution, 12 through secondary distribution. Six men never initiated ART (all secondary HIVST distribution). Barriers to ART initiation centred on the absence of healthcare workers at the time of diagnosis and included lack of external motivation for linkage to care (men had to motivate themselves) and lack of counselling before and after testing (leaving ART-related fears and misconceptions unaddressed)--the latter was especially true for secondary HIVST distribution. Desired interventions were similar across distribution strategies and included ongoing peer mentorship for normalizing treatment adherence, counselling messages tailored to men, outside-facility services for convenience and privacy, and facility navigation to help men understand how to navigate ART clinics. CONCLUSIONS Male HIVST users face unique challenges to ART initiation, especially those receiving HIVST through secondary distribution. Male-tailored interventions are desired by men and may help overcome barriers to care.
Collapse
Affiliation(s)
- Julie A. Hubbard
- Division of Infectious DiseasesDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
- Partners in Hope Medical CenterLilongweMalawi
| | | | | | | | - Risa M. Hoffman
- Division of Infectious DiseasesDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Joseph Daniels
- Edson College of Nursing and Health InnovationArizona State UniversityPhoenixArizonaUSA
| | - Augustine Choko
- Malawi‐Liverpool‐Wellcome Trust Clinical Research ProgrammeTB/HIVBlantyreMalawi
| | - Thomas J. Coates
- Division of Infectious DiseasesDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
- University of California Global Health InstituteSan FranciscoCaliforniaUSA
| | - Kathryn Dovel
- Division of Infectious DiseasesDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
- Partners in Hope Medical CenterLilongweMalawi
| |
Collapse
|
23
|
Choi Y, Ibrahim S, Park LP, Cohen CR, Bukusi EA, Huchko MJ. Uptake and correlates of cervical cancer screening among women attending a community-based multi-disease health campaign in Kenya. BMC Womens Health 2022; 22:122. [PMID: 35436908 PMCID: PMC9014598 DOI: 10.1186/s12905-022-01702-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/16/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Despite the increased risk of cervical cancer among HIV-positive women, many HIV-care programs do not offer integrated cervical cancer screening. Incorporating self-collected Human Papillomavirus (HPV) testing into HIV programs is a potential strategy to identify women at higher risk for cervical cancer while leveraging the staffing, infrastructure and referral systems for existing services. Community-based HIV and HPV testing has been effective and efficient when offered in single-disease settings. METHODS This cross-sectional study was conducted within a community outreach and multi-disease screening campaigns organized by the Family AIDS Care and Education Services in Kisumu County, Kenya. In addition to HIV testing, the campaigns provided screening for TB, malaria, hypertension, diabetes, and referrals for voluntary medical male circumcision. After these services, women aged 25-65 were offered self-collected HPV testing. Rates and predictors of cervical cancer screening uptake and of HPV positivity were analyzed using tabular analysis and Fisher's Exact Test. Logistic regression was performed to explore multivariate associations with screening uptake. RESULTS Among the 2016 women of screening age who attended the outreach campaigns, 749 women (35.6%) were screened, and 134 women (18.7%) were HPV-positive. In bivariate analysis, women who had no children (p < 0.01), who were not pregnant (p < 0.01), who were using contraceptives (p < 0.01), who had sex without using condoms (p < 0.05), and who were encouraged by a family member other than their spouse (p < 0.01), were more likely to undergo screening. On multivariable analysis, characteristics associated with higher screening uptake included: women aged 45-54 (OR 1.62, 95% CI 1.05-2.52) compared to women aged 25-34; no children (OR 1.65, 95% CI 1.06-2.56); and family support other than their spouse (OR 1.53, 95% CI 1.09-2.16). Women who were pregnant were 0.44 times (95% CI 0.25-0.76) less likely to get screened. Bivariate analyses with participant characteristics and HPV positivity found that women who screened HPV-positive were more likely to be HIV-positive (p < 0.001) and single (p < 0.001). CONCLUSIONS The low screening uptake may be attributed to implementation challenges including long waiting times for service at the campaign and delays in procuring HPV test kits. However, given the potential benefits of integrating HPV testing into HIV outreach campaigns, these challenges should be examined to develop more effective multi-disease outreach interventions.
