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Musiime V, Rujumba J, Kakooza L, Namisanvu H, Atuhaire L, Naguti E, Beinomugisha J, Kiggwe A, Nkinzi S, Segawa I, Matsiko N, Babirekere-Iriso E, Musoke P. HIV prevalence among children admitted with severe acute malnutrition and associated factors with mother-to-child HIV transmission at Mulago Hospital, Uganda: A mixed methods study. PLoS One 2024; 19:e0301887. [PMID: 38626109 PMCID: PMC11020493 DOI: 10.1371/journal.pone.0301887] [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: 02/23/2023] [Accepted: 03/25/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Despite global efforts to eliminate mother-to-child-transmission of HIV (MTCT), many children continue to become infected. We determined the prevalence of HIV among children with severe acute malnutrition (SAM) and that of their mothers, at admission to Mwanamugimu Nutrition Unit, Mulago Hospital, Uganda. We also assessed child factors associated with HIV-infection, and explored factors leading to HIV-infection among a subset of the mother-child dyads that tested positive. METHODOLOGY We conducted a cross-sectional evaluation within the REDMOTHIV (Reduce mortality in HIV) clinical trial that investigated strategies to reduce mortality among HIV-infected and HIV-exposed children admitted with SAM at the Nutrition Unit. From June 2021 to December 2022, we consecutively tested children aged 1 month to 5 years with SAM for HIV, and the mothers who were available, using rapid antibody testing upon admission to the unit. HIV-antibody positive children under 18 months of age had a confirmatory HIV-DNA PCR test done. In-depth interviews (IDIs) were conducted with mothers of HIV positive dyads, to explore the individual, relationship, social and structural factors associated with MTCT, until data saturation. Quantitative data was analyzed using descriptive statistics and logistic regression in STATAv14, while a content thematic approach was used to analyze qualitative data. RESULTS Of 797 children tested, 463(58.1%) were male and 630(79.1%) were ≤18months of age; 76 (9.5%) tested positive. Of 709 mothers, median (IQR) age 26 (22, 30) years, 188(26.5%) were HIV positive. Sixty six of the 188 mother-infant pairs with HIV exposure tested positive for HIV, an MTCT rate of 35.1% (66/188). Child age >18 months was marginally associated with HIV-infection (crude OR = 1.87,95% CI: 1.11-3.12, p-value = 0.02; adjusted OR = 1.72, 95% CI: 0.96, 3.09, p-value = 0.068). The IDIs from 16 mothers revealed associated factors with HIV transmission at multiple levels. Individual level factors: inadequate information regarding prevention of MTCT(PMTCT), limited perception of HIV risk, and fear of antiretroviral drugs (ARVs). Relationship level factors: lack of family support and unfaithfulness (infidelity) among sexual partners. Health facility level factors: negative attitude of health workers and missed opportunities for HIV testing. Community level factors: poverty and health service disruptions due to the COVID-19 pandemic. CONCLUSION In this era of universal antiretroviral therapy for PMTCT, a 10% HIV prevalence among severely malnourished children is substantially high. To eliminate vertical HIV transmission, more efforts are needed to address challenges mothers living with HIV face intrinsically and within their families, communities and at health facilities.
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Affiliation(s)
- Victor Musiime
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Research Department, Joint Clinical Research Centre, Kampala, Uganda
| | - Joseph Rujumba
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lawrence Kakooza
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henriator Namisanvu
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Loice Atuhaire
- Mwanamugimu Nutrition Unit, Directorate of Paediatrics and Child Care, Mulago National Referral Hospital, Kampala, Uganda
| | - Erusa Naguti
- Mwanamugimu Nutrition Unit, Directorate of Paediatrics and Child Care, Mulago National Referral Hospital, Kampala, Uganda
| | - Judith Beinomugisha
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrew Kiggwe
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sharafat Nkinzi
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ivan Segawa
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nicholas Matsiko
- Research Department, Joint Clinical Research Centre, Kampala, Uganda
| | - Esther Babirekere-Iriso
- Mwanamugimu Nutrition Unit, Directorate of Paediatrics and Child Care, Mulago National Referral Hospital, Kampala, Uganda
| | - Philippa Musoke
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Pfledderer CD, von Klinggraeff L, Burkart S, da Silva Bandeira A, Lubans DR, Jago R, Okely AD, van Sluijs EMF, Ioannidis JPA, Thrasher JF, Li X, Beets MW. Consolidated guidance for behavioral intervention pilot and feasibility studies. Pilot Feasibility Stud 2024; 10:57. [PMID: 38582840 PMCID: PMC10998328 DOI: 10.1186/s40814-024-01485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/26/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND In the behavioral sciences, conducting pilot and/or feasibility studies (PFS) is a key step that provides essential information used to inform the design, conduct, and implementation of a larger-scale trial. There are more than 160 published guidelines, reporting checklists, frameworks, and recommendations related to PFS. All of these publications offer some form of guidance on PFS, but many focus on one or a few topics. This makes it difficult for researchers wanting to gain a broader understanding of all the relevant and important aspects of PFS and requires them to seek out multiple sources of information, which increases the risk of missing key considerations to incorporate into their PFS. The purpose of this study was to develop a consolidated set of considerations for the design, conduct, implementation, and reporting of PFS for interventions conducted in the behavioral sciences. METHODS To develop this consolidation, we undertook a review of the published guidance on PFS in combination with expert consensus (via a Delphi study) from the authors who wrote such guidance to inform the identified considerations. A total of 161 PFS-related guidelines, checklists, frameworks, and recommendations were identified via a review of recently published behavioral intervention PFS and backward/forward citation tracking of a well-known PFS literature (e.g., CONSORT Ext. for PFS). Authors of all 161 PFS publications were invited to complete a three-round Delphi survey, which was used to guide the creation of a consolidated list of considerations to guide the design, conduct, and reporting of PFS conducted by researchers in the behavioral sciences. RESULTS A total of 496 authors were invited to take part in the three-round Delphi survey (round 1, N = 46; round 2, N = 24; round 3, N = 22). A set of twenty considerations, broadly categorized into six themes (intervention design, study design, conduct of trial, implementation of intervention, statistical analysis, and reporting) were generated from a review of the 161 PFS-related publications as well as a synthesis of feedback from the three-round Delphi process. These 20 considerations are presented alongside a supporting narrative for each consideration as well as a crosswalk of all 161 publications aligned with each consideration for further reading. CONCLUSION We leveraged expert opinion from researchers who have published PFS-related guidelines, checklists, frameworks, and recommendations on a wide range of topics and distilled this knowledge into a valuable and universal resource for researchers conducting PFS. Researchers may use these considerations alongside the previously published literature to guide decisions about all aspects of PFS, with the hope of creating and disseminating interventions with broad public health impact.
