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Astawesegn FH, Mannan H, Stulz V, Conroy E. Understanding the uptake and determinants of prevention of mother-to-child transmission of HIV services in East Africa: Mixed methods systematic review and meta-analysis. PLoS One 2024; 19:e0300606. [PMID: 38635647 PMCID: PMC11025786 DOI: 10.1371/journal.pone.0300606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 02/28/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Prevention of mother-to-child transmission (PMTCT) of HIV service is conceptualized as a series of cascades that begins with all pregnant women and ends with the detection of a final HIV status in HIV-exposed infants (HEIs). A low rate of cascade completion by mothers' results in an increased risk of HIV transmission to their infants. Therefore, this review aimed to understand the uptake and determinants of key PMTCT services cascades in East Africa. METHODS We searched CINAHL, EMBASE, MEDLINE, Scopus, and AIM databases using a predetermined search strategy to identify studies published from January 2012 through to March 2022 on the uptake and determinants of PMTCT of HIV services. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. A random-effects model was used to obtain pooled estimates of (i) maternal HIV testing (ii) maternal ART initiation, (iii) infant ARV prophylaxis and (iv) early infant diagnosis (EID). Factors from quantitative studies were reviewed using a coding template based on the domains of the Andersen model (i.e., environmental, predisposing, enabling and need factors) and qualitative studies were reviewed using a thematic synthesis approach. RESULTS The searches yielded 2231 articles and we systematically reduced to 52 included studies. Forty quantitative, eight qualitative, and four mixed methods papers were located containing evidence on the uptake and determinants of PMTCT services. The pooled proportions of maternal HIV test and ART uptake in East Africa were 82.6% (95% CI: 75.6-88.0%) and 88.3% (95% CI: 78.5-93.9%). Similarly, the pooled estimates of infant ARV prophylaxis and EID uptake were 84.9% (95% CI: 80.7-88.3%) and 68.7% (95% CI: 57.6-78.0) respectively. Key factors identified were the place of residence, stigma, the age of women, the educational status of both parents, marital status, socioeconomic status, Knowledge about HIV/PMTCT, access to healthcare facilities, attitudes/perceived benefits towards PMTCT services, prior use of maternal and child health (MCH) services, and healthcare-related factors like resource scarcity and insufficient follow-up supervision. CONCLUSION Most of the identified factors were modifiable and should be considered when formulating policies and planning interventions. Hence, promoting women's education and economic empowerment, strengthening staff supervision, improving access to and integration with MCH services, and actively involving the community to reduce stigma are suggested. Engaging community health workers and expert mothers can also help to share the workload of healthcare providers because of the human resource shortage.
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Affiliation(s)
- Feleke Hailemichael Astawesegn
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Haider Mannan
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
| | - Virginia Stulz
- School of Nursing and Midwifery Centre for Nursing and Midwifery Research, Western Sydney University, Kingswood, New South Wales, Australia
| | - Elizabeth Conroy
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
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Vourli G, Noori T, Pharris A, Porter K, Axelsson M, Begovac J, Cazein F, Costagliola D, Cowan S, Croxford S, d'Arminio Monforte A, Delpech V, Díaz A, Girardi E, Gunsenheimer-Bartmeyer B, Hernando V, Leierer G, Lot F, Nunez O, Obel N, Op de Coul E, Paraskeva D, Patrinos S, Reiss P, Schmid D, Sonnerborg A, Suligoi B, Supervie V, van Sighem A, Zangerle R, Touloumi G. Human Immunodeficiency Virus Continuum of Care in 11 European Union Countries at the End of 2016 Overall and by Key Population: Have We Made Progress? Clin Infect Dis 2021; 71:2905-2916. [PMID: 32960957 PMCID: PMC7778352 DOI: 10.1093/cid/ciaa696] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 08/21/2020] [Indexed: 12/18/2022] Open
Abstract
Background High uptake of antiretroviral treatment (ART) is essential to reduce human immunodeficiency virus (HIV) transmission and related mortality; however, gaps in care exist. We aimed to construct the continuum of HIV care (CoC) in 2016 in 11 European Union (EU) countries, overall and by key population and sex. To estimate progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target, we compared 2016 to 2013 estimates for the same countries, representing 73% of the population in the region. Methods A CoC with the following 4 stages was constructed: number of people living with HIV (PLHIV); proportion of PLHIV diagnosed; proportion of those diagnosed who ever initiated ART; and proportion of those ever treated who achieved viral suppression at their last visit. Results We estimated that 87% of PLHIV were diagnosed; 92% of those diagnosed had ever initiated ART; and 91% of those ever on ART, or 73% of all PLHIV, were virally suppressed. Corresponding figures for men having sex with men were: 86%, 93%, 93%, 74%; for people who inject drugs: 94%, 88%, 85%, 70%; and for heterosexuals: 86%, 92%, 91%, 72%. The proportion suppressed of all PLHIV ranged from 59% to 86% across countries. Conclusions The EU is close to the 90-90-90 target and achieved the UNAIDS target of 73% of all PLHIV virally suppressed, significant progress since 2013 when 60% of all PLHIV were virally suppressed. Strengthening of testing programs and treatment support, along with prevention interventions, are needed to achieve HIV epidemic control.