Collapse
Affiliation(s)
- Yujung Choi
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | | | - Lawrence P Park
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, San Francisco, CA, USA
| | | | - Megan J Huchko
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| |
Collapse
|
24
|
Le Tourneau N, Germann A, Thompson RR, Ford N, Schwartz S, Beres L, Mody A, Baral S, Geng EH, Eshun-Wilson I. Evaluation of HIV treatment outcomes with reduced frequency of clinical encounters and antiretroviral treatment refills: A systematic review and meta-analysis. PLoS Med 2022; 19:e1003959. [PMID: 35316272 PMCID: PMC8982898 DOI: 10.1371/journal.pmed.1003959] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/05/2022] [Accepted: 03/04/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Global HIV treatment programs have sought to lengthen the interval between clinical encounters for people living with HIV (PLWH) who are established on antiretroviral treatment (ART) to reduce the burden of seeking care and to decongest health facilities. The overall effect of reduced visit frequency on HIV treatment outcomes is however unknown. We conducted a systematic review and meta-analysis to evaluate the effect of implementation strategies that reduce the frequency of clinical appointments and ART refills for PLWH established on ART. METHODS AND FINDINGS We searched databases between 1 January 2010 and 9 November 2021 to identify randomized controlled trials (RCTs) and observational studies that compared reduced (6- to 12-monthly) clinical consultation or ART refill appointment frequency to 3- to 6-monthly appointments for patients established on ART. We assessed methodological quality and real-world relevance, and used Mantel-Haenszel methods to generate pooled risk ratios (RRs) with 95% confidence intervals for retention, viral suppression, and mortality. We evaluated heterogeneity quantitatively and qualitatively, and overall evidence certainty using GRADE. Searches yielded 3,955 records, resulting in 10 studies (6 RCTs, 3 observational studies, and 1 study contributing observational and RCT data) representing 15 intervention arms with 33,599 adults (≥16 years) in 8 sub-Saharan African countries. Reduced frequency clinical consultations occurred at health facilities, while reduced frequency ART refills were delivered through facility or community pharmacies and adherence groups. Studies were highly pragmatic, except for some study settings and resources used in RCTs. Among studies comparing reduced clinical consultation frequency (6- or 12-monthly) to 3-monthly consultations, there appeared to be no difference in retention (RR 1.01, 95% CI 0.97-1.04, p = 0.682, 8 studies, low certainty), and this finding was consistent across 6- and 12-monthly consultation intervals and delivery strategies. Viral suppression effect estimates were markedly influenced by under-ascertainment of viral load outcomes in intervention arms, resulting in inconclusive evidence. There was similarly insufficient evidence to draw conclusions on mortality (RR 1.12, 95% CI 0.75-1.66, p = 0.592, 6 studies, very low certainty). For ART refill frequency, there appeared to be little to no difference in retention (RR 1.01, 95% CI 0.98-1.06, p = 0.473, 4 RCTs, moderate certainty) or mortality (RR 1.45, 95% CI 0.63-3.35, p = 0.382, 4 RCTs, low certainty) between 6-monthly and 3-monthly visits. Similar to the analysis for clinical consultations, although viral suppression appeared to be better in 3-monthly arms, effect estimates were markedly influence by under-ascertainment of viral load outcomes in intervention arms, resulting in overall inclusive evidence. This systematic review was limited by the small number of studies available to compare 12- versus 6-monthly clinical consultations, insufficient data to compare implementation strategies, and lack of evidence for children, key populations, and low- and middle-income countries outside of sub-Saharan Africa. CONCLUSIONS Based on this synthesis, extending clinical consultation intervals to 6 or 12 months and ART dispensing intervals to 6 months appears to result in similar retention to 3-month intervals, with less robust conclusions for viral suppression and mortality. Future research should ensure complete viral load outcome ascertainment, as well as explore mechanisms of effect, outcomes in other populations, and optimum delivery and monitoring strategies to ensure widespread applicability of reduced frequency visits across settings.