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Affiliation(s)
- Christopher D Pfledderer
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, TX, 78701, USA.
- Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, TX, 78701, USA.
| | | | - Sarah Burkart
- Arnold School of Public Health, University of South Carolina, Columbia, SC, 29205, USA
| | | | - David R Lubans
- College of Human and Social Futures, The University of Newcastle Australia, Callaghan, NSW, 2308, Australia
| | - Russell Jago
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 1QU, UK
| | - Anthony D Okely
- Faculty of Arts, Social Sciences and Humanities, School of Health and Society, University of Wollongong, Wollongong, NSW, 2522, Australia
| | | | - John P A Ioannidis
- Department of Medicine, Stanford University, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
- Department of Statistics, Stanford University, Stanford, CA, USA
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - James F Thrasher
- Arnold School of Public Health, University of South Carolina, Columbia, SC, 29205, USA
| | - Xiaoming Li
- Arnold School of Public Health, University of South Carolina, Columbia, SC, 29205, USA
| | - Michael W Beets
- Arnold School of Public Health, University of South Carolina, Columbia, SC, 29205, USA
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Pfledderer CD, von Klinggraeff L, Burkart S, da Silva Bandeira A, Lubans DR, Jago R, Okely AD, van Sluijs EM, Ioannidis JP, Thrasher JF, Li X, Beets MW. Expert Perspectives on Pilot and Feasibility Studies: A Delphi Study and Consolidation of Considerations for Behavioral Interventions. RESEARCH SQUARE 2023:rs.3.rs-3370077. [PMID: 38168263 PMCID: PMC10760234 DOI: 10.21203/rs.3.rs-3370077/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background In the behavioral sciences, conducting pilot and/or feasibility studies (PFS) is a key step that provides essential information used to inform the design, conduct, and implementation of a larger-scale trial. There are more than 160 published guidelines, reporting checklists, frameworks, and recommendations related to PFS. All of these publications offer some form of guidance on PFS, but many focus on one or a few topics. This makes it difficult for researchers wanting to gain a broader understanding of all the relevant and important aspects of PFS and requires them to seek out multiple sources of information, which increases the risk of missing key considerations to incorporate into their PFS. The purpose of this study was to develop a consolidated set of considerations for the design, conduct, implementation, and reporting of PFS for interventions conducted in the behavioral sciences. Methods To develop this consolidation, we undertook a review of the published guidance on PFS in combination with expert consensus (via a Delphi study) from the authors who wrote such guidance to inform the identified considerations. A total of 161 PFS-related guidelines, checklists, frameworks, and recommendations were identified via a review of recently published behavioral intervention PFS and backward/forward citation tracking of well-know PFS literature (e.g., CONSORT Ext. for PFS). Authors of all 161 PFS publications were invited to complete a three-round Delphi survey, which was used to guide the creation of a consolidated list of considerations to guide the design, conduct, and reporting of PFS conducted by researchers in the behavioral sciences. Results A total of 496 authors were invited to take part in the Delphi survey, 50 (10.1%) of which completed all three rounds, representing 60 (37.3%) of the 161 identified PFS-related guidelines, checklists, frameworks, and recommendations. A set of twenty considerations, broadly categorized into six themes (Intervention Design, Study Design, Conduct of Trial, Implementation of Intervention, Statistical Analysis and Reporting) were generated from a review of the 161 PFS-related publications as well as a synthesis of feedback from the three-round Delphi process. These 20 considerations are presented alongside a supporting narrative for each consideration as well as a crosswalk of all 161 publications aligned with each consideration for further reading. Conclusion We leveraged expert opinion from researchers who have published PFS-related guidelines, checklists, frameworks, and recommendations on a wide range of topics and distilled this knowledge into a valuable and universal resource for researchers conducting PFS. Researchers may use these considerations alongside the previously published literature to guide decisions about all aspects of PFS, with the hope of creating and disseminating interventions with broad public health impact.
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Affiliation(s)
| | | | - Sarah Burkart
- University of South Carolina Arnold School of Public Health
| | | | | | - Russ Jago
- University of Bristol Population Health Sciences
| | | | | | | | | | - Xiaoming Li
- University of South Carolina Arnold School of Public Health
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Mlay JP, Jamieson L, Ntlantsana V, Naidu T, Bhengu BS, Paruk S, Burns JK, Chiliza B, Lessells R, Tomita A. Developing and testing unconditional cash transfer strategies among young adults with first-episode psychosis in South Africa: a study protocol for a pilot randomised control trial (PRS-FEP trial). BMJ Open 2022; 12:e067026. [PMID: 36576187 PMCID: PMC9723892 DOI: 10.1136/bmjopen-2022-067026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Access to mental health services is a challenge, especially for young people who are over-represented in the unemployment and poverty index in South Africa. Therefore, continuing care is a problem after hospital discharge for young people with first-episode psychosis (FEP) due to a lack of clinical engagement and follow-up, for which they need support, including financial, to improve their outcomes. This pilot randomised control trial (RCT) aims to assess the feasibility and acceptability of financial support, in the form of an unconditional cash transfer (UCT), among young patients with FEP to prevent relapse. METHODS AND ANALYSIS This study will use a 1:1 ratio two-arm open-label pilot RCT of 60 young participants (18-29 years) with FEP in remission, who will be recruited from specialised psychiatric facilities in KwaZulu-Natal Province, South Africa. This study will implement an UCT and assess its feasibility, acceptability and preliminary clinical outcomes (ie, medication adherence, relapse, quality of life, personal and social function). The follow-up time will be 3 months, the outcomes being measured at baseline, months 1 and 3. Descriptive and conventional content analysis will be done for quantitative and qualitative data, respectively. ETHICS AND DISSEMINATION The study obtained provisional approval from the Biomedical Research Ethics Committee at the University of KwaZulu-Natal(#BREC/00004117/2022). Also is registered on the South African National clinical trial registry (#DOH-27-092022-5894) and approved by the KwaZulu-Natal department of health (#NHRD Ref: KZ_2002209_033). The results from this investigation will be actively disseminated through peer-reviewed journal publications, conference presentations and stakeholder engagement. TRIAL REGISTRATION NUMBER DOH-27-092022-5894.
