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Njah JM, Halle-Ekane GE, Atanga SN, Tshimwanga EK, Desembuin F, Muffih PT. From Option B+ to Universal "Test and Treat" in Cameroon: Identification and Evaluation of District-level Factors Associated with Retention in Care. Int J MCH AIDS 2023; 12:e631. [PMID: 38312498 PMCID: PMC10548496 DOI: 10.21106/ijma.631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background and Objective Retaining women in Option B+ services is crucial for eliminating new pediatric HIV infections. However, there are few studies on factors influencing retention at the district level. This study evaluates the factors associated with retention in two health districts of Cameroon. Methods From September 1, 2015, to February 29, 2016, we reviewed the records of pregnant and breastfeeding women initiating Option B+, a lifelong approach to preventing mother-to-child transmission (PMTCT) of HIV, between October 2013 and July 2014. We abstracted sociodemographic and clinical data from registers in 22 health facilities in the Bamenda urban and Kumba rural districts into spreadsheets. Cox regression age-adjusted survival curves were used to compare retention probabilities at 6 and 12 months post-antiretroviral therapy (ART) initiation. Multivariable modified Poisson regressions were run to estimate adjusted relative risk (aRR) of factors associated with retention in PMTCT care at 12 months post-ART initiation. STATA software was used for the analyses. Results Of the 560 files reviewed, majority, 62.7% (n=351), were above 24 years of age and married, 68.9% (n=386). From the multivariable analysis, enrolling early in antenatal care (ANC) (aRR: 1.50, 95% CIL: 1.17-1.93) and knowing the male partner's HIV-negative status (aRR: 1.16, 95% CI: 1.00-1.34) were significantly associated with higher retention in care, adjusting for maternal age, marital status, and distance from the health facility. By health district, knowing the male partner's HIV-negative status (aRR: 1.30, 95% CI: 1.13-1.50) in the Bamenda urban and enrolling early in ANC (aRR: 2.03, 95% CI" 1.21-3.41) in the Kumba rural district, had significantly higher retention rates after adjusting for the same covariates. Conclusion and Global Health Implications Overall, factors influencing retention varied by urban or rural district. Therefore, tailored district-level interventions are needed to enhance early ANC enrollment in the rural and partner HIV status disclosure in the urban districts to improve retention in PMTCT care.
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Affiliation(s)
- Joel M. Njah
- ICAP Global Health at Columbia University’s Mailman School of Public Health, 722 W. 168 St. New York, USA
- The Afya Bora Consortium, Seattle, WA, USA
| | - Gregory E. Halle-Ekane
- Faculty of Health Sciences, University of Buea, Cameroon
- The Afya Bora Consortium, Seattle, WA, USA
| | - Sylvester N. Atanga
- School of Health and Human Sciences, Saint Monica University Higher Institute, Buea, Cameroon
- The Afya Bora Consortium, Seattle, WA, USA
| | - Edouard K. Tshimwanga
- AIDS Care and Prevention Program, Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Felix Desembuin
- AIDS Care and Prevention Program, Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Pius T. Muffih
- AIDS Care and Prevention Program, Cameroon Baptist Convention Health Services, Bamenda, Cameroon
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Sutcliffe CG, Moyo N, Hamahuwa M, Mutanga JN, van Dijk JH, Hamangaba F, Schue JL, Thuma PE, Moss WJ. The Evolving Pediatric HIV Epidemic in Rural Southern Zambia: The Beneficial Impact of Advances in Prevention and Treatment at a District Hospital From 2007 to 2019. Pediatr Infect Dis J 2023; 42:489-495. [PMID: 36795584 PMCID: PMC10360039 DOI: 10.1097/inf.0000000000003873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Remarkable progress has been made in expanding access to services addressing the pediatric HIV epidemic, including programs to prevent mother-to-child transmission, early diagnosis and treatment for children living with HIV. Few long-term data are available from rural sub-Saharan Africa to assess implementation and impact of national guidelines. METHODS Results from 3 cross-sectional studies and 1 cohort study conducted at Macha Hospital in Southern Province, Zambia from 2007 to 2019 were summarized. For infant diagnosis, maternal antiretroviral treatment, infant test results and turnaround times for results were evaluated by year. For pediatric HIV care, the number and age of children initiating care and treatment, and treatment outcomes within 12 months were evaluated by year. RESULTS Receipt of maternal combination antiretroviral treatment increased from 51.6% in 2010-2012 to 93.4% in 2019, and the proportion of infants testing positive decreased from 12.4% to 4.0%. Turnaround times for results returning to clinic varied but were shorter when labs consistently used a text messaging system. The proportion of mothers receiving results was higher when a text message intervention was piloted. The number of children living with HIV enrolled into care and the proportion initiating treatment with severe immunosuppression and dying within 12 months decreased over time. CONCLUSIONS These studies demonstrate the long-term beneficial impact of implementing a strong HIV prevention and treatment program. While expansion and decentralization brought challenges, the program succeeded in decreasing the rate of mother-to-child transmission and ensuring that children living with HIV benefit from access to life-saving treatment.
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Affiliation(s)
- Catherine G. Sutcliffe
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, Maryland, USA
| | | | | | | | | | | | - Jessica L. Schue
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, Maryland, USA
| | - Philip E. Thuma
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, Maryland, USA
- Macha Research Trust, Choma, Zambia
| | - William J. Moss
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, Maryland, USA
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3
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Fonzo M, Zuanna TD, Amoruso I, Resti C, Tsegaye A, Azzimonti G, Sgorbissa B, Centomo M, Ferretti S, Manenti F, Putoto G, Baldovin T, Bertoncello C. The HIV paradox: Perinatal mortality is lower in HIV-positive mothers-A field case-control study in Ethiopia. Int J Gynaecol Obstet 2023. [PMID: 36815783 DOI: 10.1002/ijgo.14738] [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: 11/03/2022] [Revised: 02/02/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Sub-Saharan African countries have the highest perinatal mortality rates. Although HIV is a risk factor for perinatal death, antioretroviral therapy (ART) programs have been associated with better outcomes. We aimed to investigate how maternal HIV affects perinatal mortality. METHODS The authors performed a nested case-control study at Saint Luke Hospital, Wolisso, Ethiopia. Data on sociodemographic characteristics, current maternal conditions, obstetric history, and antenatal care (ANC) services utilization were collected. The association between perinatal mortality and HIV was assessed with logistic regression adjusting for potential confounders. RESULTS A total of 3525 birthing women were enrolled, including 1175 cases and 2350 controls. Perinatal mortality was lower among HIV-positive women (18.3% vs. 33.6%, P = 0.007). Crude analysis showed a protective effect of HIV (odds ratio, 0.442 [95% confidence interval, 0.241-0.810]), which remained after adjustment (adjusted odds ratio, 0.483 [95% confidence interval, 0.246-0.947]). Among HIV-negative women, access to ANC for women from rural areas was almost half (18.8% vs. 36.2%; P < 0.001), whereas in HIV-positive women, no differences were noted (P = 0.795). CONCLUSION Among HIV-positive mothers, perinatal mortality was halved and differences in access to ANC services by area were eliminated. These data highlight the benefits of integrating ANC and HIV services in promoting access to the health care system, reducing inequalities and improving neonatal mortality.
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Affiliation(s)
- M Fonzo
- Hygiene and Public Health Unit, DCTVSP, University of Padova, Padova, Italy
| | - T D Zuanna
- Hygiene and Public Health Unit, DCTVSP, University of Padova, Padova, Italy
| | - I Amoruso
- Hygiene and Public Health Unit, DCTVSP, University of Padova, Padova, Italy
| | - C Resti
- Doctors with Africa CUAMM, Addis Ababa, Ethiopia
| | - A Tsegaye
- Doctors with Africa CUAMM, Addis Ababa, Ethiopia
| | | | - B Sgorbissa
- Hygiene and Public Health Unit, DCTVSP, University of Padova, Padova, Italy
| | - M Centomo
- Hygiene and Public Health Unit, DCTVSP, University of Padova, Padova, Italy
| | - S Ferretti
- Hygiene and Public Health Unit, DCTVSP, University of Padova, Padova, Italy
| | - F Manenti
- Doctors with Africa CUAMM, Padova, Italy
| | - G Putoto
- Doctors with Africa CUAMM, Padova, Italy
| | - T Baldovin
- Hygiene and Public Health Unit, DCTVSP, University of Padova, Padova, Italy
| | - C Bertoncello
- Hygiene and Public Health Unit, DCTVSP, University of Padova, Padova, Italy
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Jiang W, Ronen K, Osborn L, Drake AL, Unger JA, Matemo D, Richardson BA, Kinuthia J, John-Stewart G. Programmatic Retention in Prevention of Mother-to-Child Transmission (PMTCT) Programs: Estimated Rates and Cofactors Using Different Nonretention Measures. J Acquir Immune Defic Syndr 2023; 92:106-114. [PMID: 36215980 PMCID: PMC9839514 DOI: 10.1097/qai.0000000000003117] [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: 04/05/2022] [Accepted: 09/13/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Prevention of mother-to-child transmission programs serve women continuing and initiating antiretroviral therapy (ART) in pregnancy, and follow-up schedules align to delivery rather than ART initiation, making conventional HIV retention measures (assessed from ART initiation) challenging to apply. We evaluated 3 measures of peripartum nonretention in Kenyan women living with HIV from pregnancy to 2 years postpartum. METHODS This longitudinal analysis used programmatic data from the Mobile WAChX trial (NCT02400671). Outcomes included loss to follow-up (LTFU) (no visit for ≥6 months), incomplete visit coverage (<80% of 3-month intervals with a visit), and late visits (>2 weeks after scheduled date). Predictors of nonretention were determined using Cox proportional hazards, log-binomial, and generalized estimating equation models. RESULTS Among 813 women enrolled at a median of 24 weeks gestation, incidence of LTFU was 13.6/100 person-years; cumulative incidence of LTFU by 6, 12, and 24 months postpartum was 16.7%, 20.9%, and 22.5%, respectively. Overall, 35.5% of women had incomplete visit coverage. Among 794 women with 12,437 scheduled visits, a median of 11.1% of visits per woman were late (interquartile range 4.3%-23.5%). Younger age, unsuppressed viral load, unemployment, ART initiation in pregnancy, and nondisclosure were associated with nonretention by all measures. Partner involvement was associated with better visit coverage and timely attendance. Women who became LTFU had higher frequency of previous late visits (16.7% vs. 7.7%, P < 0.0001). CONCLUSIONS Late visit attendance may be a sentinel indicator of LTFU. Identified cofactors of prevention of mother-to-child transmission programmatic retention may differ depending on retention measure assessed, highlighting the need for standardized measures.