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Affiliation(s)
- Georgia Vourli
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Solna, Sweden
| | | | | | | | - Josip Begovac
- Department of Infectious Diseases, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Francoise Cazein
- Santé publique France, the French national public health agency, Saint-Maurice, France
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | | | | | | | | | - Asunción Díaz
- Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain
| | - Enrico Girardi
- Istituto Nazionale Malattie Infettive 'L. Spallanzani, Roma, Italy
| | | | - Victoria Hernando
- Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Florence Lot
- Santé publique France, the French national public health agency, Saint-Maurice, France
| | - Olivier Nunez
- Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain
| | - Niels Obel
- Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Eline Op de Coul
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Dimitra Paraskeva
- Hellenic Center for Disease Control and Prevention, Amarousio, Greece
| | - Stavros Patrinos
- Hellenic Center for Disease Control and Prevention, Amarousio, Greece
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, The Netherlands.,Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniela Schmid
- Austrian Agency for Health and Food Safety, Vienna, Austria
| | - Anders Sonnerborg
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Barbara Suligoi
- National AIDS Unit, Istituto Superiore di Sanita, Rome, Italy
| | - Virginie Supervie
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | | | | | - Giota Touloumi
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Tran TC, Pillonel J, Cazein F, Sommen C, Bonnet C, Blondel B, Lot F. Antenatal HIV screening: results from the National Perinatal Survey, France, 2016. ACTA ACUST UNITED AC 2020; 24. [PMID: 31595877 PMCID: PMC6784449 DOI: 10.2807/1560-7917.es.2019.24.40.1800573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Universal antenatal HIV screening programmes are an effective method of preventing mother-to-child transmission. Aims To assess the coverage and yield of the French programme on a nationally representative sample of pregnant women, and predictive factors for being unscreened or missing information on the performance/ result of a HIV test. Methods Data came from the medical records of women included in the cross-sectional 2016 French National Perinatal Survey. We calculated odds ratios (OR) to identify factors for being unscreened for HIV and for missing information by multivariable analyses. Results Of 13,210 women, 12,782 (96.8%) were screened for HIV and 134 (1.0%) were not; information was missing for 294 (2.2%). HIV infection was newly diagnosed in 19/12,769 (0.15%) women screened. The OR for being unscreened was significantly higher in women in legally registered partnerships (OR: 1.3; 95% CI: 1.1–1.6), with 1–2 years of post-secondary schooling (OR: 1.6; 95% CI: 1.2–2.1), part-time employment (OR: 1.4; 95% CI: 1.1–1.8), inadequate antenatal care (OR: 1.9; 95% CI: 1.5–2.4) and receiving care from > 1 provider (OR: 1.8; 95% CI: 1.1–2.8). The OR of missing information was higher in multiparous women (OR: 1.4; 95% CI: 1.2–1.5) and women cared for by general practitioners (OR: 1.4; 95% CI: 1.1–1.9). Conclusions The French antenatal HIV screening programme is effective in detecting HIV among pregnant women. However, a few women are still not screened and awareness of the factors that predict this could contribute to improved screening levels.
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Affiliation(s)
- Thi-Chiên Tran
- Santé publique France, French national public health agency, Saint-Maurice, France
| | - Josiane Pillonel
- Santé publique France, French national public health agency, Saint-Maurice, France
| | - Françoise Cazein
- Santé publique France, French national public health agency, Saint-Maurice, France
| | - Cécile Sommen
- Santé publique France, French national public health agency, Saint-Maurice, France
| | | | | | - Florence Lot
- Santé publique France, French national public health agency, Saint-Maurice, France
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Tchidjou HK, Palandri L, Vescio FM, Pezzotti P, Bernardi S. The unexposed world of the (HIV-negative) exposed. HIV Med 2019; 21:e5-e6. [PMID: 31642577 DOI: 10.1111/hiv.12804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Lucia Palandri
- Medicine and Surgery Department, University of Parma, Parma, Italy
| | - Fenicia M Vescio
- Epidemiology Unit, Department of Infectious Diseases, Italian National Institute of Health, Rome, Italy
| | - Patrizio Pezzotti
- Epidemiology Unit, Department of Infectious Diseases, Italian National Institute of Health, Rome, Italy
| | - Stefania Bernardi
- Unit of Immune and Infectious Disease, University Department of Pediatrics DPUO, Bambino Gesù Children's Hospital, Rome, Italy
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Fransen MP, Hopman ME, Murugesu L, Rosman AN, Smith SK. Preconception counselling for low health literate women: an exploration of determinants in the Netherlands. Reprod Health 2018; 15:192. [PMID: 30470239 PMCID: PMC6251122 DOI: 10.1186/s12978-018-0617-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 09/30/2018] [Indexed: 11/10/2022] Open
Abstract