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Affiliation(s)
- Joyce Protas Mlay
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Lise Jamieson
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
| | - Vuyokazi Ntlantsana
- Discipline of Psychiatry, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa
| | - Thirusha Naidu
- Discipline of Behavioural Medicine, University of KwaZulu-Natal School of Nursing and Public Health, Durban, KwaZulu-Natal, South Africa
| | - Busisiwe Siphumelele Bhengu
- Discipline of Psychiatry, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa
| | - Saeeda Paruk
- Discipline of Psychiatry, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa
| | - Jonathan K Burns
- Discipline of Psychiatry, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Bonginkosi Chiliza
- Discipline of Psychiatry, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa
| | - Richard Lessells
- Centre for the Aids Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Andrew Tomita
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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Schlehr SR, Singh L, Nyatela A, Nqakala S, Lalla-Edward ST. Experiences in receiving financial incentives to access HIV care in Johannesburg, South Africa. South Afr J HIV Med 2022; 23:1426. [PMID: 36479419 PMCID: PMC9724036 DOI: 10.4102/sajhivmed.v23i1.1426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/07/2022] [Indexed: 09/10/2024] Open
Abstract
Background Financial incentivisation has been used to improve all steps of the HIV cascade with varying results. Most studies conducted on the matter are of a quantitative nature, not giving enough space for in-depth understanding as to why financial incentives work or do not work. Objectives To describe experiences with, and opinions on, the use of financial incentives to promote linkage to and retention in care from the perspective of people living with HIV. Method We performed a qualitative cross-sectional study. In-depth interviews were conducted with adult men and women with HIV accessing health services or research study visits. After codebook development, NVivo 12 software was used to code and analyse the data. Results Through the provision of financial incentives, participants were able to cover basic needs. However, some deemed financial incentives as a form of income rather than a nudge to spark interest in changing their health behaviour. Participants communicated that a need for some type of incentive exists and recommended food vouchers as the best possible solution. Conclusion Financial incentivisation can facilitate engagement in the HIV care continuum through providing support to people living with HIV. What this study adds This study complements the body of research that explores the feasibility of using incentives and which of them may be most beneficial in encouraging patients with HIV to enter into and sustain HIV care.
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Affiliation(s)
- Sara Rachel Schlehr
- Department of Interdisciplinary Social Sciences, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, the Netherlands
- Department of Research Development, Ezintsha Research Centre, Johannesburg, South Africa
| | - Leanne Singh
- Department of Research Development, Ezintsha Research Centre, Johannesburg, South Africa
| | - Athini Nyatela
- Department of Research Development, Ezintsha Research Centre, Johannesburg, South Africa
| | - Sizwe Nqakala
- Department of Research Development, Ezintsha Research Centre, Johannesburg, South Africa
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Andrawis A, Tapa J, Vlaev I, Read D, Schmidtke KA, Chow EPF, Lee D, Fairley CK, Ong JJ. Applying Behavioural Insights to HIV Prevention and Management: a Scoping Review. Curr HIV/AIDS Rep 2022; 19:358-374. [PMID: 35930186 PMCID: PMC9508055 DOI: 10.1007/s11904-022-00615-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW This scoping review summarises the literature on HIV prevention and management interventions utilizing behavioural economic principles encapsulated in the MINDSPACE framework. RECENT FINDINGS MINDSPACE is an acronym developed by the UK's behavioural insights team to summarise nine key influences on human behaviour: Messenger, Incentives, Norms, Default, Salience, Priming, Affect, Commitment, and Ego. These effects have been used in various settings to design interventions that encourage positive behaviours. Currently, over 200 institutionalised behavioural insight teams exist internationally, which may draw upon the MINDSPACE framework to inform policy and improve public services. To date, it is not clear how behavioural insights have been applied to HIV prevention and management interventions. After screening 899 studies for eligibility, 124 were included in the final review. We identified examples of interventions that utilised all the MINDSPACE effects in a variety of settings and among various populations. Studies from high-income countries were most common (n = 54) and incentives were the most frequently applied effect (n = 100). The MINDSPACE framework is a useful tool to consider how behavioural science principles can be applied in future HIV prevention and management interventions. Creating nudges to enhance the design of HIV prevention and management interventions can help people make better choices as we strive to end the HIV/AIDS pandemic by 2030.
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Affiliation(s)
- Alexsandra Andrawis
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - James Tapa
- Central Clinical School, Monash University, Melbourne, Australia
| | - Ivo Vlaev
- Warwick Business School, Coventry, UK
| | | | | | - Eric P F Chow
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Melbourne, Australia
| | - David Lee
- Melbourne Sexual Health Centre, Melbourne, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Melbourne, Australia
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Melbourne, Australia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- , Carlton, Australia
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Dickin S, Vanhuyse F, Stirrup O, Liera C, Copas A, Odhiambo A, Palmer T, Haghparast-Bidgoli H, Batura N, Mwaki A, Skordis J. Implementation of the Afya conditional cash transfer intervention to retain women in the continuum of care: a mixed-methods process evaluation. BMJ Open 2022; 12:e060748. [PMID: 36123052 PMCID: PMC9486356 DOI: 10.1136/bmjopen-2022-060748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES We report the results of a mixed-methods process evaluation that aimed to provide insight on the Afya conditional cash transfer (CCT) intervention fidelity and acceptability. INTERVENTION, SETTING AND PARTICIPANTS The Afya CCT intervention aimed to retain women in the continuum of maternal healthcare including antenatal care (ANC), delivery at facility and postnatal care (PNC) in Siaya County, Kenya. The cash transfers were delivered using an electronic card reader system at health facilities. It was evaluated in a trial that randomised 48 health facilities to intervention or control, and which found modest increases in attendance for ANC and immunisation appointments, but little effect on delivery at facility and PNC visits. DESIGN A mixed-methods process evaluation was conducted. We used the Afya electronic portal with recorded visits and payments, and reports on use of the electronic card reader system from each healthcare facility to assess fidelity. Focus group interviews with participants (N=5) and one-on-one interviews with participants (N=10) and healthcare staff (N=15) were conducted to assess the acceptability of the intervention. Data analyses were conducted using descriptive statistics and qualitative content analysis, as appropriate. RESULTS Delivery of the Afya CCT intervention was negatively affected by problems with the electronic card reader system and a decrease in adherence to its use over the intervention period by healthcare staff, resulting in low implementation fidelity. Acceptability of cash transfers in the form of mobile transfers was high for participants. Initially, the intervention was acceptable to healthcare staff, especially with respect to improvements in attaining facility targets for ANC visits. However, acceptability was negatively affected by significant delays linked to the card reader system. CONCLUSIONS The findings highlight operational challenges in delivering the Afya CCT intervention using the Afya electronic card reader system, and the need for greater technology readiness before further scale-up. TRIAL REGISTRATION NUMBER NCT03021070.