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Affiliation(s)
- Wenwen Jiang
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Keshet Ronen
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Lusi Osborn
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Alison L. Drake
- Global Health, University of Washington, Seattle, Washington, USA
| | - Jennifer A. Unger
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Daniel Matemo
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Barbra A. Richardson
- Departments of Biostatistics and Global Health, University of Washington, Division of Vaccine and Infectious Disease, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Grace John-Stewart
- Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
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Morris BM, Nyamhagata M, Tarimo E, Sunguya B. Eliminating mother-to-child transmission of HIV in Tanzania calls for efforts to address factors associated with a low confirmatory test. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001218. [PMID: 36963073 PMCID: PMC10021727 DOI: 10.1371/journal.pgph.0001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/28/2022] [Indexed: 03/14/2023]
Abstract
Option B+ approach for prevention of mother-to-child transmission (PMTCT) has demonstrated the potential to eliminate pediatric HIV infections. Its success depends on early infant diagnosis (EID) of HIV among the exposed infants within the first 6 weeks, and a subsequent confirmatory HIV test within 18 months. However, most mothers enrolling in option B+ in Tanzania do not come for such confirmatory tests. We examined factors associated with the turning-up of mother-baby pairs on the PMTCT program for a confirmatory HIV testing 18 months post-delivery in Tanzania. This study utilized longitudinal data collected between 2015 and 2017, from 751 mother-baby pairs enrolled in the PMTCT-option B+ approach in 79 health facilities from the 12 regions of Tanzania-mainland. Only 44.2% of 751 mother-baby records observed received the HIV confirmatory test by the 18th month. Mothers aged 25 years or above (adults' mothers) were 1.44 more likely to turn up for confirmatory HIV testing than young mothers; mothers with partners tested for HIV were 1.74 more likely to have confirmatory HIV testing compared with partners not tested for HIV. Newly diagnosed HIV-positive mothers were 28% less likely to bring their babies for a confirmatory HIV-testing compared to known HIV-positive mothers. Mothers with treatment supporters were 1.58 more likely to receive confirmatory HIV-testing compared to mothers without one. Mother-baby pairs who collected DBS-PCR-1 were 3.61 more likely to have confirmatory HIV-testing than those who didn't collect DBS-PCR-1. In conclusion, the confirmatory HIV testing within 18 months among mother-baby pairs enrolled in the Option B+ approach is still low in Tanzania. This is associated with low maternal age, having a male partner not tested for HIV, lack of experience with HIV services, lack of treatment supporters, and failure to take the DBS-PCR-1 HIV test within the first two months post-delivery.
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Affiliation(s)
- Baraka M Morris
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | | | - Edith Tarimo
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
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McCann NC, Stanic T, Penazzato M, Flanagan CF, Abrams EJ, Dugdale CM, Johnson LF, Neilan AM, Davies M, Freedberg KA, Fassinou P, Doherty M, Essajee S, Mushavi A, Soeteman DI, Ciaranello AL. Prevalence of undiagnosed HIV among children in South Africa, Côte d'Ivoire and Zimbabwe: a model-based analysis to inform paediatric HIV screening programmes. J Int AIDS Soc 2022; 25:e26045. [PMID: 36519674 PMCID: PMC9753158 DOI: 10.1002/jia2.26045] [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: 02/28/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION To improve the diagnosis and survival of children living with HIV (CLWH), the World Health Organization recommends testing approaches beyond traditional infant HIV testing programmes. Information about undiagnosed HIV prevalence among children of varying ages in the general population is needed to guide innovative national/subnational case-finding and testing approaches. METHODS We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Pediatric model to estimate the prevalence of undiagnosed HIV in 2-, 5- and 10-year-old children in South Africa, Côte d'Ivoire and Zimbabwe in 2018. We simulated cohorts of children born in 2008 (10-year-olds), 2013 (5-year-olds) and 2016 (2-year-olds). Country-/year-specific inputs for pregnant/breastfeeding women included: HIV prevalence (4.2-32.3%), HIV incidence (0.03-0.24%/month), knowledge of HIV status (27-89%) and antiretroviral drug coverage (36-95%). Paediatric inputs included early infant testing coverage (6-95%) and breastfeeding duration (0-20 months). We projected the proportion of surviving CLWH in whom HIV remained undiagnosed and the undiagnosed HIV prevalence among surviving children of each age in the general population. For children born in 2016, we projected survival and diagnosis of all CLWH through 2026. We conducted sensitivity analyses on model parameters. RESULTS In 2018, the projected proportion of surviving CLWH whose HIV remained undiagnosed in South Africa/Côte d'Ivoire/Zimbabwe was 44.2%/55.8%/52.9% among 2-year-old CLWH; 29.0%/37.8%/33.2% among 5-year-old CLWH; and 18.3%/25.4%/23.1% among 10-year-old CLWH. Projected general population undiagnosed HIV prevalence in South Africa/Côte d'Ivoire/Zimbabwe was 0.44%/0.32%/0.68% among 2-year-olds; 0.25%/0.17%/0.41% among 5-year-olds; and 0.24%/0.14%/0.38% among 10-year-olds. Among all CLWH born in 2016, 50-54% were projected to die without HIV diagnosis (and subsequently without treatment) within 10 years after birth; 80-85% of these deaths occurred in the first 2 years. CONCLUSIONS Projected population-level undiagnosed HIV prevalence is low and sharply decreases after age 2, with more CLWH dying than being diagnosed. Despite low undiagnosed prevalence in the general population of older children, we project that a large proportion of CLWH remain undiagnosed, suggesting that innovative strategies targeting untested children of all ages outside of health facility settings should be prioritized. Programmes could consider routine testing of the general population of children below 2 in all settings and children of all ages in high-prevalence settings.
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Affiliation(s)
- Nicole C. McCann
- Medical Practice Evaluation CenterDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Tijana Stanic
- Medical Practice Evaluation CenterDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Martina Penazzato
- Global HIVHepatitis and STI ProgrammeWorld Health OrganizationGenevaSwitzerland
| | - Clare F. Flanagan
- Medical Practice Evaluation CenterDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Elaine J. Abrams
- ICAP at Columbia UniversityMailman School of Public HealthColumbia UniversityNew YorkUSA,Department of PediatricsVagellos College of Physicians and SurgeonsColumbia UniversityNew YorkUSA
| | - Caitlin M. Dugdale
- Medical Practice Evaluation CenterDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA,Division of Infectious DiseasesMassachusetts General HospitalBostonMassachusettsUSA
| | - Leigh F. Johnson
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public Health and Family MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Anne M. Neilan
- Medical Practice Evaluation CenterDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA,Division of Infectious DiseasesMassachusetts General HospitalBostonMassachusettsUSA,Division of Pediatric Outcomes ResearchMassachusetts General HospitalBostonMassachusettsUSA
| | - Mary‐Ann Davies
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public Health and Family MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Kenneth A. Freedberg
- Medical Practice Evaluation CenterDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA,Division of Infectious DiseasesMassachusetts General HospitalBostonMassachusettsUSA,Division of General Internal MedicineDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA,Harvard University Center for AIDS ResearchBostonMassachusettsUSA,Department of Health Policy and ManagementHarvard School of Public HealthBostonMassachusettsUSA
| | | | - Meg Doherty
- Global HIVHepatitis and STI ProgrammeWorld Health OrganizationGenevaSwitzerland
| | | | | | - Djøra I. Soeteman
- Medical Practice Evaluation CenterDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA,Center for Health Decision ScienceHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Andrea L. Ciaranello
- Medical Practice Evaluation CenterDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA,Division of Infectious DiseasesMassachusetts General HospitalBostonMassachusettsUSA,Harvard University Center for AIDS ResearchBostonMassachusettsUSA
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Nahirney M, Grist J, Namasopo S, Brophy J, Hawkes MT. Evolution of prevention of vertical
HIV
transmission in Uganda: 2008–2017. HIV Med 2022; 24:605-615. [PMID: 36451299 DOI: 10.1111/hiv.13449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES Uganda adapted its policy for prevention of vertical transmission (VT) of HIV transmission as the World Health Organization released Options A, B and B+. We assessed trends in diagnostic testing, breastfeeding practices, maternal and infant antiretroviral therapy (ART), mortality, VT and HIV-free survival (HFS) among Ugandan infants born to women living with HIV during this period of successive guideline changes. METHODS This is is a retrospective observational study of infants attending early infant diagnosis clinics at two Ugandan hospitals. RESULTS A total of 1885 infants (48% female) were managed from 2009 to 2017. DNA polymerase chain reaction (PCR) for early infant diagnosis was performed on 1719 infants (92%, one or more PCR tests) and 676 infants (36%, two PCR tests). HIV serology was performed on 90 infants (4.8%). Testing increased over the study period but remained suboptimal, due to high loss to follow-up (LTFU). A total of 93% of infants were breastfed, for a median of 9.5 months. The duration of breast milk exposure increased over the study period, consistent with guidelines that increasingly encouraged breastfeeding. Nine cases (0.48%) of suspected breast milk transmission were observed. The use of ART increased significantly over the study period. Mortality (3.5%, 2.7% and 1.1%; p = 0.0076) and VT (17%, 12% and 7.4%; p < 0.0001) decreased over the study period (2008-2010, 2011-2012 and 2013-2017, respectively). LTFU values were 31%, 49% and 59% at 6, 12 and 18 months of age, respectively, with only modest improvements over time. HFS could only be conclusively documented in 532 infants (28%) because of LTFU. CONCLUSIONS From 2009 to 2017, outcomes improved among HIV-exposed infants in Uganda. LTFU remains a barrier to optimal care.
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Affiliation(s)
- Marissa Nahirney
- Department of Pediatrics University of Alberta Edmonton Alberta Canada
| | - Jesse Grist
- Department of Pediatrics University of Alberta Edmonton Alberta Canada
| | | | - Jason Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario University of Ottawa Ottawa Ontario Canada
| | - Michael T. Hawkes
- Department of Pediatrics University of Alberta Edmonton Alberta Canada
- Department of Medical Microbiology and Immunology University of Alberta Edmonton Alberta Canada
- Department of Global Health, School of Public Health University of Alberta Edmonton Alberta Canada
- Distinguished Researcher, Stollery Science Lab University of Alberta Edmonton Alberta Canada
- Member, Women and Children's Health Research Institute University of Alberta Edmonton Alberta Canada
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8
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Dinis A, Augusto O, Ásbjörnsdóttir KH, Crocker J, Gimbel S, Inguane C, Ramiro I, Coutinho J, Agostinho M, Cruz E, Amaral F, Tavede E, Isidoro X, Sidat Y, Nassiaca R, Murgorgo F, Cuembelo F, Hazim CE, Sherr K. Association between service readiness and PMTCT cascade effectiveness: a 2018 cross-sectional analysis from Manica province, Mozambique. BMC Health Serv Res 2022; 22:1422. [PMID: 36443742 PMCID: PMC9703771 DOI: 10.1186/s12913-022-08840-3] [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: 05/26/2022] [Accepted: 10/17/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Despite high coverage of maternal and child health services in Mozambique, prevention of mother-to-child transmission of HIV (PMTCT) cascade outcomes remain sub-optimal. Delivery effectiveness is modified by health system preparedness. Identifying modifiable factors that impact quality of care and service uptake can inform strategies to improve the effectiveness of PMTCT programs. We estimated associations between facility-level modifiable health system readiness measures and three PMTCT outcomes: Early infant diagnosis (polymerase chain reaction (PCR) before 8 weeks of life), PCR ever (before or after 8 weeks), and positive PCR test result. METHODS A 2018 cross-sectional, facility-level survey was conducted in a sample of 36 health facilities covering all 12 districts in Manica province, central Mozambique, as part of a baseline assessment for the SAIA-SCALE trial (NCT03425136). Data on HIV testing outcomes among 3,427 exposed infants were abstracted from at-risk child service registries. Nine health system readiness measures were included in the analysis. Logistic regressions were used to estimate associations between readiness measures and pediatric HIV testing outcomes. Odds ratios (OR) and 95% confidence intervals (95%CI) are reported. RESULTS Forty-eight percent of HIV-exposed infants had a PCR test within 8 weeks of life, 69% had a PCR test ever, and 6% tested positive. Staffing levels, glove stockouts, and distance to the reference laboratory were positively associated with early PCR (OR = 1.02 [95%CI: 1.01-1.02], OR = 1.73 [95%CI: 1.24-2.40] and OR = 1.01 [95%CI: 1.00-1.01], respectively) and ever PCR (OR = 1.02 [95%CI: 1.01-1.02], OR = 1.80 [95%CI: 1.26-2.58] and OR = 1.01 [95%CI: 1.00-1.01], respectively). Catchment area size and multiple NGOs supporting PMTCT services were associated with early PCR testing OR = 1.02 [95%CI: 1.01-1.03] and OR = 0.54 [95%CI: 0.30-0.97], respectively). Facility type, stockout of prophylactic antiretrovirals, the presence of quality improvement programs and mothers' support groups in the health facility were not associated with PCR testing. No significant associations with positive HIV diagnosis were found. CONCLUSION Salient modifiable factors associated with HIV testing for exposed infants include staffing levels, NGO support, stockout of essential commodities and accessibility of reference laboratories. Our study provides insights into modifiable factors that could be targeted to improve PMTCT performance, particularly at small and rural facilities.