Collapse
Affiliation(s)
- Noelle Le Tourneau
- Division of Infectious Diseases, School of Medicine, Washington University in St. Louis, Saint Louis, Missouri, United States of America
| | - Ashley Germann
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ryan R. Thompson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nathan Ford
- Department of Global HIV, Hepatitis and Sexually Transmitted Diseases, World Health Organization, Geneva, Switzerland
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Laura Beres
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Aaloke Mody
- Division of Infectious Diseases, School of Medicine, Washington University in St. Louis, Saint Louis, Missouri, United States of America
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Elvin H. Geng
- Division of Infectious Diseases, School of Medicine, Washington University in St. Louis, Saint Louis, Missouri, United States of America
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, Saint Louis, Missouri, United States of America
| | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, School of Medicine, Washington University in St. Louis, Saint Louis, Missouri, United States of America
| |
Collapse
|
25
|
Abstract
Identifying evidence-based interventions that can optimize the re-engagement into care of people living with HIV is necessary to achieve and sustain HIV epidemic control. We conducted a systematic review of interventions for re-engagement into HIV care to examine the accumulated evidence and to identify similarities and differences across studies. Between January and March 2020, we searched MEDLINE, Embase, CINAHL, and PsycINFO databases for publications from 1996 to 2020. We screened 765 references and selected 125 publications for full-text review. For the nine included studies, the intervention centered on (1) integration of clinic and HIV surveillance data; (2) additional or different levels of support provided by healthcare workers; or (3) multi-component intervention. Irrespective of the interventions, mixed results were found for re-engagement into care or ART re-initiation. None of the studies led to an improvement in viral suppression. Re-engagement in HIV care is critical for longitudinal HIV and national program success. Standardizing definitions for out-of-care and re-engagement would facilitate the comparison of interventions. Rigorous study designs to assess strategies to enhance HIV re-engagement are warranted.
Collapse
|
26
|
Mabuto T, Setswe G, Mshweshwe-Pakela N, Clark D, Day S, Molobetsi L, Pienaar J. Findings from a novel and scalable community-based HIV testing approach to reduce the time required to complete point-of-care HIV testing in South Africa. BMC Health Serv Res 2021; 21:1176. [PMID: 34711236 PMCID: PMC8555215 DOI: 10.1186/s12913-021-07173-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mobile HIV testing approaches are a key to reaching the global targets of halting the HIV epidemic by 2030. Importantly, the number of clients reached through mobile HIV testing approaches, need to remain high to maintain the cost-effectiveness of these approaches. Advances in rapid in-vitro tests such as INSTI® HIV-1/HIV-2 (INSTI) which uses flow-through technologies, offer opportunities to reduce the HIV testing time to about one minute. Using data from a routine mobile HTS programme which piloted the use of the INSTI point-of-care (POC) test, we sought to estimate the effect of using a faster test on client testing volumes and the number of people identified to be living with HIV, in comparison with standard of care HIV rapid tests. METHODS In November 2019, one out of four mobile HTS teams operating in Ekurhuleni District (South Africa) was randomly selected to pilot the field use of INSTI-POC test as an HIV screening test (i.e., the intervention team). We compared the median number of clients tested for HIV and the number of HIV-positive clients by the intervention team with another mobile HTS team (matched on performance and area of operation) which used the standard of care (SOC) HIV screening test (i.e., SOC team). RESULTS From 19 to 20 December 2019, the intervention team tested 7,403 clients, and the SOC team tested 2,426 clients. The intervention team tested a median of 442 (IQR: 288-522) clients/day; SOC team tested a median of 97 (IQR: 40-187) clients/day (p<0.0001). The intervention team tested about 180 more males/day compared to the SOC team, and the median number of adolescents and young adults tested/day by the intervention team were almost four times the number tested by the SOC team. The intervention team identified a higher number of HIV-positive clients compared to the SOC team (142 vs. 88), although the proportion of HIV-positive clients was lower in the intervention team due to the higher number of clients tested. CONCLUSIONS This pilot programme provides evidence of high performance and high reach, for men and young people through the use of faster HIV rapid tests, by trained lay counsellors in mobile HTS units.
Collapse
Affiliation(s)
- Tonderai Mabuto
- The Aurum Institute NPC, 29 Queens Road, Parktown, 2193, Johannesburg, South Africa.