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Affiliation(s)
- Sarah Dickin
- Stockholm Environment Institute, Stockholm, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Oliver Stirrup
- Institute for Global Health, University College London, London, UK
| | - Carla Liera
- Stockholm Environment Institute, Stockholm, Sweden
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | | | - Tom Palmer
- Institute for Global Health, University College London, London, UK
| | | | - Neha Batura
- Institute for Global Health, University College London, London, UK
| | - Alex Mwaki
- Safe Water and AIDS Project, Kisumu, Kenya
| | - Jolene Skordis
- Institute for Global Health, University College London, London, UK
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Leshargie CT, Demant D, Burrowes S, Frawley J. The proportion of loss to follow-up from antiretroviral therapy (ART) and its association with age among adolescents living with HIV in sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2022; 17:e0272906. [PMID: 35951621 PMCID: PMC9371308 DOI: 10.1371/journal.pone.0272906] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) remains a global health threat, especially in developing countries. The successful scale-up of antiretroviral therapy (ART) programs to address this threat is hindered by a high proportion of patient loss to follow-up (LTFU). LTFU is associated with poor viral suppression and increased mortality. It is particularly acute among adolescents, who face unique adherence challenges. Although LTFU is a critical obstacle on the continuum of care for adolescents, few regional-level studies report the proportion of LTFU among adolescents receiving ART. Therefore, a systematic review and meta-analysis were conducted to estimate the pooled LTFU in ART programs among adolescents living with HIV in sub-Saharan Africa (SSA). METHODS We searched five databases (PubMed, Embase (Elsevier), PsycINFO, CINAHL, and Scopus) for articles published between 2005 and 2020 and reference lists of included articles. The PRISMA guidelines for systematic reviews were followed. A standardised checklist to extract data was used. Descriptive summaries were presented using narrative tables and figures. Heterogeneity within the included studies was examined using the Cochrane Q test statistics and I2 test. Random effect models were used to estimate the pooled prevalence of LTFU among ALHIV. We used Stata version 16 statistical software for our analysis. RESULTS Twenty-nine eligible studies (n = 285,564) were included. An estimated 15.07% (95% CI: 11.07, 19.07) of ALHIV were LTFU. Older adolescents (15-19 years old) were 43% (AOR = 0.57, 95% CI: 0.37, 0.87) more likely to be LTFU than younger (10-14 years old) adolescents. We find an insignificant relationship between gender and LTFU (AOR = 0.95, 95% CI: 0.87, 1.03). A subgroup analysis found that regional differences in the proportion of adolescent LTFU were not statistically significant. The trend analysis indicates an increasing proportion of adolescent LTFU over time. CONCLUSIONS AND RECOMMENDATIONS The proportion of LTFU among HIV-positive adolescents in SSA seems higher than those reported in other regions. Older adolescents in the region are at an increased risk for LTFU than younger adolescents. These findings may help policymakers develop appropriate strategies to retain ALHIV in ART services. Such strategies could include community ART distribution points, appointment spacing, adherence clubs, continuous free access to ART, and community-based adherence support.
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Affiliation(s)
- Cheru Tesema Leshargie
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Daniel Demant
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Sahai Burrowes
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, United States of America
| | - Jane Frawley
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
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Swartz A, Maughan-Brown B, Perera S, Harrison A, Kuo C, Lurie MN, Smith P, Bekker LG, Galárraga O. "The Money, It's OK but It's not OK": Patients' and Providers' Perceptions of the Acceptability of Cash Incentives for HIV Treatment Initiation in Cape Town, South Africa. AIDS Behav 2022; 26:116-122. [PMID: 34148206 PMCID: PMC8685299 DOI: 10.1007/s10461-021-03355-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 01/03/2023]
Abstract
Incentive-based interventions are used to encourage HIV testing, linkage to HIV care, and antiretroviral therapy (ART) adherence. Studies assessing efficacy of cash incentives have raised questions about the perceived ethicality of and attitudes towards incentives. Here we explore patients' and health providers' perspectives of the acceptability of a conditional cash transfer for ART initiation after receiving a positive HIV test through community-based services in resource-poor communities in Cape Town, South Africa. Drawing on in-depth interviews with patients and health care workers (HCWs), we find that, despite the perception that cash incentives are effective in promoting ART initiation, significant ambivalence surrounds the acceptability of such incentives. The receipt of a financial incentive was highly moralized, and fraught with challenges. Increasing the acceptability of cash incentives through careful design and delivery of interventions is central to the potential of this type of intervention for improving outcomes along the HIV care continuum.