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Affiliation(s)
- Aneth Dinis
- grid.419229.5National Directorate of Public Health, Ministry of Health of Mozambique, Maputo, Mozambique ,grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, USA
| | - Orvalho Augusto
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, USA ,grid.8295.60000 0001 0943 5818Eduardo Mondlane University, Maputo, Mozambique
| | - Kristjana H. Ásbjörnsdóttir
- grid.14013.370000 0004 0640 0021Centre of Public Health Sciences, University of Iceland, Reykjavík, Iceland ,grid.34477.330000000122986657Department of Epidemiology, University of Washington, Seattle, USA
| | - Jonny Crocker
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, USA
| | - Sarah Gimbel
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, USA ,grid.34477.330000000122986657Department of Child, Family & Population Health Nursing, University of Washington, Seattle, USA
| | - Celso Inguane
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, USA
| | - Isaías Ramiro
- Comité para a Saúde de Moçambique, Chimoio, Mozambique
| | | | | | - Emilia Cruz
- Comité para a Saúde de Moçambique, Chimoio, Mozambique
| | | | | | - Xavier Isidoro
- Manica Provincial Health Directorate, Chimoio, Mozambique
| | - Yaesh Sidat
- Manica Provincial Health Directorate, Chimoio, Mozambique
| | | | | | - Fátima Cuembelo
- grid.8295.60000 0001 0943 5818Eduardo Mondlane University, Maputo, Mozambique
| | - Carmen E. Hazim
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, USA
| | - Kenneth Sherr
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, USA ,grid.34477.330000000122986657Department of Epidemiology, University of Washington, Seattle, USA ,grid.34477.330000000122986657Department of Industrial and Systems Engineering, University of Washington, Seattle, USA
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Morales JA, Hamahuwa M, Moyo N, Mutanga JN, Schue JL, Maunga S, Thuma PE, Moss WJ, Sutcliffe CG. Factors associated with antiretroviral therapy use among pregnant women in rural and urban settings in Southern Province, Zambia: 2016-2019. Trop Med Int Health 2022; 27:902-912. [PMID: 36127148 PMCID: PMC10375440 DOI: 10.1111/tmi.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To assess antiretroviral therapy (ART) coverage among pregnant women living with HIV and compare the characteristics of women who received and did not receive ART during pregnancy in Zambia. METHODS A cross-sectional study was conducted at urban and rural health facilities in Southern Province, Zambia, from 2016 to 2019. Pregnant women living with HIV delivering at study sites were enrolled and administered a questionnaire, and the results of infant diagnostic testing for HIV at birth was documented. RESULTS About 1184 mother/infant pairs were enrolled. ART coverage was 93.7%. Most women who did not receive ART during pregnancy reported HIV diagnosis at delivery (18.0%) or during pregnancy (57.7%). The primary reported reason for not receiving ART was not wanting to take the drugs. Women who did not receive ART during pregnancy were significantly younger, less likely to have disclosed their HIV-infection status to others, and less likely to have received antenatal care than women who received ART. ART use correlated with higher levels of education in urban but not rural sites. Overall, 1.0% of infants were infected with HIV at birth, including 0.8% of infants born to women who received ART and 4.1% of infants born to women who did not. CONCLUSIONS Most women received ART according to guidelines, resulting in low perinatal transmission rates of HIV to infants. Efforts to increase ART coverage and prevent vertical transmission should focus on identifying incident HIV infections during pregnancy and strengthening counselling for newly diagnosed pregnant women.
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Affiliation(s)
- Juliet A Morales
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | - Jane N Mutanga
- Department of Paediatrics and Child Health, Livingstone Central Hospital, Livingstone, Zambia
| | - Jessica L Schue
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Philip E Thuma
- Macha Research Trust, Zambia.,Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - William J Moss
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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10
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van Lettow M, Tippett Barr BA, van Oosterhout JJ, Schouten E, Jahn A, Kalua T, Auld A, Nyirenda R, Wadonda N, Kim E, Landes M. The National Evaluation of Malawi's PMTCT Program (NEMAPP) study: 24-month HIV-exposed infant outcomes from a prospective cohort study. HIV Med 2021; 23:573-584. [PMID: 34970836 PMCID: PMC9303195 DOI: 10.1111/hiv.13209] [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] [Received: 05/26/2021] [Revised: 09/21/2021] [Accepted: 11/09/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Data on long-term HIV-free survival in breastfeeding, HIV-exposed infants (HEIs) are limited. The National Evaluation of Malawi's Prevention of Mother-to-Child Transmission (PMTCT) Program (NEMAPP), conducted between 2014 and 2018, evaluated mother-to-child transmission (MTCT) and infant outcomes up to 24 months postpartum. METHODS We enrolled a nationally representative cohort of HEIs at 54 health facilities across four regional strata in Malawi and used multivariable Cox regression analysis to investigate the risk of adverse outcomes (HIV transmission, infant death and loss to follow-up) to 24 months postpartum. Models, controlling for survey design, were fitted for the total cohort (n = 3462) and for a subcohort that received maternal viral load (VL) monitoring (n = 1282). RESULTS By 24 months, in 3462 HEIs, weighted cumulative MTCT was 4.9% [95% confidence interval (CI) 3.7-6.4%], 1.3% (95% CI 0.8-2.2%) of HEIs had died, 26.2% (95% CI 24.0-28.6%) had been lost to follow-up and 67.5% (95% CI 65.0-70.0%) were alive and HIV-free. Primiparity [weighted adjusted hazard ratio (aHR) 1.6; 95% CI 1.1-2.2; parity 2-3: weighted aHR 1.5; 95% CI 1.2-1.9], the mother not disclosing her HIV status to her partner (no disclosure: weighted aHR 1.3; 95% CI 1.1-1.6; no partner: weighted aHR 0.7; 95% CI 0.5-0.9), unknown maternal ART start (weighted aHR 2.0; 95% CI 1.0-3.9) and poor adherence (missed ≥ 2 days of ART in the last month: weighted aHR 1.7; 95% CI 1.2-2.2; not on ART: weighted aHR 1.7; 95% CI 1.0-2.7) were associated with adverse outcomes by 24 months. In the subcohort analysis, risk of HIV transmission or infant death was higher among HEIs whose mothers started ART post-conception (during pregnancy: weighted aHR 3.2; 95% CI 1.3-7.7; postpartum: weighted aHR 12.4; 95% CI 1.5-99.6) or when maternal viral load at enrolment was > 1000 HIV-1 RNA copies/mL (weighted aHR 15.7; 95% CI 7.8-31.3). CONCLUSIONS Infant positivity and infant mortality at 24 months were low for a breastfeeding population. Starting ART pre-conception had the greatest impact on HIV-free survival in HEIs. Further population-level reduction in MTCT may require additional intervention during breastfeeding for women new to PMTCT programmes. Pre-partum diagnosis and linkage to ART, followed by continuous engagement in care during breastfeeding can further reduce MTCT but are challenging to implement.
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Affiliation(s)
- Monique van Lettow
- Dignitas International, Zomba, Malawi.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Nyanja Health Research Institute, Salima, Malawi
| | - Beth A Tippett Barr
- Nyanja Health Research Institute, Salima, Malawi.,US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Joep J van Oosterhout
- Dignitas International, Zomba, Malawi.,Department of Medicine, College of Medicine University of Malawi, Blantyre, Malawi
| | | | - Andreas Jahn
- Malawi Ministry of Health, Department of HIV and AIDS, Lilongwe, Malawi.,International Training Education and Community Health (ITECH), Lilongwe, Malawi
| | - Thokozani Kalua
- Malawi Ministry of Health, Department of HIV and AIDS, Lilongwe, Malawi
| | - Andrew Auld
- US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Rose Nyirenda
- Malawi Ministry of Health, Department of HIV and AIDS, Lilongwe, Malawi
| | - Nellie Wadonda
- US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Evelyn Kim
- US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Megan Landes
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Nyanja Health Research Institute, Salima, Malawi.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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11
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Boeke CE, Khan S, Walsh FJ, Lejeune C, Hettema A, Spiegelman D, Okello V, Bärnighausen T. Longitudinal analysis of client appointment adherence under Universal Test and Treat strategy: A stepped-wedge trial. HIV Med 2021; 22:854-859. [PMID: 34293243 DOI: 10.1111/hiv.13144] [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: 06/02/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Universal Test and Treat (UTT) strategies are being adopted across sub-Saharan Africa based on clinical benefits to morbidity and mortality and to attain targets of the Joint United Nations Programme on HIV/AIDS (UNAIDS). Universal Test and Treat is expected to change the client population at clinics, due to more asymptomatic HIV clients initiating antiretroviral therapy (ART). We assessed the impact of UTT on client appointment adherence at 14 government-managed health facilities in Eswatini's public sector health system. METHODS We assessed the impact of UTT on client adherence to appointment schedules from 2014 to 2017 in a stepped-wedge trial. Repeated measures analysis was used to assess adherence to each scheduled appointment (primary definition: presenting for care within 7 days after the scheduled appointment), adjusting for time, age, sex, stage, marital status, ART status and facility. RESULTS Among 3354 clients (62.1% female; 57.4% < 35 years), a median (interquartile range) of 10 (6-15) appointments were scheduled during follow-up. In a multivariable-adjusted model, appointment adherence was significantly greater in clients who were female [odds ratio (OR) = 1.38, 95% confidence interval (CI): 1.25-1.52], older (e.g. 40 to < 50 years vs. < 20 years; OR = 1.45, 95% CI: 1.00-2.09), married (OR = 1.31, 95% CI: 1.19-1.44), had lower WHO stage at study enrolment (1-2 vs. 3-4: OR = 1.26, 95% CI: 1.13-1.41), and were currently on ART (OR = 3.55, 95% CI: 2.62-4.82). However, UTT strategy was not significantly associated with client adherence to scheduled appointments (OR = 1.02, 95% CI: 0.72-1.45). CONCLUSIONS Despite transitioning to UTT, there was no change in visit adherence, a reassuring finding given the large volume of clients currently being initiated at earlier stages of HIV.
