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Dringus S, Davis K, Simms V, Bernays S, Redzo N, Bandason T, Chikodzore R, Sibanda E, Webb K, Ncube G, Kranzer K, Ferrand RA, Dziva Chikwari C. Delivery of index-linked HIV testing for children: learnings from a qualitative process evaluation of the B-GAP study in Zimbabwe. BMC Infect Dis 2023; 23:262. [PMID: 37101147 PMCID: PMC10131435 DOI: 10.1186/s12879-023-08088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 02/16/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Index-linked HIV testing for children, whereby HIV testing is offered to children of individuals living with HIV, has the potential to identify children living with undiagnosed HIV. The "Bridging the Gap in HIV Testing and Care for Children in Zimbabwe" (B-GAP) study implemented and evaluated the provision of index-linked HIV testing for children aged 2-18 years in Zimbabwe. We conducted a process evaluation to understand the considerations for programmatic delivery and scale-up of this strategy. METHODS We used implementation documentation to explore experiences of the field teams and project manager who delivered the index-linked testing program, and to describe barriers and facilitators to index-linked testing from their perspectives. Qualitative data were drawn from weekly logs maintained by the field teams, monthly project meeting minutes, the project coordinator's incident reports and WhatsApp group chats between the study team and the coordinator. Data from each of the sources was analysed thematically and synthesised to inform the scale-up of this intervention. RESULTS Five main themes were identified related to the implementation of the intervention: (1) there was reduced clinic attendance of potentially eligible indexes due to community-based differentiated HIV care delivery and collection of HIV treatment by proxy individuals; (2) some indexes reported that they did not live in the same household as their children, reflecting the high levels of community mobility; (3) there were also thought to be some instances of 'soft refusal'; (4) further, delivery of HIV testing was limited by difficulties faced by indexes in attending health facilities with their children for clinic-based testing, stigma around community-based testing, and the lack of familiarity of indexes with caregiver provided oral HIV testing; (5) and finally, test kit stockouts and inadequate staffing also constrained delivery of index-linked HIV testing. CONCLUSIONS There was attrition along the index-linked HIV testing cascade of children. While challenges remain at all levels of implementation, programmatic adaptations of index-linked HIV testing approaches to suit patterns of clinic attendance and household structures may strengthen implementation of this strategy. Our findings highlight the need to tailor index-linked HIV testing to subpopulations and contexts to maximise its effectiveness.
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Affiliation(s)
- Stefanie Dringus
- Public Health, Environments and Society Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
| | - Katherine Davis
- MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
| | - Victoria Simms
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Sarah Bernays
- Global Health Department, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, University of Sydney, Sydney, Australia
| | - Nicol Redzo
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rudo Chikodzore
- Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| | - Edwin Sibanda
- City Health Department, Bulawayo City Council, Bulawayo, Zimbabwe
| | - Karen Webb
- Organization for Public Health Interventions and Development, Harare, Zimbabwe
| | - Getrude Ncube
- Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| | - Katharina Kranzer
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Division of Infectious and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - Rashida A Ferrand
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
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Growth improvement following antiretroviral therapy initiation in children with perinatally-acquired HIV diagnosed in older childhood in Zimbabwe: a prospective cohort study. BMC Pediatr 2022; 22:446. [PMID: 35879693 PMCID: PMC9317209 DOI: 10.1186/s12887-022-03466-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 07/01/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Children who initiate antiretroviral therapy (ART) before age 5 years can recover height and weight compared to uninfected peers, but growth outcomes are unknown for children initiating ART at older ages. We investigated factors associated with growth failure at ART initiation and modelled growth by age on ART. METHODS We conducted secondary analysis of cohort of children aged 6-15 years late-diagnosed with HIV in Harare, Zimbabwe, with entry at ART initiation in 2013-2015. Factors associated with height-for-age (HAZ), weight-for-age (WAZ) and BMI-for-age (BAZ) z-scores <- 2 (stunting, underweight and wasting respectively) at ART initiation were assessed using multivariable logistic regression. These outcomes were compared at ART initiation and 12 month follow-up using paired t-tests. HAZ and BAZ were modelled using restricted cubic splines. RESULTS Participants (N = 302; 51.6% female; median age 11 years) were followed for a median of 16.6 months (IQR 11.0-19.8). At ART initiation 34.8% were stunted, 34.5% underweight and 15.1% wasted. Stunting was associated with age ≥ 12 years, CD4 count < 200 cells/μl, tuberculosis (TB) history and history of hospitalisation. Underweight was associated with older age, male sex and TB history, and wasting was associated with older age, TB history and hospitalisation. One year post-initiation, t-tests showed increased WAZ (p = 0.007) and BAZ (p = 0.004), but no evidence of changed HAZ (p = 0.85). Modelling showed that HAZ and BAZ decreased in early adolescence for boys on ART, but not girls. CONCLUSION Stunting and underweight were prevalent at ART initiation among late-diagnosed children, and HAZ did not improve after 1 year. Adolescent boys with perinatally acquired HIV and late diagnosis are particularly at risk of growth failure in puberty.