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Affiliation(s)
- Alison Swartz
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Brendan Maughan-Brown
- Southern Africa Labour and Development Research Unit, School of Economics, University of Cape Town, Cape Town, South Africa
| | - Shehani Perera
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Abigail Harrison
- School of Public Health, International Health Institute, Brown University, Providence, RI, USA
| | - Caroline Kuo
- School of Public Health, International Health Institute, Brown University, Providence, RI, USA
| | - Mark N Lurie
- School of Public Health, International Health Institute, Brown University, Providence, RI, USA
| | - Philip Smith
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Omar Galárraga
- School of Public Health, International Health Institute, Brown University, Providence, RI, USA
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10
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Kadota JL, Nabwire S, Nalugwa T, White JS, Cattamanchi A, Katamba A, Shete PB. Patient Perspectives and Willingness to Accept Incentives for Tuberculosis Diagnostic Evaluation in Uganda. Value Health Reg Issues 2021; 25:48-56. [PMID: 33773327 DOI: 10.1016/j.vhri.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We assessed attitudes and perceptions and willingness to accept (WTA) varying incentive structures for completing tuberculosis (TB) diagnostic evaluation among patients in Uganda. METHODS We surveyed 177 adult patients undergoing TB evaluation at 10 health centers between September 2018 and March 2019. We collected household sociodemographic information and assessed attitudes and perceptions of incentives. We surveyed patients regarding their willingness to complete TB diagnostic evaluation in exchange for incentives ranging in value from 500 Ugandan shillings (USh) to 25 000USh (~$0.15-$6.75). We compared associations between WTA and patient characteristics using ordered logistic regression. RESULTS Participant willingness to return to the health center to complete TB diagnostic evaluation increased proportionally with incentive amount. The median participant accepted between 2000 and 5000 USh. Cash (52%) and transportation vouchers (34%) were the most popular incentive types. Half of respondents preferred unconditional incentives; for a multiday evaluation, 84% preferred conditioning incentive receipt upon returning to the health center. In multivariate models, we found the pairwise difference between the third and lowest income quartile (aOR = 2.38, 95% CI: 1.20-4.69; P = .01), younger age, and difficulty returning to the health center to be significantly associated with WTA higher incentive thresholds. CONCLUSIONS In Uganda, incentives such as cash transfers or transportation vouchers are an acceptable intervention for facilitating adherence to TB diagnostic evaluation. Household income is associated with preferred incentive structure and amount, especially for those at the cusp of the poverty threshold who are more likely to prefer unconditional and higher valued incentives. Targeted and context-specific socioeconomic supports for at-risk patients are needed to optimize outcomes.
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Affiliation(s)
- Jillian L Kadota
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA USA.
| | - Sarah Nabwire
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Talemwa Nalugwa
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Justin S White
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA USA; Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda; Clinical Epidemiology & Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Priya B Shete
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA USA; Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
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11
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Phillips TK, Teasdale CA, Geller A, Ng'eno B, Mogoba P, Modi S, Abrams EJ. Approaches to transitioning women into and out of prevention of mother-to-child transmission of HIV services for continued ART: a systematic review. J Int AIDS Soc 2021; 24:e25633. [PMID: 33372730 PMCID: PMC7771153 DOI: 10.1002/jia2.25633] [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: 02/14/2020] [Revised: 09/22/2020] [Accepted: 10/08/2020] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Women living with HIV are required to transition into the prevention of mother-to-child transmission of HIV (PMTCT) services when they become pregnant and back to ART services after delivery. Transition can be a vulnerable time when many women are lost from HIV care yet there is little guidance on the optimal transition approaches to ensure continuity of care. We reviewed the available evidence on existing approaches to transitioning women into and out of PMTCT, outcomes following transition and factors influencing successful transition. METHODS We searched PubMed and SCOPUS, as well as abstracts from international HIV-focused meetings, from January 2006 to July 2020. Studies were included that examined three points of transition: pregnant women already on ART into PMTCT (transition 1), pregnant women living with HIV not yet on ART into treatment services (transition 2) and postpartum women from PMTCT into general ART services after delivery (transition 3). Results were grouped and reported as descriptions of transition approach, comparison of outcomes following transition and factors influencing successful transition. RESULTS & DISCUSSION Out of 1809 abstracts located, 36 studies (39 papers) were included in this review. Three studies included transition 1, 26 transition 2 and 17 transition 3. Approaches to transition were described in 26 studies and could be grouped into the provision of information at the point of transition (n = 8), strengthened communication or linkage of data between services (n = 4), use of transition navigators (n = 12), and combination approaches (n = 4). Few studies were designed to directly assess transition and only nine compared outcomes between transition approaches, with substantial heterogeneity in study design, setting and outcomes. Four themes were identified in 25 studies reporting on factors influencing successful transition: fear, knowledge and preparedness, clinic characteristics and the transition requirements and process. CONCLUSIONS This review highlights that, despite the need for women to transition into and out of PMTCT services for continued ART in many settings, there is very limited evidence on optimal transition approaches. Ongoing operational research is required to identify sustainable and acceptable transition approaches and service delivery models that support continuity of HIV care during and after pregnancy.
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Affiliation(s)
- Tamsin K Phillips
- Division of Epidemiology and BiostatisticsSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
- Centre for Infectious Diseases Epidemiology & ResearchSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Chloe A Teasdale
- ICAP‐Columbia UniversityMailman School of Public HealthNew YorkNYUSA
- Department of EpidemiologyMailman School of Public HealthNew YorkNYUSA
- Department of Epidemiology and BiostatisticsCUNY Graduate School of Public Health & Health PolicyNew YorkNYUSA
| | - Amanda Geller
- US Centers for Disease Control and Prevention (CDC)AtlantaGAUSA
| | | | - Pheposadi Mogoba
- Centre for Infectious Diseases Epidemiology & ResearchSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Surbhi Modi
- US Centers for Disease Control and Prevention (CDC)AtlantaGAUSA
| | - Elaine J Abrams
- ICAP‐Columbia UniversityMailman School of Public HealthNew YorkNYUSA
- Department of EpidemiologyMailman School of Public HealthNew YorkNYUSA
- College Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
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12
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Retention in HIV Care Among HIV-Seropositive Pregnant and Postpartum Women in Uganda: Results of a Randomized Controlled Trial. AIDS Behav 2020; 24:3164-3175. [PMID: 32314120 DOI: 10.1007/s10461-020-02875-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We tested an intervention that aimed to increase retention in antiretroviral therapy (ART) among HIV-positive pregnant and postpartum women, a population shown to be vulnerable to poor ART outcomes. 133 pregnant women initiating ART at 2 hospitals in Uganda used real time-enabled wireless pill monitors (WPM) for 1 month, and were then randomized to receive text message reminders (triggered by late dose-taking) and data-informed counseling through 3 months postpartum or standard care. We assessed "full retention" (proportion attending all monthly clinic visits and delivering at a study facility; "visit retention" (proportion of clinic visits attended); and "postpartum retention" (proportion retained at 3 months postpartum). Intention-to-treat and per protocol analyses found that retention was relatively low and similar between groups, with no significant differences. Retention declined significantly post-delivery. The intervention was unsuccessful in this population, which experiences suboptimal ART retention and is in urgent need of effective interventions.