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Affiliation(s)
| | - Shaukat Khan
- Clinton Health Access Initiative, Mbabane, Eswatini
| | | | | | | | | | | | - Till Bärnighausen
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,Africa Health Research Institute (AHRI), Durban, South Africa
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12
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Augustine N, Philip O, Kumar AM, Simukai Z, Owen M, Dumisani MH, Brian K. Gaps in the Care Cascade among Human Immunodeficiency Virus-Exposed Infants Born in 2017 in Mashonaland East Province of Zimbabwe. J Glob Infect Dis 2021; 13:72-79. [PMID: 34194173 PMCID: PMC8213089 DOI: 10.4103/jgid.jgid_171_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 08/17/2020] [Accepted: 10/17/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction: Prevention of mother-to-child transmission (PMTCT) is a key strategy for ending the human immunodeficiency virus (HIV) pandemic. Most studies have focused on the mothers' side of the PMTCT cascade or the rate of vertical HIV transmission. Information on child-focused cascade is limited. We aimed to evaluate HIV testing, antiretroviral therapy (ART), and cotrimoxazole prophylaxis uptake and associated factors among HIV-exposed infants (HEIs) born in 2017. Methods: This was a record-based descriptive study in Mashonaland East Province, Zimbabwe. We analyzed routinely collected program data abstracted from electronic and paper-based HEI registers. Uptakes were calculated as proportions while associations were measured using adjusted risk ratios (log-binomial regression). Results: Of 1028 HEIs, 1015 (98.7%) were commenced on nevirapine prophylaxis, while 915 (89.0%) were commenced on cotrimoxazole prophylaxis. A total of 880 (85.0%) HEIs were tested for HIV by 6 weeks and 445 (44.4%) by 9 months. Overall, 40 (3.9%) were found to be HIV positive, and of them, 34 (85.0%) commenced on ART. Secondary and tertiary health facilities, being born through nonvaginal delivery, and certain districts were significantly associated with not commencing cotrimoxazole prophylaxis or getting tested for HIV. One district was associated with less risk of not having an HIV test by 9 months. Conclusions: While nevirapine, cotrimoxazole, and ART uptake were high among the HEIs, HIV testing by 9 months was suboptimal. The vertical HIV transmission rate was 3.9%. There is a need to strengthen HIV testing and antiretroviral and cotrimoxazole prophylaxes, especially at high-level facilities and certain districts.
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Affiliation(s)
- Ndaimani Augustine
- Biomedical Informatics and Biomedical Engineering Department, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Owiti Philip
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France.,National Tuberculosis, Leprosy and Lung Disease Programme, Nairobi, Kenya
| | - Ajay Mv Kumar
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France.,International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India.,Department of Community Medicine Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Zizhou Simukai
- Mashonaland East Provincial Medical Directorate, Ministry of Health and Child Care, Marondera, Zimbabwe
| | - Mugurungi Owen
- AIDS and TB Programme Unit, Ministry of Health and Child Welfare, Harare, Zimbabwe
| | | | - Komtenza Brian
- AIDS and TB Programme Unit, Ministry of Health and Child Welfare, Harare, Zimbabwe
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13
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Saleska JL, Turner AN, Gallo MF, Shoben A, Kawende B, Ravelomanana NLR, Thirumurthy H, Yotebieng M. Role of temporal discounting in a conditional cash transfer (CCT) intervention to improve engagement in the prevention of mother-to-child transmission (PMTCT) cascade. BMC Public Health 2021; 21:477. [PMID: 33691667 PMCID: PMC7944635 DOI: 10.1186/s12889-021-10499-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 02/24/2021] [Indexed: 11/22/2022] Open
Abstract
Background Temporal discounting, the tendency of individuals to discount future costs and benefits relative to the present, is often associated with greater engagement in risky behaviors. Incentives such as conditional cash transfers (CCTs) have the potential to counter the effects of high discount rates on health behaviors. Methods With data from a randomized trial of a CCT intervention among 434 HIV-positive pregnant women in the Democratic Republic of Congo, we used binomial models to assess interactions between discount rates (measured using a delay-discounting task) and the intervention. The analysis focused on two outcomes: 1) retention in HIV care, and 2) uptake of prevention of mother-to-child transmission (PMTCT) services. Results The effect of high discount rates on retention was small, and we did not observe evidence of interaction between high discount rates and CCT on retention. However, our findings suggest that CCT may mitigate the negative effect of high discount rates on uptake of PMTCT services (interaction contrast (IC): 0.18, 95% CI: − 0.09, 0.44). Conclusions Our findings provide evidence to support the continued use of small, frequent incentives, to motivate improved uptake of PMTCT services, especially among women exhibiting high rates of temporal discounting. Trial registration Clinicaltrials.gov number NCT01838005, April 23, 2013. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10499-0.
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Affiliation(s)
- Jessica Londeree Saleska
- Division of Epidemiology, Cunz Hall, The Ohio State University, College of Public Health, 1841 Neil Avenue, Columbus, OH, 43210, USA. .,The University of California Los Angeles, Global Center for Children and Families, Semel Institute for Neuroscience and Human Behavior, 10920 Wilshire Blvd, Los Angeles, CA, 90024, USA.
| | - Abigail Norris Turner
- Division of Infectious Disease, Doan Hall, The Ohio State University, College of Medicine, 410 W. 10th Avenue, Columbus, OH, 43210, USA
| | - Maria F Gallo
- Division of Epidemiology, Cunz Hall, The Ohio State University, College of Public Health, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Abigail Shoben
- Division of Epidemiology, Cunz Hall, The Ohio State University, College of Public Health, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Bienvenu Kawende
- The University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Noro Lantoniaina Rosa Ravelomanana
- Division of Epidemiology, Cunz Hall, The Ohio State University, College of Public Health, 1841 Neil Avenue, Columbus, OH, 43210, USA.,The University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, USA
| | - Marcel Yotebieng
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA
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14
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Zewdu LB, Reta MM, Yigzaw N, Tamirat KS. Prevalence of suicidal ideation and associated factors among HIV positive perinatal women on follow-up at Gondar town health institutions, Northwest Ethiopia: a cross-sectional study. BMC Pregnancy Childbirth 2021; 21:42. [PMID: 33422024 PMCID: PMC7797091 DOI: 10.1186/s12884-020-03529-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/26/2020] [Indexed: 11/24/2022] Open
Abstract
Background Suicidal behaviors cover a range or continuum of acts from suicidal ideations to a series of actions, commonly known as suicidal attempts or deliberate self-harms. Though different mental disorders related studies were conducted among HIV/AIDS patients, there is a scarcity of information about the magnitude and determinants of suicidal thoughts among perinatal women. Therefore, this study aimed to determine the prevalence of suicidal ideation and associated factors among HIV positive perinatal women in the study setting. Methods An institution-based cross-sectional study was conducted among perinatal women on treatment to the prevention of mother to child transmission of HIV/AIDS at Gondar town health facilities. A total of 422 HIV-positive perinatal women were selected systematically and the data collected through medical record review and interview using a Composite International Diagnostic Interview (CIDI) toolkit. A binary and multivariable logistic regression model was employed to identify factors associated with suicidal ideation. An Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was computed to see the strength of association between outcome and independent variables. Characteristics having less than 0.05 p-value had been taken as significant factors associated with the outcome of interest. Result The prevalence of suicidal ideation was found to be 8.2% (95% CI; 5.7 to 11.3) and with a standard error of 0.013. Perinatal depression (AOR=4.40, 95%CI: 1.63 11.85), not disclosed HIV status (AOR=3.73, 95%CI: 1.44 9.65), and unplanned pregnancy (AOR=2.75, 95%CI: 1.21 6.21) were significant factors associated with suicidal ideation. Conclusion The magnitude of suicidal ideation among HIV positive perinatal women was found to be low. Perinatal depression, non-disclosed HIV status, and unplanned pregnancy were factors significantly associated with suicidal ideation. This finding suggests the integration of mental health services with maternal and HIV support programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03529-z.
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Affiliation(s)
| | - Mebratu Mitiku Reta
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Niguse Yigzaw
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
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15
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Chibi B, Yende-Zuma N, Mashamba-Thompson TP. Prevalence and correlates of prescription drug diversion and misuse among people living with HIV in the eThekwini district, KwaZulu-Natal, South Africa. PLoS One 2020; 15:e0243718. [PMID: 33326499 PMCID: PMC7744047 DOI: 10.1371/journal.pone.0243718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/29/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Prescription drug diversion, and misuse has increased over the past decade and is notably in high-income-countries and significantly contributes to the opioid epidemic. People living with HIV (PLWH) are particularly vulnerable to prescription drug diversion, and misuse as most experience chronic pain, mental health problems and HIV-related illnesses. The researchers investigated the prevalence and correlates of prescription drug diversion, and misuse among PLWH in the eThekwini district, KwaZulu-Natal. METHODS A cross-sectional study was conducted among 392 PLWH, conveniently recruited from the public healthcare facilities located in rural, semi-urban and urban areas of the eThekwini district. Participants answered questions about their background, prescription medications, substance use, and prescription drug diversion, and misuse. Descriptive analysis was performed to estimate the prevalence of prescription drug diversion, and misuse. Multivariable logistic regression was used to identify predictors of prescription drug diversion, and misuse. FINDINGS Overall, 13% of the participants reported lifetime prescription drug diversion. The most common type of diversion was using prescription medication not prescribed by a healthcare provider (11%), followed by sharing of prescription medication (9%) and buying prescription medication without a medical script (5%). Twenty-three per cent of the participants reported prescription drug misuse in the past 90 days, with using prescription medication without a healthcare providers' guidance (9%) and not following the scheduled time periods (8%) being the most common reported types of misuse. Self-medicating was identified as a risk factor for prescription drug misuse. There was no association between ART adherence and prescription drug diversion, and misuse. CONCLUSION The study findings contribute to improving the limited data available on prescription drug diversion, and misuse among PLWH in South Africa. The prevalence underscores a need for urgent interventions when prescribing medications with potential risks. Addressing the risk of self-medicating is imperative for HIV care outcomes and to avert death.