| | - Geoffrey Setswe
- The Aurum Institute NPC, 29 Queens Road, Parktown, 2193, Johannesburg, South Africa
- University of South Africa, Preller St, Muckleneuk, Pretoria, South Africa
| | - Nolundi Mshweshwe-Pakela
- The Aurum Institute NPC, 29 Queens Road, Parktown, 2193, Johannesburg, South Africa
- The University of the Witwatersrand School of Public Health, 60 York Rd, Johannesburg, South Africa
| | - Dave Clark
- The Aurum Institute NPC, 29 Queens Road, Parktown, 2193, Johannesburg, South Africa
- Vanderbilt University, 2201 West End Ave, Nashville, TN, USA
| | - Sarah Day
- The Centre for HIV-AIDS Prevention Studies, 25 St Johns Road, Houghton Estate, Johannesburg, South Africa
| | - Lerato Molobetsi
- The Centre for HIV-AIDS Prevention Studies, 25 St Johns Road, Houghton Estate, Johannesburg, South Africa
| | - Jacqueline Pienaar
- The Centre for HIV-AIDS Prevention Studies, 25 St Johns Road, Houghton Estate, Johannesburg, South Africa
| |
Collapse
|
27
|
Effects of implementing universal and rapid HIV treatment on initiation of antiretroviral therapy and retention in care in Zambia: a natural experiment using regression discontinuity. Lancet HIV 2021; 8:e755-e765. [PMID: 34656208 DOI: 10.1016/s2352-3018(21)00186-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Universal testing and treatment (UTT) for all people living with HIV has only been assessed under experimental conditions in cluster-randomised trials. The public health effectiveness of UTT policies on the HIV care cascade under real-world conditions is not known. We assessed the real-world effectiveness of universal HIV treatment policies that were implemented in Zambia on Jan 1, 2017. METHODS We used data from Zambia's routine electronic health record system to analyse antiretroviral therapy (ART)-naive adults who newly enrolled in HIV care up to 1 year before and after the implementation of universal treatment (ie, Jan 1, 2016, to Jan 1, 2018) at 117 clinics supported by the Centre for Infectious Disease Research in Zambia. We used a regression discontinuity design to estimate the effects of implementing UTT on same-day ART initiation, ART initiation within 1 month, and retention on ART at 12 months (defined as clinic attendance 9-15 months after enrolment and at least 6 months on ART), under the assumption that patients presenting immediately before and after UTT implementation were balanced on both measured and unmeasured characteristics. We did an instrumental variable analysis to estimate the effect of same-day ART initiation under routine conditions on 12-month retention on ART. FINDINGS 65 673 newly enrolled patients with HIV (40 858 [62·2%] female, median age 32 years [IQR 26-39], median CD4 count 287 cells per μL [IQR 147-466]) were eligible for inclusion in the analyses; 31 145 enrolled before implementation of UTT, and 34 528 enrolled after UTT. Implementation of universal treatment increased same-day ART initiation from 41·7% to 74·8% (risk difference [RD] 33·1%, 95% CI 30·5-35·7), ART initiation by 1 month from 69·6% to 87·0% (RD 17·4%, 15·5-19·3), and 12-month retention on ART from 56·2% to 63·3% (RD 7·1%, 4·3-9·9). ART initiation rates became more uniform across patient subgroups after implementation of universal treatment, but heterogeneity in 12-month retention on ART between subgroups was unchanged. Instrumental variable analyses indicated that same-day ART initiation in routine settings led to a 15·8% increase (95% CI 12·1-19·5) in 12-month retention on ART. INTERPRETATION UTT policies implemented in Zambia increased the rapidity and uptake of ART, as well as retention on ART at 12 months, although overall retention on ART remained suboptimal. UTT policies reduced disparities in treatment initiation, but not 12-month retention on ART. Natural experiments reveal both the anticipated and unanticipated effects of real-world implementation and indicate the need for new strategies leveraging the short-term effects of UTT to cultivate long-term treatment success. FUNDING National Institutes of Health.
Collapse
|
28
|
Bisnauth MA, Davies N, Monareng S, Buthelezi F, Struthers H, McIntyre J, Rees K. Why do patients interrupt and return to antiretroviral therapy? Retention in HIV care from the patient's perspective in Johannesburg, South Africa. PLoS One 2021; 16:e0256540. [PMID: 34473742 PMCID: PMC8412245 DOI: 10.1371/journal.pone.0256540] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/09/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Retention in care is required for optimal clinical outcomes in people living with HIV (PLHIV). Although most PLHIV in South Africa know their HIV status, only 70% are on antiretroviral therapy (ART). Improved retention in care is needed to get closer to sustained ART for all. In January 2019, Anova Health Institute conducted a campaign to encourage patients who had interrupted ART to return to care. METHODS Data collection was conducted in one region of Johannesburg. This mixed methods study consisted of two components: 1) healthcare providers entered data into a structured tool for all patients re-initiating ART at nine clinics over a nine-month period, 2) Semi-structured interviews were conducted with a sub-set of patients. Responses to the tool were analysed descriptively, we report frequencies, and percentages. A thematic approach was used to analyse participant experiences in-depth. RESULTS 562 people re-initiated ART, 66% were women, 75% were 25-49 years old. The three most common reasons for disengagement from care were mobility (30%), ART related factors (15%), and time limitations due to work (10%). Reasons for returning included it becoming easier to attend the clinic (34%) and worry about not being on ART (19%). Mobile interview participants often forgot their medical files and expressed that managing their ART was difficult because they often needed a transfer letter to gain access to ART at another facility. On the other hand, clinics that had flexible and extended hours facilitated retention in care. CONCLUSION In both the quantitative data, and the qualitative analysis, changing life circumstances was the most prominent reason for disengagement from care. Health services were not perceived to be responsive to life changes or mobility, leading to disengagement. More client-centred and responsive health services should improve retention on ART.