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13
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Acceptability of Interventions to Improve Engagement in HIV Care Among Pregnant and Postpartum Women at Two Urban Clinics in South Africa. Matern Child Health J 2020; 23:1260-1270. [PMID: 31218606 DOI: 10.1007/s10995-019-02766-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Pregnant women initiating antiretroviral therapy (ART) in sub-Saharan Africa have been shown to have sub-optimal engagement in care, particularly after delivery, and interventions to improve engagement in care for this unique population are urgently needed. METHODS We enrolled 25 pregnant women living with HIV at each of two large antenatal clinics in Johannesburg and Cape Town, South Africa (n = 50), and conducted in-depth interviews. We assessed participants' reported acceptability of the following proposed interventions to improve engagement in care and retention monitoring data systems: financial incentives, educational toys, health education, combined maternal/infant visits, cell phone text reminders, mobility tracking, fingerprint/biometric devices, and smartcards. RESULTS Acceptability overall for interventions was high, with mixed responses for some interventions. Overall themes identified included (i) the intersection of individual and facility responsibility for a patient's health, (ii) a call for more health education, (iii) issues of disclosure and concerns about privacy, and (iv) openness to interventions that could improve health systems. DISCUSSION These findings provide insight into the preferences and concerns of potential users of interventions to improve engagement in HIV care for pregnant women, and support the development of tools that specifically target this high-risk group.
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Keita A, Sereme Y, Pillet S, Coulibaly S, Diallo F, Pozzetto B, Thiero TA, Bourlet T. Impact of HIV-1 primary drug resistance on the efficacy of a first-line antiretroviral regimen in the blood of newly diagnosed individuals in Bamako, Mali. J Antimicrob Chemother 2020; 74:165-171. [PMID: 30285106 DOI: 10.1093/jac/dky382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/24/2018] [Indexed: 12/30/2022] Open
Abstract
Background To achieve the 90-90-90 targets assigned by UNAIDS, it is crucial to monitor ART in HIV-1-infected patients, especially in resource-limited countries. Objectives To evaluate the immunovirological response after 12 months of ART in newly HIV-1-diagnosed people in Bamako, Mali; to determine primary and acquired resistance rates to antiretroviral drugs; and to evaluate the impact of primary resistance on the efficacy of ART. Patients and methods One hundred and nineteen HIV-1-infected people (88.2% women; median age 34 years) were enrolled between January and June 2014. HIV-1 RNA loads (Abbott RealTime HIV-1 assay) were tested in the blood before and at months 3, 6 and 12 after initiation of ART. Primary and acquired resistances to ART were evaluated by the Viroseq™ HIV-1 genotyping assay. Results During the study, 8.4% of people died and 37% were lost to follow-up. After 1 year of ART, an undetectable HIV-1 RNA viral load was found in 87.7% of cases. The overall rate of primary drug resistance mutations was 17.5% (3.2%, 15.9% and 0% for NRTIs, NNRTIs and PIs, respectively). These mutations were not associated with either higher mortality rates or larger numbers of virological failures. The acquired resistance rate was estimated at 3.1%. Conclusions Our study showed a high primary resistance level and a huge proportion of people non-adherent to the treatment programme. Reassuringly, almost 90% virological success and a low level of acquired mutations were observed in adherent people at month 12. Reinforced education, regular virological monitoring and early HIV-1 diagnosis may help to improve retention in the care system.
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Affiliation(s)
- Abdelaye Keita
- Institut National de Recherche en Santé Publique (INRSP), Bamako, Mali.,Groupe Immunité des Muqueuses et Agents Pathogènes GIMAP EA3064, University of Saint-Etienne, University of Lyon, Saint-Etienne, France
| | - Youssouf Sereme
- Groupe Immunité des Muqueuses et Agents Pathogènes GIMAP EA3064, University of Saint-Etienne, University of Lyon, Saint-Etienne, France
| | - Sylvie Pillet
- Groupe Immunité des Muqueuses et Agents Pathogènes GIMAP EA3064, University of Saint-Etienne, University of Lyon, Saint-Etienne, France.,Laboratoire des Agents Infectieux et d'Hygiène, University Hospital of Saint-Etienne, Saint Etienne, France
| | | | - Fodié Diallo
- Centre d'écoute de soins et d'accompagnement (CESAC), Bamako, Mali
| | - Bruno Pozzetto
- Groupe Immunité des Muqueuses et Agents Pathogènes GIMAP EA3064, University of Saint-Etienne, University of Lyon, Saint-Etienne, France.,Laboratoire des Agents Infectieux et d'Hygiène, University Hospital of Saint-Etienne, Saint Etienne, France
| | - Tenin Aoua Thiero
- Institut National de Recherche en Santé Publique (INRSP), Bamako, Mali
| | - Thomas Bourlet
- Groupe Immunité des Muqueuses et Agents Pathogènes GIMAP EA3064, University of Saint-Etienne, University of Lyon, Saint-Etienne, France.,Laboratoire des Agents Infectieux et d'Hygiène, University Hospital of Saint-Etienne, Saint Etienne, France
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15
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Carlucci JG, Liu Y, Clouse K, Vermund SH. Attrition of HIV-positive children from HIV services in low and middle-income countries. AIDS 2019; 33:2375-2386. [PMID: 31764102 PMCID: PMC6905128 DOI: 10.1097/qad.0000000000002366] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Identification and retention of HIV-positive children in HIV services is essential to ensure optimal health outcomes. This systematic review and meta-analysis examines the magnitude of attrition [loss to follow-up (LTFU) and death) of HIV-positive children from HIV services in low and middle-income countries (LMICs). METHODS We performed a comprehensive multidatabase search of original studies reporting retention/attrition data for HIV-positive children in LMICs through April 2016. Outcomes included LTFU, death, and overall attrition (LTFU + death) at intervals up to 60 months of follow-up. At least two authors determined study eligibility, performed data extraction, and made quality assessments. We used random-effects meta-analytic methods to aggregate effect sizes and perform meta-regression analyses. RESULTS We identified 3040 unique studies; 91 met eligibility criteria and were included in the analysis. This represents 147 129 HIV-positive children; most were from Africa (83%). LTFU definitions varied widely, with significant variability in outcomes across studies. Most attrition occurred in the first 6 months of follow-up, increasing to 23% by 36 months. HIV-positive children receiving antiretroviral therapy (ART) had significantly better retention in care than those not on ART. Studies that performed case-finding/tracing for those LTFU had better retention in care up to 24 months of follow-up. CONCLUSIONS These findings underscore the high attrition of children from HIV services in LMICs. Early ART initiation and decentralized patient support services (e.g. tracing for those LTFU) have potential to improve retention in care. Implementation research and resources are urgently needed to improve retention among this vulnerable population.