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Affiliation(s)
- Buyisile Chibi
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa, Doris Duke Medical Research Institute, Durban, South Africa
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa, Doris Duke Medical Research Institute, Durban, South Africa
| | - Tivani P. Mashamba-Thompson
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Public Health, Faculty of Health Science, University of Limpopo, Limpopo Province, South Africa
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16
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Kassaw MW, Matula ST, Abebe AM, Kassie AM, Abate BB. The perceived determinants and recommendations by mothers and healthcare professionals on the loss-to-follow-up in Option B+ program and child mortality in the Amhara region, Ethiopia. BMC Infect Dis 2020; 20:876. [PMID: 33228559 PMCID: PMC7686694 DOI: 10.1186/s12879-020-05583-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/03/2020] [Indexed: 11/13/2022] Open
Abstract
Background The third United Nations Sustainable Development Goal includes a commitment to end AIDS-related death by 2030. In line with the Goal, Option B+ programs hold a great promise for eliminating vertical transmission of HIV. Option B+ was introduced in 2013 in Ethiopia. The Global Plan identified Ethiopia as one of 22 high priority countries requiring improvement in prevention of mother to child HIV transmission services. Despite HIV treatment being free in Ethiopia, only 59% of children are on treatment. The discrepancies in high uptake of Option B+ and low numbers of children in Ethiopia can be attributed to Loss-to-follow-up, which is estimated from 16 to 80%. While LFTU is expected in the region, no-to-minimal evidence exists on the magnitude and its determinants, which hampers the development of interventions and strategies to reduce LFTU. The purpose of this study is to explore perception of mothers and healthcare providers on determinants of and recommendations to reduce LTFU and HIV exposed infants’ mortality. Method Explorative, descriptive qualitative study conducted in five zones of Amhara region. The sample consisted of mothers enrolled to the option B+ programs at the five referral hospitals PMTCT departments, nurses and midwives working in those departments, and HIV officers in zonal departments. Data were collected in 2019 using in-depth interviews. Data were analyzed using content analysis and deduced to themes. Results Overall, nine themes were identified from the interviews. Five themes represented the determinants of LTFU and mortality while four themes addressed the recommendations to reduce LFTU among mothers and their infant mortality. The determinants themes centered on apathy, stigma and discrimination, poor access to services, healthcare providers behavior and attitudes, and social determinants of health. While recommendations themes suggested that improving access, capitalizing on psychosocial support, education and awareness, and empowerment. Conclusions Social and structural issues are major contributors to low retention of mothers and death of children due to HIV. A multi-stakeholder approach, including structural changes, are required to support women and their children to ensure that individuals, communities and country enjoy the full benefits of option B+ and lead to an HIV free generation. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05583-6.
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Affiliation(s)
- Mesfin Wudu Kassaw
- Department of Nursing, Woldia University, College of Health Science, P.O Box 400, Woldia, Ethiopia.
| | - Samuel T Matula
- Faculty of Health Sciences, School of Nursing, University of Botswana, Gaborone, Botswana
| | - Ayele Mamo Abebe
- Department of Nursing, Debre Berhan University, College of Health Science, Debre Berhan, Ethiopia
| | - Ayelign Mengesha Kassie
- Department of Nursing, Woldia University, College of Health Science, P.O Box 400, Woldia, Ethiopia
| | - Biruk Beletew Abate
- Department of Nursing, Woldia University, College of Health Science, P.O Box 400, Woldia, Ethiopia
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17
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High nonnucleoside reverse transcriptase inhibitor resistance levels in HIV-1-infected Zambian mother-infant pairs. AIDS 2020; 34:1833-1842. [PMID: 32889853 DOI: 10.1097/qad.0000000000002614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE(S) To elucidate relationships in antiretroviral resistance between HIV-1-infected mother-infant pairs by defining the resistance profiles in the mothers and infants and quantifying drug resistance prevalence in the pairs post-Option B+ implementation. DESIGN Collection of dried blood spots from mother-infant pairs during routine HIV-1 screens in Lusaka, Zambia from 2015 to 2018. METHODS DNA was extracted from the dried blood spots, the HIV-1 pol region was amplified, and the purified proviral DNA was sequenced using Sanger sequencing. Drug resistance mutations (DRM) were identified in sequenced DNA using the Stanford HIVdb (https://hivdb.stanford.edu/). RESULTS DRM were detected in 45% (44/97) of samples, and these samples were found to harbor resistance to at least two antiretrovirals. The prevalence of nonnucleoside reverse transcriptase inhibitor resistance was significantly higher than that of other antiretroviral classes. DRM were detected disproportionately in infants (67%; 33/49) compared with mothers (23%; 11/48), but the magnitude of resistance did not differ when resistance was detected. The disparity in drug resistance profiles was reinforced in pairwise comparison of resistance profiles in mother-infant pairs. CONCLUSION While Option B+ is effective in reducing mother-to-child transmission, in cases where this regimen fails, high-level nonnucleoside reverse transcriptase inhibitor resistance is frequently detected in infants. This underscores the importance of pretreatment drug resistance screening in both mothers and infants and emphasizes the necessary change to protease inhibitor-based and integrase inhibitor-based regimens for treatment of HIV-1-infected infants and mothers.
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18
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King R, Matovu JN, Rujumba J, Wavamunno P, Amone A, Gabagaya G, Fowler MG, Homsy J, Seeley J, Musoke P. PMTCT Option B+ 2012 to 2018 - Taking stock: barriers and strategies to improve adherence to Option B+ in urban and rural Uganda. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 19:135-146. [PMID: 32780677 DOI: 10.2989/16085906.2020.1760325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Since 2012, PMTCT Option B+ has been recommended by the World Health Organization to reduce vertical transmission but numerous adherence challenges remain. We conducted a qualitative study at baseline using six focus group discussions and 14 in-depth interviews to explore knowledge, beliefs, attitudes and challenges towards the Option B+ strategy for PMTCT among HIV-infected pregnant and post-partum women and health workers engaged in Uganda's national Option B+ PMTCT programme. Data were analysed using a thematic approach to capture latent and manifest content with the social ecological model as a theoretic foundation in order to make contextual sense of key stakeholders' needs for an effective Option B+ intervention. Overall, among all study participants, we found multi-level barriers to adhering to Option B+ cutting across all levels of the social ecological model. In line with the model, our study revealed barriers at personal, relational, organizational and societal levels. Some personal beliefs such as that the baby's health is more important that the mother's, organizational (negative attitudes and behaviour of health workers), structural such as poverty, work conflicts, fear and lack of disclosure related to community stigma were all critical obstacles to women adhering to the Option B+ programme. We found that both health workers and participants in the programme have a relatively clear understanding of the benefits of adhering to their treatment; though a more nuanced understanding and thus emphasis in counselling on side effects, is critical to helping patients adhere.
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Affiliation(s)
- Rachel King
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Joyce Namale Matovu
- Makerere University/Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Joseph Rujumba
- Department of Pediatrics, Makerere University, Kampala, Uganda
| | - Priscilla Wavamunno
- Makerere University/Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Alexander Amone
- Makerere University/Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Grace Gabagaya
- Makerere University/Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Mary Glenn Fowler
- Makerere University/Johns Hopkins University Research Collaboration, Kampala, Uganda.,Department of Medicine, Johns Hopkins University, Baltimore, USA
| | - Jaco Homsy
- Makerere University/Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK
| | - Philippa Musoke
- Makerere University/Johns Hopkins University Research Collaboration, Kampala, Uganda
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Clinical Consequences of Using an Indeterminate Range for Early Infant Diagnosis of HIV: A Decision Model. J Acquir Immune Defic Syndr 2020; 82:287-296. [PMID: 31609928 DOI: 10.1097/qai.0000000000002155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To minimize false-positive diagnoses of HIV in exposed infants, the World Health Organization recommends confirmatory testing for all infants initiating antiretroviral therapy (ART). In settings where confirmatory testing is not feasible or intermittently performed, clinical decisions may be aided by semi-quantitative cycle thresholds (Cts) that identify positive results most likely to be false-positive. METHODS We developed a decision analysis model of HIV-exposed infants in sub-Saharan Africa to estimate the clinical consequences of deferring ART for infants with weakly positive ("indeterminate") results. We assessed the degree to which "indeterminate" results may reduce the number of infants starting ART unnecessarily while missing a small number of HIV-infected infants. Our primary outcome was the ratio of averted unnecessary ART regimens to additional HIV-related deaths (due to false-negative diagnosis) at different Ct cutoffs. RESULTS The clinical consequences of adopting an indeterminate range varied with the prevalence of HIV and Ct cutoff. Considering a Ct cutoff ≥33, adopting an indeterminate range could prevent a median of 1.4 infants from receiving ART unnecessarily (95% UR: 1.0-2.0) for each additional HIV-related death. This ratio could be improved by prioritizing infants with indeterminate results for confirmatory testing [median 8.8 (95% UR: 6.0-13.3)] and by adopting a higher cutoff [median 82.3 (95% UR: 49.0-155.8) with Ct ≥36]. CONCLUSIONS When implemented in settings where confirmatory testing is not universal, the benefits of classifying weakly positive results as "indeterminate" may outweigh the risks. Accordingly, the World Health Organization has recommended Ct values ≥33 be considered indeterminate for infant HIV diagnosis.
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Vieira L, Mahumane AM, Napua M, Chale F, Manuel JL, Cowan JG, Sherr K, Chapman RR, Pfeiffer JT. HIV-exposed infant follow-up in Mozambique: formative research findings for the design of a cluster randomized controlled trial to improve testing and ART initiation. BMC Health Serv Res 2020; 20:226. [PMID: 32183779 PMCID: PMC7079378 DOI: 10.1186/s12913-020-5051-8] [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] [Received: 10/05/2019] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early infant diagnosis (EID) of HIV-exposed and initiation of HIV-positive infants on anti-retroviral therapy (ART) requires a well-coordinated cascade of care. Loss-to-follow-up (LTFU) can occur at multiple steps and effective EID is impeded by human resource constraints, difficulty with patient tracking, and long waiting periods. The objective of this research was to conduct formative research to guide the development of an intervention to improve the pediatric HIV care cascade in central Mozambique. The study was conducted in Manica and Sofala Provinces where the adult HIV burden is higher than the national average. The research focused on 3 large clinics in each province, along the highly populated Beira corridor. METHODS The research was conducted in 2014 over 3 months at six facilities and consisted of 1) patient flow mapping and collection of health systems data from postpartum, child-at-risk, and ART service registries, 2) measurement of clinic waiting times, and 3) patient and health worker focus groups. RESULTS HIV testing and ART initiation coverage for mothers tends to be high, but EID and pediatric ART initiation are hampered by lack of patient tracking, long waiting times, and inadequate counseling to navigate the care cascade. About 76% of HIV-positive infants were LTFU and did not initiate ART. CONCLUSIONS Effective interventions to reduce LTFU in EID and improve pediatric ART initiation should focus on patient tracking, active follow-up of defaulting patients, reduction in EID turn-around times for PCR results, and initiation of ART by nurses in child-at-risk services. TRIAL REGISTRATION Retrospectively registered, ISRCTN67747315, July 24, 2019.