Collapse
Affiliation(s)
| | | | | | | | - Helen Struthers
- Anova Health Institute, Johannesburg, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - James McIntyre
- Anova Health Institute, Johannesburg, South Africa
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kate Rees
- Anova Health Institute, Johannesburg, South Africa
- Department of Community Health, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
29
|
Makurumidze R. Experiences and Lessons Learnt from the HIV Treat All Pilot Phase Implementation in Zimbabwe. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:823-828. [PMID: 34429660 PMCID: PMC8378930 DOI: 10.2147/hiv.s319850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/01/2021] [Indexed: 11/23/2022]
Abstract
Zimbabwe adopted the Treat All recommendations and started to implement them nationwide in 2017. Before launch, Treat All was piloted in nine districts. The sharing of implementation experiences and knowledge gained will significantly contribute to the implementation success in settings where Treat All still needs to be rolled out. We report on experiences and lessons learnt from the implementation of Treat All during the pilot phase in Zimbabwe. Coordination and well-structured engagement plans with the districts led to the successful implementation of the Treat All pilot. The established technical working groups offered standardisation and a platform for the exchange of experience between the implementing partners and the Ministry of Health and Child Care. Training and capacity building of the healthcare workers through mentoring, support and supervision, and the provision of job aides were necessary to equip them with the required skills. Community knowledge, commitment and support were critical to the successful implementation of the guidelines. Health facilities preparedness was of great importance. This enabled the health facilities to develop mitigating strategies at the local level using existing resources. Studies examining how patient outcomes will progress under Treat All are pertinent.
Collapse
Affiliation(s)
- Richard Makurumidze
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.,Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Gerontology, Faculty of Medicine & Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| |
Collapse
|
30
|
Mody A, Tram KH, Glidden DV, Eshun-Wilson I, Sikombe K, Mehrotra M, Pry JM, Geng EH. Novel Longitudinal Methods for Assessing Retention in Care: a Synthetic Review. Curr HIV/AIDS Rep 2021; 18:299-308. [PMID: 33948789 DOI: 10.1007/s11904-021-00561-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Retention in care is both dynamic and longitudinal in nature, but current approaches to retention often reduce these complex histories into cross-sectional metrics that obscure the nuanced experiences of patients receiving HIV care. In this review, we discuss contemporary approaches to assessing retention in care that captures its dynamic nature and the methodological and data considerations to do so. RECENT FINDINGS Enhancing retention measurements either through patient tracing or "big data" approaches (including probabilistic matching) to link databases from different sources can be used to assess longitudinal retention from the perspective of the patient when they transition in and out of care and access care at different facilities. Novel longitudinal analytic approaches such as multi-state and group-based trajectory analyses are designed specifically for assessing metrics that can change over time such as retention in care. Multi-state analyses capture the transitions individuals make in between different retention states over time and provide a comprehensive depiction of longitudinal population-level outcomes. Group-based trajectory analyses can identify patient subgroups that follow distinctive retention trajectories over time and highlight the heterogeneity of retention patterns across the population. Emerging approaches to longitudinally measure retention in care provide nuanced assessments that reveal unique insights into different care gaps at different time points over an individuals' treatment. These methods help meet the needs of the current scientific agenda for retention and reveal important opportunities for developing more tailored interventions that target the varied care challenges patients may face over the course of lifelong treatment.