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Affiliation(s)
- James G. Carlucci
- Vanderbilt Institute for Global Health, Vanderbilt
University Medical Center, Nashville, Tennessee, USA
- Division of Pediatric Infectious Diseases, Department of
Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yu Liu
- Department of Public Health Sciences, School of Medicine
and Dentistry, University of Rochester, Rochester, New York, USA
| | - Kate Clouse
- Vanderbilt Institute for Global Health, Vanderbilt
University Medical Center, Nashville, Tennessee, USA
- School of Nursing, Vanderbilt University, Nashville,
Tennessee, USA
| | - Sten H. Vermund
- Yale School of Public Health, Yale University, New Haven,
Connecticut, USA
- Department of Pediatrics, Yale School of Medicine, Yale
University, New Haven, Connecticut, USA
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16
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Haskins JL, Phakathi SA, Grant M, Horwood CM. Integrating services for impact and sustainability: a proof-of-concept project in KwaZulu-Natal, South Africa. S Afr Fam Pract (2004) 2019. [DOI: 10.1080/20786190.2019.1656435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- J Lyn Haskins
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Sifiso A Phakathi
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Merridy Grant
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
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17
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Banigbe B, Audet CM, Okonkwo P, Arije OO, Bassi E, Clouse K, Simmons M, Aliyu MH, Freedberg KA, Ahonkhai AA. Effect of PEPFAR funding policy change on HIV service delivery in a large HIV care and treatment network in Nigeria. PLoS One 2019; 14:e0221809. [PMID: 31553735 PMCID: PMC6760763 DOI: 10.1371/journal.pone.0221809] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/15/2019] [Indexed: 01/10/2023] Open
Abstract
The transition to PEPFAR 2.0 with its focus on country ownership was accompanied by substantial funding cuts. We describe the impact of this transition on HIV care in a large network of HIV clinics in Nigeria. We surveyed 30 comprehensive HIV treatment clinics to assess services supported before (October 2013-September 2014) and after (October 2014-September 2015) the PEPFAR funding policy change, the impact of these policy changes on service delivery areas, and response of clinics to the change. We compared differences in support for staffing, laboratory services, and clinical operations pre- and post-policy change using paired t-tests. We used framework analysis to assess answers to open ended questions describing responses to the policy change. Most sites (83%, n = 25) completed the survey. The majority were public (60%, n = 15) and secondary (68%, n = 17) facilities. Clinics had a median of 989 patients in care (IQR: 543-3326). All clinics continued to receive support for first and second line antiretrovirals and CD4 testing after the policy change, while no clinics received support for other routine drug monitoring labs. We found statistically significant reductions in support for viral load testing, staff employment, defaulter tracking, and prevention services (92% vs. 64%, p = 0.02; 80% vs. 20%, 100% vs. 44%, 84% vs. 16%, respectively, p<0.01 for all) after the policy change. Service delivery was hampered by interrupted laboratory services and reduced wages and staff positions leading to reduced provider morale, and compromised quality of care. Almost all sites (96%) introduced user fees to address funding shortages. Clinics in Nigeria are experiencing major challenges in providing routine HIV services as a result of PEPFAR's policy changes. Funding cutbacks have been associated with compromised quality of care, staff shortages, and reliance on fee-based care for historically free services. Sustainable HIV services funding models are urgently needed.
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Affiliation(s)
| | - Carolyn M. Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Friends in Global Health, Maputo, Mozambique
| | | | - Olujide O. Arije
- Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Kate Clouse
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Division of Infectious Disease, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Melynda Simmons
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Muktar H. Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Kenneth A. Freedberg
- Division of Infectious Disease and General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Aima A. Ahonkhai
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Division of Infectious Disease, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Division of Infectious Disease and General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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18
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Phillips TK, Myer L. Shifting to the long view: engagement of pregnant and postpartum women living with HIV in lifelong antiretroviral therapy services. Expert Rev Anti Infect Ther 2019; 17:349-361. [PMID: 30978126 DOI: 10.1080/14787210.2019.1607296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: The advent of policies promoting lifelong antiretroviral therapy (ART) for all pregnant and postpartum women living with HIV has shifted focus from short-term prevention of mother-to-child transmission (PMTCT) to lifelong engagement in ART services. However, disengagement from care threatens the long-term treatment and prevention benefits of lifelong ART. Areas covered: A framework for considering the unique aspects of ART for pregnant and postpartum women is presented along with a review of the literature on maternal engagement in care in sub-Saharan Africa and a discussion of potential interventions to sustain engagement in lifelong ART. Expert opinion: Engaging women and mothers in ART services for life is critical for maternal health, PMTCT, and prevention of sexual transmission. Evidence-based interventions exist to support engagement in care but most focus on periods of mother-to-child transmission risk. In the long term, life transitions and health-care transfers are inevitable. Thus, interventions that can reach beyond a single facility or provide a bridge between health services should be prioritized. Multicomponent interventions will also be essential to address the numerous intersecting barriers to sustained engagement in ART services.