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Affiliation(s)
- Lúcia Vieira
- Ministry of Health, Centro de Investigação Operacional da Beira, Institute Nacional de Saúde, 1323 Correia de Brito Street, Ponta-gêa Health Center Building, Beira, Sofala, Mozambique.
| | - Arlete Miloque Mahumane
- Ministry of Health, Centro de Investigação Operacional da Beira, Institute Nacional de Saúde, 1323 Correia de Brito Street, Ponta-gêa Health Center Building, Beira, Sofala, Mozambique
| | - Manuel Napua
- Ministry of Health, Centro de Investigação Operacional da Beira, Institute Nacional de Saúde, 1323 Correia de Brito Street, Ponta-gêa Health Center Building, Beira, Sofala, Mozambique
| | - Falume Chale
- Ministry of Health, Centro de Investigação Operacional da Beira, Institute Nacional de Saúde, 1323 Correia de Brito Street, Ponta-gêa Health Center Building, Beira, Sofala, Mozambique
| | - João Luís Manuel
- Ministry of Health, Centro de Investigação Operacional da Beira, Institute Nacional de Saúde, 1323 Correia de Brito Street, Ponta-gêa Health Center Building, Beira, Sofala, Mozambique
| | - Jessica Greenberg Cowan
- School of Nursing, University of Washington, Seattle, USA.,Department of Family Medicine, University of Washington, Seattle, USA
| | - Kenneth Sherr
- School of Nursing, University of Washington, Seattle, USA.,Health Alliance International, Beira, Mozambique
| | - Rachel R Chapman
- Department of Anthropology, University of Washington, Seattle, USA
| | - James T Pfeiffer
- School of Nursing, University of Washington, Seattle, USA.,Health Alliance International, Beira, Mozambique.,Department of Anthropology, University of Washington, Seattle, USA
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Gitonga LK, Boru WG, Muthoni L, Odhiambo J, Ransom J. Characteristics and outcomes of HIV-exposed infants in Homa Bay County, Kenya, 2015. Trop Doct 2020; 50:154-156. [PMID: 31948336 DOI: 10.1177/0049475519899586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Homa Bay County in south-western Kenya has a low uptake of antenatal care services and the highest prevalence of HIV in the country. We present the findings of a retrospective review of HIV-exposed infants (HEI) who sought early infant diagnosis services in the county throughout 2015. HEI who were breastfed >6 months, had replacement feeding and did not receive prophylaxis were 2-6 times more likely to be HIV-positive.
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Affiliation(s)
- Lawrence K Gitonga
- Epidemiologist, Embu County Health Department, Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Waqo G Boru
- Deputy Head, Field Epidemiology and Laboratory Training Program, Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Lilly Muthoni
- Medical Director, Ministry of Health, National AIDS and STI Control Program, Ministry of Health, Nairobi, Kenya
| | - Jacob Odhiambo
- Deputy Project Director, HMIS, Ministry of Health, National AIDS and STI Control Program, Ministry of Health, Nairobi, Kenya
| | - James Ransom
- James Ransom, Director, Research and Evaluation, Piret Partners Consulting, Research and Evaluation, Washington, DC, USA
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22
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Rotheram-Borus MJ, Weichle TW, Wynn A, Almirol E, Davis E, Stewart J, Gordon S, Tubert J, Tomlinson M. Alcohol, But Not Depression or IPV, Reduces HIV Adherence Among South African Mothers Living with HIV Over 5 Years. AIDS Behav 2019; 23:3247-3256. [PMID: 31401739 DOI: 10.1007/s10461-019-02617-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Alcohol, depression, and intimate partner violence (IPV) are endemic in sub-Saharan Africa. This article examines whether and how these conditions affect mothers living with HIV (MLH), compared to mothers without HIV (MWOH). In particular, we assess the influence of these comorbidities on engagement in HIV care and adherence to antiretroviral therapies (ARV) among MLH. Data on maternal HIV care are typically based on clinic samples, with substantial loss to follow-up. This study fills that gap by including all mothers in specified areas. A cohort study examines MLH in Cape Town, South Africa recruited in pregnancy and followed repeatedly for 5 years, compared to MWOH. Almost all (98%) pregnant women in 12 neighborhoods (N = 594) were recruited in pregnancy. Mothers and children were reassessed five times over 5 years with high retention rates at each of the six assessments, from 98.7% at 2 weeks to 82.8% at 5 years post-birth. MLH's uptake and adherence to HIV care was evaluated over time associated with maternal comorbidities of alcohol use, depressed mood, and IPV using mixed effects logistic regression. MLH have fewer resources (income, food, education) and are more likely to face challenges from alcohol, depression, and having seropositive partners over time than MWOH. Only 22.6% of MLH were consistently engaged in HIV care from 6 months to 5 years post-birth. At 5 years, 86.7% self-reported engaged in HIV care, 76.9% were receiving ARVs and 87% of those on ARV reported consistent ARV adherence. However, data on viral suppression are unavailable. Alcohol use, but not depressed mood or IPV, was significantly related to reduced uptake of HIV care and adherence to ARV over time. Adherence to lifelong ARV by MLH requires a combination of structural and behaviorally-focused interventions. Alcohol abuse is not typically addressed in low and middle-income countries, but is critical to support MLH.
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Affiliation(s)
- Mary Jane Rotheram-Borus
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA.
| | - Thomas W Weichle
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA
| | - Adriane Wynn
- Division of Infectious Diseases & Global Public Health, School of Medicine, UCSD, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Ellen Almirol
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA
| | - Emily Davis
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA
| | - Jacqueline Stewart
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Francie van Zijl Drive, Cape Town, 7505, South Africa
| | - Sarah Gordon
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Francie van Zijl Drive, Cape Town, 7505, South Africa
| | - Julia Tubert
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Francie van Zijl Drive, Cape Town, 7505, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
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Strategies for Prevention of Mother-to-Child Transmission Adopted in the "Real-World" Setting: Data From the Italian Register for HIV-1 Infection in Children. J Acquir Immune Defic Syndr 2019; 79:54-61. [PMID: 29957673 DOI: 10.1097/qai.0000000000001774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Strategies for prevention of HIV-1 mother-to-child transmission (PMTCT) have been continuously optimized. However, cases of vertical transmission continue to occur in high-income countries. OBJECTIVES To investigate changes in PMTCT strategies adopted by Italian clinicians over time and to evaluate risk factors for transmission. METHODS Data from mother-child pairs prospectively collected by the Italian Register, born in Italy in 1996-2016, were analyzed. Risk factors for MTCT were explored by logistic regression analyses. RESULTS Six thousand five hundred three children (348 infections) were included. In our cohort, the proportion of children born to foreign mothers increased from 18.3% (563/3078) in 1996%-2003% to 66.2% (559/857) in 2011-2016 (P < 0.0001). Combination neonatal prophylaxis use significantly (P < 0.0001) increased over time, reaching 6.3% (56/857) after 2010, and it was largely (4.2%) adopted in early preterm infants. The proportion of vaginal deliveries in women with undetectable viral load (VL) increased over time and was 9.9% (85/857) in 2011-2016; no infection occurred among them. In children followed up since birth MTCT, rate was 3.5% (96/2783) in 1996-2003; 1.4% (36/2480) in 2004-2010; and 1.1% (9/835) in 2011-2016. At a multivariate analysis, factors associated with MTCT were vaginal delivery with detectable or missing VL or nonelective caesarean delivery, prematurity, breastfeeding, lack of maternal or neonatal antiretroviral therapy, detectable maternal VL, and age at first observation. Previously described increased risk of offspring of immigrant women was not confirmed. CONCLUSIONS Risk of MTCT in Italy is ongoing, even in recent years, underling the need for implementation of the current screening program in pregnancy. Large combination neonatal prophylaxis use in preterm infants was observed, even if data on safety and efficacy in prematures are poor.
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Determinants of antenatal HIV testing in the opt-out approach in Nigeria: findings from the Nigerian Demographic and Health Survey. J Biosoc Sci 2019; 52:473-490. [PMID: 31587669 DOI: 10.1017/s0021932019000555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Children in Nigeria are frequently born with HIV, despite available services to prevent mother-to-child transmission (MTCT). Not offering, or non-acceptance of, HIV testing during antenatal care (ANC) delays anti-retroviral commencement for infected women, thereby increasing the risk of MTCT. This study assessed the determinants of HIV testing during antenatal care in Nigeria using nationally representative data from the 2013 Nigerian Demographic Health Survey. This study included 13,352 women aged 15-49 years who reported having at least one antenatal visit. The outcome variables were HIV testing during ANC and during labour, while socio-demographic and maternal factors, including number of ANC visits, offer of HIV testing during ANC and labour, place of delivery and knowledge and counselling on MTCT, were among the independent variables. Multivariate regression analysis was used to predict HIV testing during ANC and labour. About half (53%) of the women were tested for HIV during antenatal care with 85% of those tested receiving their test results. Only 6% had HIV tests during labour. There was a 33% excess probability of urban women testing during ANC compared with rural women. Never having a previous pregnancy terminated was associated with lower odds of testing during ANC. No counselling on MTCT and no counselling to get tested were associated with a lower probability of testing during ANC. Counselling on the prevention of MTCT is crucial for women's willingness to be tested, and acceptance of testing. More effort is needed to ensure that providers in Nigeria offer these services to all women, educate women on the dangers of opting out and ensure the earliest commencement of ARV enrolment for those infected.
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Samreth S, Keo V, Tep R, Ke A, Ouk V, Ngauv B, Mam S, Ferradini L, Ly PS, Mean CV, Delvaux T. Access to prevention of mother-to-child transmission of HIV along HIV services cascade through integrated active case management in 15 operational districts in Cambodia. J Int AIDS Soc 2019; 22:e25388. [PMID: 31631583 PMCID: PMC6801228 DOI: 10.1002/jia2.25388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 08/06/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Following the introduction of option B+ in 2013, and with the perspective of eliminating mother-to-child transmission of HIV by 2025, Cambodia has implemented an integrated active case management (IACM) approach since 2014 to improve the notification and follow-up of all HIV-infected cases including pregnant women, and to ensure access to and use of the full prevention of mother-to-child transmission (PMTCT) service package by HIV-infected pregnant women and their HIV-exposed infants. This study aimed to analyse PMTCT cascade data in 15 operational districts (ODs) implementing the IACM approach in Cambodia. METHODS We analysed PMTCT cohort data from 15 ODs implementing IACM approach between 1 January 2014 and 31 December 2016. We measured key indicators along the PMTCT cascade and compared them to available (cross-sectional) PMTCT indicators during the 2011 to 2013 period. RESULTS During the period 2014 to 2016, among 938 identified HIV-infected pregnant women, 308 (32.8%) were tested HIV positive during their pregnancy, 9 (1.0%) during labour, while the remaining 621 (66.2%) were women on antiretroviral therapy (ART) who became pregnant. During the study period, 867 (92.4%) of the 938 women received ART during pregnancy and labour. Subsequently, 456 (85.6%) of the 533 HEI born and alive during the study period received 6-week antiretroviral (ARV) prophylaxis, 390 (76.6%) and 396 (77.8%) of the 509 infants aged six weeks or older received cotrimoxazole prophylaxis and HIV-DNA PCR test respectively. Among the 396 HEI who received HIV-DNA PCR test, 7 (1.8%) were found HIV positive. The comparison with cross-sectional PMTCT indicator obtained during the previous 2011 to 2013 period in the same 15 ODs, showed a significant increase in ARV uptake among HIV-infected pregnant women (from 72.3% to 92.4%), in cotrimoxazole uptake (from 41.6% to 73.2%), and in HIV-DNA PCR testing coverage among HEI (from 41.2% to 74.3%). CONCLUSIONS The implementation of option B+ and IACM may have contributed to the improvement of the PMTCT cascade in Cambodia. However, some gaps in accessing PMTCT services along the HIV cascade persist and need to be addressed.