Collapse
Affiliation(s)
- Aaloke Mody
- Division of Infectious Diseases, Washington University School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, Missouri, 63110, USA.
| | - Khai Hoan Tram
- Division of Infectious Diseases, Washington University School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, Missouri, 63110, USA
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, Washington University School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, Missouri, 63110, USA
| | - Kombatende Sikombe
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
- Department of Public Health Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Megha Mehrotra
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Jake M Pry
- Division of Infectious Diseases, Washington University School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, Missouri, 63110, USA
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Elvin H Geng
- Division of Infectious Diseases, Washington University School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, Missouri, 63110, USA
| |
Collapse
|
31
|
Dubé K, Kanazawa J, Taylor J, Dee L, Jones N, Roebuck C, Sylla L, Louella M, Kosmyna J, Kelly D, Clanton O, Palm D, Campbell DM, Onaiwu MG, Patel H, Ndukwe S, Henley L, Johnson MO, Saberi P, Brown B, Sauceda JA, Sugarman J. Ethics of HIV cure research: an unfinished agenda. BMC Med Ethics 2021; 22:83. [PMID: 34193141 PMCID: PMC8243312 DOI: 10.1186/s12910-021-00651-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The pursuit of a cure for HIV is a high priority for researchers, funding agencies, governments and people living with HIV (PLWH). To date, over 250 biomedical studies worldwide are or have been related to discovering a safe, effective, and scalable HIV cure, most of which are early translational research and experimental medicine. As HIV cure research increases, it is critical to identify and address the ethical challenges posed by this research. METHODS We conducted a scoping review of the growing HIV cure research ethics literature, focusing on articles published in English peer-reviewed journals from 2013 to 2021. We extracted and summarized key developments in the ethics of HIV cure research. Twelve community advocates actively engaged in HIV cure research provided input on this summary and suggested areas warranting further ethical inquiry and foresight via email exchange and video conferencing. DISCUSSION Despite substantial scholarship related to the ethics of HIV cure research, additional attention should focus on emerging issues in six categories of ethical issues: (1) social value (ongoing and emerging biomedical research and scalability considerations); (2) scientific validity (study design issues, such as the use of analytical treatment interruptions and placebos); (3) fair selection of participants (equity and justice considerations); (4) favorable benefit/risk balance (early phase research, benefit-risk balance, risk perception, psychological risks, and pediatric research); (5) informed consent (attention to language, decision-making, informed consent processes and scientific uncertainty); and (6) respect for enrolled participants and community (perspectives of people living with HIV and affected communities and representation). CONCLUSION HIV cure research ethics has an unfinished agenda. Scientific research and bioethics should work in tandem to advance ethical HIV cure research. Because the science of HIV cure research will continue to rapidly advance, ethical considerations of the major themes we identified will need to be revisited and refined over time.
Collapse
Affiliation(s)
- Karine Dubé
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - John Kanazawa
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - Jeff Taylor
- HIV + Aging Research Project – Palm Springs (HARP–PS), Palm Springs, CA USA
- AntiViral Research Center (AVRC) Community Advisory Board (CAB), San Diego, CA USA
- Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Chapel Hill, NC USA
| | - Lynda Dee
- AIDS Action Baltimore, Baltimore, MD USA
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA USA
| | - Nora Jones
- BEAT-HIV Collaboratory CAB, Philadelphia, PA USA
| | | | | | | | - Jan Kosmyna
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA
| | - David Kelly
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA
| | - Orbit Clanton
- AIDS Clinical Trials Group Global CAB, Washington, D.C. USA
| | - David Palm
- Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Chapel Hill, NC USA
- Institute of Global Health and Infectious Diseases HIV Treatment and Prevention CAB, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Danielle M. Campbell
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA USA
- Charles R. Drew College of Medicine and Science, Los Angeles, CA USA
| | - Morénike Giwa Onaiwu
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA
- Center for the Study of Women, Gender, and Sexuality (School of Humanities), Rice University, Houston, TX USA
| | - Hursch Patel
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - Samuel Ndukwe
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - Laney Henley