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Affiliation(s)
- Tamsin K Phillips
- a Division of Epidemiology & Biostatistics and Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Landon Myer
- a Division of Epidemiology & Biostatistics and Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine , University of Cape Town , Cape Town , South Africa
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19
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Carlucci JG, Liu Y, Friedman H, Pelayo BE, Robelin K, Sheldon EK, Clouse K, Vermund SH. Attrition of HIV-exposed infants from early infant diagnosis services in low- and middle-income countries: a systematic review and meta-analysis. J Int AIDS Soc 2018; 21:e25209. [PMID: 30649834 PMCID: PMC6287094 DOI: 10.1002/jia2.25209] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 10/22/2018] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Identification and retention of HIV-exposed infants in early infant diagnosis (EID) services helps to ensure optimal health outcomes. This systematic review and meta-analysis examines the magnitude of attrition from EID services in low- and middle-income countries (LMICs). METHODS We performed a comprehensive database search through April 2016. We included original studies reporting retention/attrition data for HIV-exposed infants in LMICs. Outcomes included loss to follow-up (LTFU), death and overall attrition (LTFU + death) at time points along the continuum of EID services. At least two authors determined study eligibility, performed data extraction and made quality assessments. We used random-effects meta-analytic methods to aggregate effect sizes and perform meta-regression analyses. This study adhered to PRISMA reporting guidelines. RESULTS We identified 3040 unique studies, of which 92 met eligibility criteria and were included in the quantitative synthesis. The included studies represent data from 110,805 HIV-exposed infants, the majority of whom were from Africa (77%). LTFU definitions varied widely, and there was significant variability in outcomes across studies. The bulk of attrition occurred in the first six months of follow-up, with additional losses over time. Overall, 39% of HIV-exposed infants were no longer in care at 18 months. When restricted to non-intervention studies, 43% were not retained at 18 months. CONCLUSIONS These findings underscore the high attrition of HIV-exposed infants from EID services in LMICs and the urgent need for implementation research and resources to improve retention among this vulnerable population.
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Affiliation(s)
- James G Carlucci
- Vanderbilt Institute for Global HealthVanderbilt University Medical CenterNashvilleTNUSA
- Division of Pediatric Infectious DiseasesDepartment of PediatricsVanderbilt University Medical CenterNashvilleTNUSA
| | - Yu Liu
- Department of Public Health SciencesSchool of Medicine and DentistryUniversity of RochesterRochesterNYUSA
| | | | | | | | - Emily K Sheldon
- Vanderbilt Institute for Global HealthVanderbilt University Medical CenterNashvilleTNUSA
| | - Kate Clouse
- Vanderbilt Institute for Global HealthVanderbilt University Medical CenterNashvilleTNUSA
| | - Sten H Vermund
- Yale School of Public HealthYale UniversityNew HavenCTUSA
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20
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Kim H, Dowdy DW, Martinson NA, E Golub J, Bridges JFP, Hanrahan CF. Maternal priorities for preventive therapy among HIV-positive pregnant women before and after delivery in South Africa: a best-worst scaling survey. J Int AIDS Soc 2018; 21:e25143. [PMID: 29972628 PMCID: PMC6031072 DOI: 10.1002/jia2.25143] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 05/15/2018] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Pregnant women newly diagnosed with HIV during pregnancy are often lost to follow up and their adherence rates drop after delivery. We quantified changes in priorities related to isoniazid preventive therapy (IPT) and antiretroviral therapy (ART) among pregnant women living with HIV. METHODS We enrolled pregnant women recently diagnosed with HIV from 14 primary health clinics during pregnancy and followed them after delivery in Matlosana, South Africa. Best-worst scaling (BWS) was used to determine the women's priorities out of 11 attributes related to preventive therapy in the ante- versus postpartum periods. Aggregate BWS scores were calculated based on the frequency with which participants selected each attribute as the best or worst among five options (across multiple choice sets). Individual BWS scores were also calculated and rescaled from 0 (always selected as worst) to 10 (always selected as best), and changes in BWS scores in the ante- versus postpartum periods were compared, using a paired t-test. Factors associated with the changes in BWS scores were examined in multiple linear regressions. Spearman's rho was used to compare the ranking of attributes. RESULTS Out of a total of 204 participants, 154 (75.5%) completed the survey in the postpartum at the median 15 (IQR: 11 to 27) weeks after delivery. Trust in healthcare providers was most highly prioritized both in the ante- (individual BWS Score = 7.34, SE = 0.13) and postpartum periods (BWS = 7.21 ± 0.11), followed by living a long life (BWS = 6.77 ± 0.09 in the ante- vs. BWS = 6.86 ± 0.10 in the postpartum). Prevention for infants' health was more prioritized in the post- (BWS = 6.54 ± 0.09) versus antepartum periods (BWS = 6.11 ± 0.10) (p = 0.05). This change was associated with IPT initiation at enrolment (regression coefficient = 0.78 ± 0.33, p = 0.001). Difficulty in daily pill-uptake was significantly more prioritized in the postpartum (BWS = 5.03 ± 0.11) than in the antepartum (BWS = 4.43 ± 0.10) (p < 0.01). Transportation cost and worry about side effects of pills were least prioritized. Overall ranking of attributes was similar in both time periods (spearman's rho = 0.90). CONCLUSIONS Comprehensive interventions to build trust in healthcare providers and support adherence may increase uptake of preventive therapy. Counselling needs to emphasize medication benefits for both maternal and infant health among HIV-positive pregnant women.
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Affiliation(s)
- Hae‐Young Kim
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Africa Health Research InstituteDurbanKwaZulu‐NatalSouth Africa
- School of Nursing & Public HealthUniversity of KwaZulu‐NatalDurbanKwaZulu‐NatalSouth Africa
| | - David W Dowdy
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Neil A Martinson
- Perinatal HIV Research UnitUniversity of WitwatersrandJohannesburgSouth Africa
- Center for Tuberculosis ResearchJohns Hopkins UniversityBaltimoreMDUSA
| | - Jonathan E Golub
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Center for Tuberculosis ResearchJohns Hopkins UniversityBaltimoreMDUSA
| | - John F P Bridges
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Department of Health Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Colleen F Hanrahan
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
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