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Affiliation(s)
| | - Vannak Keo
- National Center for HIV/AIDS, Dermatology and STDPhnom PenhCambodia
| | - Romaing Tep
- National Center for HIV/AIDS, Dermatology and STDPhnom PenhCambodia
| | - Angheng Ke
- National Center for HIV/AIDS, Dermatology and STDPhnom PenhCambodia
| | - Vichea Ouk
- National Center for HIV/AIDS, Dermatology and STDPhnom PenhCambodia
| | - Bora Ngauv
- National Center for HIV/AIDS, Dermatology and STDPhnom PenhCambodia
| | - Sovatha Mam
- University of Health SciencePhnom PenhCambodia
| | | | - Penh S Ly
- National Center for HIV/AIDS, Dermatology and STDPhnom PenhCambodia
| | - Chhi V Mean
- University of Health SciencePhnom PenhCambodia
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Gumede-Moyo S, Todd J, Bond V, Mee P, Filteau S. A qualitative inquiry into implementing an electronic health record system (SmartCare) for prevention of mother-to-child transmission data in Zambia: a retrospective study. BMJ Open 2019; 9:e030428. [PMID: 31494616 PMCID: PMC6731929 DOI: 10.1136/bmjopen-2019-030428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the challenges in implementing a Zambian electronic health records (EHR) system labelled 'SmartCare' from diverse stakeholder perspectives in order to improve prevention of mother-to-child transmission (PMTCT) data collection so that SmartCare can be used for clinic performance strengthening and programme monitoring. DESIGN This is a qualitative retrospective study. SETTING AND PARTICIPANTS SmartCare is a Zambian Ministry of Health (MoH)-led project funded by the US Centre for Disease Control and Prevention. Data were collected using in-depth interviews, observations and focus group discussions (FGDs) between September and November 2016. Seventeen in-depth interviews were held with a range of key informants from the MoH and local and international organisations implementing SmartCare. Four data entry observations and three FGDs with 22 pregnant and lactating women seeking PMTCT services were conducted. Data were analysed using a thematic content approach. RESULTS The SmartCare system has evolved from various patient tracking systems into a multifunctional system. There is a burden of information required so that sometimes not all is collected and entered into the database, resulting in poor data quality. Funding challenges impede data collection due to manpower constraints and shortages of supplies. Challenges associated with data collection depend on whether a paper-based or computer-based system is used. There is no uniformity in the data quality verification and submission strategies employed by various IPs. There is little feedback from the EHR system at health facility level, which has led to disengagement as stakeholders do not see the importance of the system. CONCLUSION SmartCare has structural challenges which can be traced from its development. Funding gaps have resulted in staffing and data collection disparities within IPs. The lack of feedback from the system has also led to complacency at the operational level, which has resulted in poor data quality in later years.
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Affiliation(s)
- Sehlulekile Gumede-Moyo
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Jim Todd
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Virginia Bond
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- ZAMBART, University of Zambia School of Medicine, Lusaka, Zambia
| | - Paul Mee
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanne Filteau
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Gumede-Moyo S, Todd J, Schaap A, Mee P, Filteau S. Increasing Proportion of HIV-Infected Pregnant Zambian Women Attending Antenatal Care Are Already on Antiretroviral Therapy (2010-2015). Front Public Health 2019; 7:155. [PMID: 31249826 PMCID: PMC6584768 DOI: 10.3389/fpubh.2019.00155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 05/28/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Accurate estimates of coverage of prevention of mother-to-child (PMTCT) services among HIV-infected pregnant women are vital for monitoring progress toward HIV elimination targets. The achievement of high coverage and uptake of services along the PMTCT cascade is crucial for national and international mother-to child transmission (MTCT) elimination goals. In eastern and southern Africa, MTCT rate fell from 18% of infants born to mothers living with HIV in 2010 to 6% in 2015. This paper describes the degree to which World Health Organization (WHO) guidelines for PMTCT services were implemented in Zambia between 2010 and 2015. Method: The study used routinely collected data from all pregnant women attending antenatal clinics (ANC) in SmartCare health facilities from January 2010 to December 2015. Categorical variables were summarized using proportions while continuous variables were summarized using medians and interquartile ranges. Results: There were 104,155 pregnant women who attended ANC services in SmartCare facilities during the study period. Of these, 9% tested HIV-positive during ANC visits whilst 43% had missing HIV test result records. Almost half (47%) of pregnant women who tested HIV-positive in their ANC visit were recorded in 2010. Among HIV-positive women, there was an increase in those already on ART at first ANC visit from 9% in 2011 to 74% in 2015. The overall mean time lag between starting ANC care and ART initiation was 7 months, over the 6 year period, but there were notable variations between provinces and years. Conclusion: The implementation of the WHO post 2010 PMTCT guidelines has resulted in an increase in the proportion of HIV-infected pregnant women attending ANC who are already on ART. However, the variability in HIV infection rates, missing data, and time to initiation of ART suggests there are some underlying health service or database issues which require attention.
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Affiliation(s)
- Sehlulekile Gumede-Moyo
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,School of Public Health, University of Zambia, Lusaka, Zambia
| | - Jim Todd
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ab Schaap
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,ZAMBART, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Paul Mee
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Suzanne Filteau
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Jones H, Wringe A, Todd J, Songo J, Gómez-Olivé FX, Moshabela M, Geubbels E, Nyamhagatta M, Kalua T, Urassa M, Zaba B, Renju J. Implementing prevention policies for mother-to-child transmission of HIV in rural Malawi, South Africa and United Republic of Tanzania, 2013-2016. Bull World Health Organ 2019; 97:200-212. [PMID: 30992633 PMCID: PMC6453322 DOI: 10.2471/blt.18.217471] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/13/2018] [Accepted: 12/28/2018] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To assess adoption of World Health Organization (WHO) guidance into national policies for prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) and to monitor implementation of guidelines at facility level in rural Malawi, South Africa and the United Republic of Tanzania. METHODS We summarized national PMTCT policies and WHO guidance for 15 indicators across the cascades of maternal and infant care over 2013-2016. Two survey rounds were conducted (2013-2015 and 2015-2016) in 46 health facilities serving five health and demographic surveillance system populations. We administered structured questionnaires to facility managers to describe service delivery. We report the proportions of facilities implementing each indicator and the frequency and durations of stock-outs of supplies, by site and survey round. FINDINGS In all countries, national policies influencing the maternal and infant PMTCT cascade of care aligned with WHO guidelines by 2016; most inter-country policy variations concerned linkage to routine HIV care. The proportion of facilities delivering post-test counselling, same-day antiretroviral therapy (ART) initiation, antenatal care and ART provision in the same building, and Option B+ increased or remained at 100% in all sites. Progress in implementing policies on infant diagnosis and treatment varied across sites. Stock-outs of HIV test kits or antiretroviral drugs in the past year declined overall, but were reported by at least one facility per site in both rounds. CONCLUSION Progress has been made in implementing PMTCT policy in these settings. However, persistent gaps across the infant cascade of care and supply-chain challenges, risk undermining infant HIV elimination goals.
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Affiliation(s)
- Harriet Jones
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, England
| | - Alison Wringe
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, England
| | - Jim Todd
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, England
| | - John Songo
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, South Africa
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Eveline Geubbels
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, England
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, United Republic of Tanzania
- Ministry of Health, Lilongwe, Malawi
- National Institute of Medical Research, Mwanza, Tanzania
| | - Mukome Nyamhagatta
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, United Republic of Tanzania
| | | | - Mark Urassa
- National Institute of Medical Research, Mwanza, Tanzania
| | - Basia Zaba
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, England
| | - Jenny Renju
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, England
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Schmitz K, Basera TJ, Egbujie B, Mistri P, Naidoo N, Mapanga W, Goudge J, Mbule M, Burtt F, Scheepers E, Igumbor J. Impact of lay health worker programmes on the health outcomes of mother-child pairs of HIV exposed children in Africa: A scoping review. PLoS One 2019; 14:e0211439. [PMID: 30703152 PMCID: PMC6355001 DOI: 10.1371/journal.pone.0211439] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/14/2019] [Indexed: 02/06/2023] Open
Abstract
Background Increased demand for healthcare services in countries experiencing high HIV disease burden and often coupled with a shortage of health workers, has necessitated task shifting from professional health workers to Lay Health Workers (LHWs) in order to improve healthcare delivery. Maternal and Child Health (MCH) services particularly benefit from task-shifting to LHWs or similar cadres. However, evidence on the roles and usefulness of LHWs in MCH service delivery in Sub-Saharan Africa (SSA) is not fully known. Objectives To examine evidence of the roles and impact of lay health worker programmes focusing on Women Living with HIV (WLH) and their HIV-exposed infants (HEIs). Methods A scoping review approach based on Arksey and O’Malley’s guiding principles was used to retrieve, review and analyse existing literature. We searched for articles published between January 2008 and July 2018 in seven (7) databases, including: MEDLINE, Embase, PsycINFO, Joanna Briggs, The Cochrane Library, EBM reviews and Web of Science. The critical constructs used for the literature search were “lay health worker”, “community health worker”, “peer mentor”, “mentor mother,” “Maternal and Child health worker”, “HIV positive mothers”, “HIV exposed infants” and PMTCT. Results Thirty-three (33) full-text articles meeting the eligibility criteria were identified and included in the final analysis. Most (n = 13, 39.4%) of the included studies were conducted in South Africa and used a cluster RCT design (n = 13, 39.4%). The most commonly performed roles of LHWs in HIV specific MCH programmes included: community engagement and sensitisation, psychosocial support, linkage to care, encouraging women to bring their infants back for HIV testing and supporting default tracing. Community awareness on Mother to Child Transmission of HIV (MTCT), proper and consistent use of condoms, clinic attendance and timely HIV testing of HEIs, as well as retention in care for infected persons, have all improved because of LHW programmes. Conclusion LHWs play significant roles in the management of WLH and their HEIs, improving MCH outcomes in the process. LHW interventions are beneficial in increasing access to PMTCT services and reducing MTCT of HIV, though their impact on improving adherence to ART remains scanty. Further research is needed to evaluate ART adherence in LHW interventions targeted at WLH. LHW programmes can be enhanced by increasing supportive supervision and remuneration of LHWs.