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - Mallory O. Johnson
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA USA
| | - Parya Saberi
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, Riverside, CA USA
| | - John A. Sauceda
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA USA
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute for Bioethics, Baltimore, MD USA
| |
Collapse
|
32
|
Yohannes NT, Jenkins CA, Clouse K, Cortés CP, Mejía Cordero F, Padgett D, Rouzier V, Friedman RK, McGowan CC, Shepherd BE, Rebeiro PF. Timing of HIV diagnosis relative to pregnancy and postpartum HIV care continuum outcomes among Latin American women, 2000 to 2017. J Int AIDS Soc 2021; 24:e25740. [PMID: 34021715 PMCID: PMC8140191 DOI: 10.1002/jia2.25740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/05/2021] [Accepted: 04/26/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND HIV incidence among women of reproductive age and vertical HIV transmission rates remain high in Latin America. We, therefore, quantified HIV care continuum barriers and outcomes among pregnant women living with HIV (WLWH) in Latin America. METHODS WLWH (aged ≥16 years) enrolling at Caribbean, Central and South America network for HIV epidemiology (CCASAnet) sites from 2000 to 2017 who had HIV diagnosis, pregnancy and delivery dates contributed. Logistic regression produced adjusted odds ratios (aOR) and 95% confidence intervals (CI) for retention in care (≥2 visits ≥3 months apart) and virological suppression (viral load <200 copies/mL) 12 months after pregnancy outcome. Cumulative incidences of loss to follow-up (LTFU) postpartum were estimated using Cox regression. Evidence of HIV status at pregnancy confirmation was the exposure. Covariates included pregnancy outcome (born alive vs. others); AIDS diagnosis prior to delivery; CD4, age, HIV-1 RNA and cART regimen at first delivery and CCASAnet country. RESULTS Among 579 WLWH, median postpartum follow-up was 4.34 years (IQR 1.91, 7.35); 459 (79%) were HIV-diagnosed before pregnancy confirmation, 445 (77%) retained in care and 259 (45%) virologically suppressed at 12 months of postpartum. Cumulative incidence of LTFU was 21% by 12 months and 40% by five years postpartum. Those HIV-diagnosed during pregnancy had lower odds of retention (aOR = 0.58, 95% CI: 0.35 to 0.97) and virological suppression (aOR = 0.50, 95% CI: 0.31 to 0.82) versus those HIV-diagnosed before. CONCLUSION HIV diagnosis during pregnancy was associated with poorer 12-month retention and virological suppression. Young women should be tested and linked to HIV care earlier to narrow these disparities.
Collapse
Affiliation(s)
| | - Cathy A Jenkins
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
| | - Kate Clouse
- Division of Infectious DiseasesDepartment of MedicineVanderbilt University Medical CenterNashvilleTNUSA
- Vanderbilt University School of NursingNashvilleTNUSA
| | | | - Fernando Mejía Cordero
- Instituto de Medicina Tropical Alexander von HumboldtUniversidad Peruana Cayetano HerediaLimaPeru
| | - Denis Padgett
- Instituto Hondureño de Seguridad Social & Hospital Escuela UniversitarioTegucigalpaHonduras
| | - Vanessa Rouzier
- Groupe Haitien d'Etudes du Sarcome de Kaposi et des Infections OpportunistesPort‐au‐PrinceHaiti
| | - Ruth K Friedman
- Instituto Nacional de Infectologia Evandro Chagas (INI)Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Catherine C McGowan
- Division of Infectious DiseasesDepartment of MedicineVanderbilt University Medical CenterNashvilleTNUSA
| | - Bryan E Shepherd
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
| | - Peter F Rebeiro
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
- Division of Infectious DiseasesDepartment of MedicineVanderbilt University Medical CenterNashvilleTNUSA
| |
Collapse
|
33
|
Ehrenkranz P, Rosen S, Boulle A, Eaton JW, Ford N, Fox MP, Grimsrud A, Rice BD, Sikazwe I, Holmes CB. The revolving door of HIV care: Revising the service delivery cascade to achieve the UNAIDS 95-95-95 goals. PLoS Med 2021; 18:e1003651. [PMID: 34029346 PMCID: PMC8186775 DOI: 10.1371/journal.pmed.1003651] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 06/08/2021] [Indexed: 01/01/2023] Open
Abstract
Peter Ehrenkranz and co-authors present a cyclical cascade of care for people with HIV infection, aiming to facilitate assessment of outcomes.
Collapse
Affiliation(s)
- Peter Ehrenkranz
- Global Health, Bill & Melinda Gates Foundation, Seattle, WA, United States of America
- * E-mail:
| | - Sydney Rosen
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Boulle
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jeffrey W. Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Nathan Ford
- HIV & Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Matthew P. Fox
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
| | - Anna Grimsrud
- HIV Programmes & Advocacy Department, International AIDS Society, Cape Town, South Africa
| | - Brian D. Rice
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Charles B. Holmes
- Center for Innovation in Global Health, Georgetown University, Washington, DC, United States of America
| |
Collapse
|