Background Women from lower socioeconomic groups tend to be at greater risk of adverse perinatal outcomes, but are less likely to participate in preconception counselling compared to higher socioeconomic groups. This could be partly because of their limited skills to assess, understand and use health related information in ways that promote and maintain good health (health literacy skills). In this study we explored determinants of participation in preconception counselling among women with low health literacy in The Netherlands. Methods Potential determinants of participation in preconception counselling were derived from the literature, and mapped onto a theoretical framework, which was tested for perceived relevance and completeness in an expert review (n = 20). The framework was used to prepare face-to-face interviews with women with low health literacy and a wish to conceive (n = 139). In the interviews we explored preconception counselling awareness, knowledge, considerations, subjective norms, self-efficacy, attitude, and intention. Linear regression analyses were used to test associations with intention to participate in preconception counselling. Results Most women (75%) were unaware of the concept of preconception counselling and the provision of counselling, even if they lived in areas where written invitations had been disseminated. Common considerations for participation were: preparation for pregnancy; perceived lack of information; and problems in a previous pregnancy. Considerations not to participate were mostly related to perceived sufficient knowledge and perceived low risk of perinatal problems. Respondents generally had a positive attitude towards participation in preconception counselling for themselves, and 41% reported that they would participate in preconception counselling. Conclusion Women with low health literacy were generally unaware of the concept and provision of preconception counselling, but seemed to be interested in participation. Further research should investigate how to effectively reach and inform this group about preconception counselling. This knowledge is essential for evidence-based development of interventions to increase the accessibility and understanding of preconception counselling. Electronic supplementary material The online version of this article (10.1186/s12978-018-0617-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mirjam P Fransen
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Miriam E Hopman
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Laxsini Murugesu
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ageeth N Rosman
- Rotterdam University of Applied Sciences, School for Healthcare Studies, Department of Master Physician Assistant Midwifery, Rochussenstraat 198, 3015, EK, Rotterdam, The Netherlands
| | - Sian K Smith
- The University of New South Wales, Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, Lowy Research Centre, Sydney, NSW, 2052, Australia
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Taborelli M, Virdone S, Camoni L, Regine V, Zucchetto A, Frova L, Grande E, Boros S, Dal Maso L, De Paoli P, Serraino D, Suligoi B. The persistent problem of late HIV diagnosis in people with AIDS: a population-based study in Italy, 1999-2013. Public Health 2016; 142:39-45. [PMID: 28057195 DOI: 10.1016/j.puhe.2016.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 09/30/2016] [Accepted: 10/13/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Despite the wide accessibility to free human immunodeficiency virus (HIV) testing and combined antiretroviral therapy (cART), late HIV diagnosis remains common with severe consequences at individual and population level. This study aimed to describe trends of late HIV testing and to identify their determinants in the late cART era in Italy. STUDY DESIGN We conducted a population-based, nationwide analysis of the Italian National AIDS Registry data (AIDS - acquired immune deficiency syndrome) for the years 1999-2013. METHODS Late testers (LTs) were defined as people with AIDS (PWA) whose first HIV-positive test preceded AIDS diagnosis by 3 months or less. Odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) were estimated to examine factors associated with being LTs. Joinpoint analysis was used to estimate annual percent changes (APCs) of LTs' proportion over time. RESULTS Among 20,753 adult PWA, 50.8% were LTs. Italian PWA showed a lower proportion of LTs than non-Italian PWA (46.5% vs 68.2%). Among Italian PWA, the odds of being LTs was higher in men than in women (OR = 2.62, 95% CI: 2.38-2.90); in the age groups below 35 years and over 49 years at diagnosis (OR = 1.24, 95% CI: 1.12-1.37 and OR = 1.51, 95% CI: 1.38-1.67, respectively) vs PWA aged 35-49 years; and in those infected through sexual contact as compared with injecting drug use (OR = 13.34, 95% CI: 12.06-14.76 for heterosexual contact and OR = 8.13, 95% CI: 7.30-9.06 for male-to-male sexual contact). The proportion of LTs increased over time among Italians, especially in the latest period (APC2006-2013 = 5.3, 95% CI: 3.8-6.9). The LTs' proportion resulted higher, though stable, among PWA aged ≥50 years. Conversely, an increasing trend was observed among PWA aged 18-34 years (APC = 5.3, 95% CI: 4.5-6.1). The LTs' proportion was persistently higher among PWA who acquired HIV infection through sexual contact, even if a marked increase among injecting drug users was observed after 2005 (APC = 11.4, 95% CI: 5.7-17.5). CONCLUSIONS The increasing trend of LTs' proportion in the late cART era highlights the need of new strategies tailored to groups who may not consider themselves to be at a high risk of infection. Active promotion of early testing and continuous education of infection, especially among young people, need to be implemented.
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Affiliation(s)
- M Taborelli
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy.
| | - S Virdone
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - L Camoni
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy
| | - V Regine
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy
| | - A Zucchetto
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - L Frova
- Servizio Sanità, Salute ed Assistenza, Istituto Nazionale di Statistica, Rome, Italy
| | - E Grande
- Servizio Sanità, Salute ed Assistenza, Istituto Nazionale di Statistica, Rome, Italy
| | - S Boros
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy
| | - L Dal Maso
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - P De Paoli
- Scientific Directorate, CRO Aviano National Cancer Institute, Aviano, Italy
| | - D Serraino
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - B Suligoi
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy
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