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Affiliation(s)
| | - Tariro Jayson Basera
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Bonaventure Egbujie
- School of Public Health, University of Western Cape, Cape Town, South Africa
| | - Preethi Mistri
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Nireshni Naidoo
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Witness Mapanga
- Center for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane Goudge
- Center for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | - Jude Igumbor
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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30
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Mulewa P, Satumba E, Mubisi C, Kandiado J, Malenga T, Nyondo-Mipando AL. "I Was Not Told That I Still Have The Virus": Perceptions of Utilization of Option B+ Services at a Health Center in Malawi. J Int Assoc Provid AIDS Care 2019; 18:2325958219870873. [PMID: 31478427 PMCID: PMC6900569 DOI: 10.1177/2325958219870873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 11/16/2022] Open
Abstract
Utilization of the prevention of mother-to-child transmission of HIV (PMTCT) services remains a challenge as losses to follow-up are substantial. This study explored factors that influence adherence to maternal antiretroviral (ARV) medications among PMTCT mothers in Malawi. We conducted a descriptive qualitative study from September 2016 to May 2017 using purposive sampling among 16 PMTCT mothers and 4 key informant interviews with health-care workers. Data were audio-recorded and analyzed thematically. The factors that influence adherence to maternal ARV medications include the quality of PMTCT services and social support. Factors that impede adherence include suboptimal counseling women receive on ARV medications, cost of travel, and conflicting advice from religious institutions. Adherence to maternal ARV medications will require the use of existing social support systems in a woman's life as a platform for delivery of the drugs while also maintaining continued and comprehensive counseling on the benefits of maternal ARV medications.
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Affiliation(s)
- Patience Mulewa
- Department of Health Systems and Policy, School of Public Health and Family
Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Egrina Satumba
- Department of Health Systems and Policy, School of Public Health and Family
Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Christopher Mubisi
- Department of Health Systems and Policy, School of Public Health and Family
Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Joseph Kandiado
- Department of Health Systems and Policy, School of Public Health and Family
Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Tumaini Malenga
- Department of Health Systems and Policy, School of Public Health and Family
Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Public Health and Family
Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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31
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Voronin Y, Jani I, Graham BS, Cunningham CK, Mofenson LM, Musoke PM, Permar SR, Scarlatti G. Recent progress in immune-based interventions to prevent HIV-1 transmission to children. J Int AIDS Soc 2018; 20. [PMID: 29282882 PMCID: PMC5810316 DOI: 10.1002/jia2.25038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 12/04/2017] [Indexed: 11/30/2022] Open
Abstract
Globally, 150,000 new paediatric human immunodeficiency virus type 1 (HIV‐1) infections occurred in 2015. There remain complex challenges to the global elimination of paediatric HIV‐1 infection. Thus, for the global community to achieve elimination of new paediatric HIV‐1 infections, innovative approaches need to be explored. Immune‐based approaches to prevention of mother‐to‐child transmission (MTCT) may help fill some of the remaining gaps and provide new opportunities to achieve an AIDS‐free generation. Immune‐based interventions to prevent MTCT of HIV‐1 may include paediatric HIV vaccines and passive immunization approaches. Recent discoveries providing evidence of robust immune responses to HIV in infants open new and exciting prospects for paediatric HIV vaccines. Moreover, successful vaccination of infants has a different set of requirements than vaccination of adults and may be easier to achieve. Proof‐of‐concept has been established over the last two decades that passively administered HIV‐1 Env‐specific monoclonal antibody (mAbs) can prevent chimeric simian human immunodeficiency virus (SHIV) transmission to newborn nonhuman primates. There has been tremendous progress in isolating and characterizing broadly neutralizing antibodies to HIV, and clinical testing of these antibodies for treatment and prevention in both infants and adults is a major effort in the field. Immune‐based interventions need to be actively explored as they can provide critically important tools to address persistent challenges in MTCT prevention. It is a pivotal time for the field with active discussions on the best strategy to further reduce HIV infection of infants and accomplish the World Health Organization Fast‐Track 2030 goals to eliminate new paediatric HIV infections.
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Affiliation(s)
| | - Ilesh Jani
- Instituto Nacional de Saúde, Maputo, Mozambique
| | - Barney S Graham
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Philippa M Musoke
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Sallie R Permar
- Department of Pediatrics and Human Vaccine Institute, Duke University Medical Center, Durham, NC, USA
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32
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Singh J, Filteau S, Todd J, Gumede-Moyo S. Progress in the performance of HIV early infant diagnosis services in Zambia using routinely collected data from 2006 to 2016. BMC Public Health 2018; 18:1297. [PMID: 30477465 PMCID: PMC6258281 DOI: 10.1186/s12889-018-6222-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/14/2018] [Indexed: 11/22/2022] Open
Abstract
Background Early diagnosis and treatment initiation of HIV-infected infants can greatly reduce the risk of infant mortality. The WHO recommends testing HIV-exposed infants at 6 weeks of age and immediate initiation of antiretroviral therapy if positive. This study aimed to determine the feasibility of using an electronic health records system to evaluate the performance of Zambia’s HIV Early Infant Diagnosis services. Methods A retrospective analysis of routinely collected data from the Zambian SmartCare database was performed for the period January 2006 to December 2016. The study population includes all HIV-infected infants (n = 32,593) registered during this period on treatment for HIV. Univariable logistic regression was conducted to identify factors associated with later infant testing and treatment initiation. Results The mean age at infant HIV test decreased from 10.10 months in 2006 to 3.49 months in 2016. Infants born in 2015 were almost 4 times more likely to be tested under 2 months of age compared to infants born in 2006 (OR: 3.72, p-value: < 0.001). The mean time from diagnosis to treatment initiation decreased from 220 days in 2006 to 9 days in 2015. There was substantial regional variability with infants in the provinces of Copperbelt, Luapula and Southern performing best in outcomes and Eastern, Lusaka and Western performing the worst. Conclusions HIV-exposed infants born more recently have significantly better outcomes than infants born a decade ago in Zambia, which could be as a result of increased attention and funding for HIV programmes.
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Affiliation(s)
- Jasleen Singh
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Suzanne Filteau
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Jim Todd
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Sehlulekile Gumede-Moyo
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,School of Public Health, University of Zambia, Lusaka, Zambia.
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Horwood C, Jama NA, Haskins L, Coutsoudis A, Spies L. A qualitative study exploring infant feeding decision-making between birth and 6 months among HIV-positive mothers. MATERNAL AND CHILD NUTRITION 2018; 15:e12726. [PMID: 30338632 DOI: 10.1111/mcn.12726] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/28/2018] [Accepted: 10/02/2018] [Indexed: 01/10/2023]
Abstract
Despite efforts to support breastfeeding for HIV-positive mothers in South Africa, being HIV-positive remains a barrier to initiating and sustaining breastfeeding. The aim was to explore decision-making about infant feeding practices among HIV-positive mothers in a rural and urban settings in KwaZulu-Natal, South Africa. HIV-positive pregnant women were purposively sampled from one antenatal clinic in each setting. A qualitative longitudinal cohort design was employed, with monthly in-depth interviews conducted over 6 months postdelivery. Data were analysed using framework analysis. We report findings from 11 HIV-positive women within a larger cohort. Participants were aged between 15 and 41 years and were all on antiretroviral therapy. Before delivery, nine mothers intended to exclusively breastfeed (EBF) for 6 months, and two intended to exclusively formula feed (EFF). Three mothers successfully EBF for 6 months, whereas four had stopped breastfeeding, and two were mixed breastfeeding by 6 months. Mothers reported receiving strong advice from health workers (HWs) to EBF and made decisions based primarily on HWs advice, resisting contrary pressure from family or friends. The main motivation for EBF was to protect the child from HIV acquisition, but sometimes fear of mixed feeding led to mothers stopping breastfeeding entirely. Infant feeding messages from HWs advice were frequently inadequate and out of date, and failed to address mothers' challenges. Minimal support was provided for EFF. In conclusion, HWs play a pivotal role in providing infant feeding support to HIV infected mothers, but need regular updates to ensure if advice is correct and appropriate.
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Affiliation(s)
- Christiane Horwood
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Lyn Haskins
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Anna Coutsoudis
- Department of Paediatrics and Child Health School of Clinical Medicine Nelson R Mandela School of Medicine, University of KwaZulu-Natal Durban, Durban, South Africa
| | - Lenore Spies
- Department of Health, Nutrition Directorate, Pietermaritzburg, South Africa
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Fleischer AB. Guideline-based medicine grading on the basis of the guidelines of care for ambulatory atopic dermatitis treatment in the United States. J Am Acad Dermatol 2018; 80:417-424. [PMID: 30287314 DOI: 10.1016/j.jaad.2018.09.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/30/2018] [Accepted: 09/08/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE This study was designed to assess the adherence to evidence-based guidelines of care for atopic dermatitis (AD). METHODS To characterize AD treatment in the United States, ambulatory visits from the 2006-2015 National Ambulatory Medical Care Survey were analyzed. For each medication prescribed, a grade was assigned on the basis of the American Academy of Dermatology treatment guidelines for topical and systemic medications. Considering all visit prescriptions, I calculated a composite grade, analogous to the US academic grading system (scores A-F). RESULTS I noted prescribing differences across specialty groups. Systemic corticosteroids were more likely to be prescribed by family and general physicians and less likely by pediatricians. Dermatologists were more likely than other specialties to prescribe nonsedating antihistamines, which lack a guideline base supporting their use. Depending upon modeling of care assumptions, all physician specialty visits earned mean guideline-based grades of B or C in their care of AD patients. LIMITATIONS The clinical, social, and demographic factors influencing prescribing behavior cannot be completely assessed by using extant data. CONCLUSIONS This preliminary study demonstrates that physicians might benefit from reviewing guidelines of care; there might be an educational gap in the implementation of these guidelines.
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Affiliation(s)
- Alan B Fleischer
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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Medley AM, Hrapcak S, Golin RA, Dziuban EJ, Watts H, Siberry GK, Rivadeneira ED, Behel S. Strategies for Identifying and Linking HIV-Infected Infants, Children, and Adolescents to HIV Treatment Services in Resource Limited Settings. J Acquir Immune Defic Syndr 2018; 78 Suppl 2:S98-S106. [PMID: 29994831 PMCID: PMC10961643 DOI: 10.1097/qai.0000000000001732] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Many children living with HIV in resource-limited settings remain undiagnosed and at risk for HIV-related mortality and morbidity. This article describes 5 key strategies for strengthening HIV case finding and linkage to treatment for infants, children, and adolescents. These strategies result from lessons learned during the Accelerating Children's HIV/AIDS Treatment Initiative, a public-private partnership between the President's Emergency Plan for AIDS Relief (PEPFAR) and the Children's Investment Fund Foundation (CIFF). The 5 strategies include (1) implementing a targeted mix of HIV case finding approaches (eg, provider-initiated testing and counseling within health facilities, optimization of early infant diagnosis, index family testing, and integration of HIV testing within key population and orphan and vulnerable children programs); (2) addressing the unique needs of adolescents; (3) collecting and using data for program improvement; (4) fostering a supportive political and community environment; and (5) investing in health system-strengthening activities. Continued advocacy and global investments are required to eliminate AIDS-related deaths among children and adolescents.
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Affiliation(s)
- Amy M. Medley
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
| | - Susan Hrapcak
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
| | - Rachel A. Golin
- United States Agency for International Development (USAID), Office of HIV/AIDS, Washington, DC
| | - Eric J. Dziuban
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
| | - Heather Watts
- U.S. State Department, Office of the Global AIDS Coordinator, Washington, DC
| | - George K. Siberry
- U.S. State Department, Office of the Global AIDS Coordinator, Washington, DC
| | - Emilia D. Rivadeneira
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
| | - Stephanie Behel
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
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