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Teferi W, Gutreuter S, Bekele A, Ahmed J, Ayalew J, Gross J, Kumsa H, Antefe T, Mengistu S, Mirkovic K, Dziuban EJ, Ross C, Belay Z, Tilahun T, Kassa D, Hrapcak S. Adapting strategies for effective and efficient pediatric HIV case finding in low prevalence countries: risk screening tool for testing children presenting at high-risk entry points in Ethiopia. BMC Infect Dis 2022; 22:480. [PMID: 35596158 PMCID: PMC9121612 DOI: 10.1186/s12879-022-07460-w] [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: 03/09/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background Implementing effective and efficient case-finding strategies is crucial to increasing pediatric antiretroviral therapy coverage. In Ethiopia, universal HIV testing is conducted for children presenting at high-risk entry points including malnutrition treatment, inpatient wards, tuberculosis (TB) clinics, index testing for children of positive adults, and referral of orphans and vulnerable children (OVC); however, low positivity rates observed at inpatient, malnutrition and OVC entry points warrant re-assessing current case-finding strategies. The aim of this study is to develop HIV risk screening tool applicable for testing children presenting at inpatient, malnutrition and OVC entry points in low-HIV prevalence settings. Methods The study was conducted from May 2017–March 2018 at 29 public health facilities in Amhara and Addis Ababa regions of Ethiopia. All children 2–14 years presenting to five high-risk entry points including malnutrition treatment, inpatient wards, tuberculosis (TB) clinics, index testing for children of positive adults, and referral of orphans and vulnerable children (OVC) were enrolled after consent. Data were collected from registers, medical records, and caregiver interviews. Screening tools were constructed using predictors of HIV positivity as screening items by applying both logistic regression and an unweighted method. Sensitivity, specificity and number needed to test (NNT) to identify one new child living with HIV (CLHIV) were estimated for each tool. Results The screening tools had similar sensitivity of 95%. However, the specificities of tools produced by logistic regression methods (61.4 and 65.6%) which are practically applicable were higher than those achieved by the unweighted method (53.6). Applying these tools could result in 58‒63% reduction in the NNT compared to universal testing approach while maintaining the overall number of CLHIV identified. Conclusion The screening tools developed using logistic regression method could significantly improve HIV testing efficiency among children presenting to malnutrition, inpatient, and OVC entry points in Ethiopia while maintaining case identification. These tools are simplified to practically implement and can potentially be validated for use at various entry points. HIV programs in low-prevalence countries can also further investigate and optimize these tools in their settings.
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Affiliation(s)
- Wondimu Teferi
- Centers for Disease Control and Prevention, US Embassy Entoto Road, P.O.B 1014, Addis Ababa, Ethiopia.
| | - Steve Gutreuter
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jelaludin Ahmed
- Centers for Disease Control and Prevention, US Embassy Entoto Road, P.O.B 1014, Addis Ababa, Ethiopia
| | - Jemal Ayalew
- Ethiopia Public Health Association, Addis Ababa, Ethiopia
| | - Jessica Gross
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hanna Kumsa
- Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia
| | | | | | - Kelsey Mirkovic
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric J Dziuban
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christine Ross
- Centers for Disease Control and Prevention, US Embassy Entoto Road, P.O.B 1014, Addis Ababa, Ethiopia
| | - Zena Belay
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tsegaye Tilahun
- United States Agency for International Development, Addis Ababa, Ethiopia
| | - Desta Kassa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Susan Hrapcak
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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4
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Mannoh I, Amundsen D, Turpin G, Lyons CE, Viswasam N, Hahn E, Ryan S, Baral S, Hansoti B. A Systematic Review of HIV Testing Implementation Strategies in Sub-Saharan African Countries. AIDS Behav 2022; 26:1660-1671. [PMID: 34797449 PMCID: PMC9426653 DOI: 10.1007/s10461-021-03518-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 11/25/2022]
Abstract
HIV/AIDS remains a looming presence in public health across the world, particularly in Sub-Saharan Africa. The HIV Care Cascade hinges on testing and knowledge of HIV status. Though significant advances have been made in diagnosing people living with HIV (PLHIV), limitations in understanding which strategies are best suited to certain regions or populations have contributed to the uneven distribution in the success of various HIV testing strategies. Here, we present a conceptual framework that outlines effective HIV testing strategies for four target groups. This framework is based on a systematic literature review of articles published from January 1st, 2008, to December 31st, 2019. The effectiveness of HIV testing strategies depends on various factors including the setting, type of test and service providers. Multiple strategies are needed to reach the UNAIDS target of 95% of individuals knowing their HIV status. Expansion of community-based approaches, self-testing and HIV testing services in antenatal care will further improve the state of HIV testing in Sub-Saharan Africa.
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Affiliation(s)
- Ivy Mannoh
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Gnilane Turpin
- Department of Epidemiology, Center for Public Health and Human Rights, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Carrie E Lyons
- Department of Epidemiology, Center for Public Health and Human Rights, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Nikita Viswasam
- Department of Epidemiology, Center for Public Health and Human Rights, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Elizabeth Hahn
- Department of Epidemiology, Center for Public Health and Human Rights, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sofia Ryan
- Department of Epidemiology, Center for Public Health and Human Rights, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Stefan Baral
- Department of Epidemiology, Center for Public Health and Human Rights, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Medicine Suite 200, 5801 Smith Avenue, Baltimore, MD, 21209, USA.
- Department of International Health, Bloomberg School of Public Health, Baltimore, MD, USA.
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5
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Okoko N, Mocello AR, Kadima J, Kulzer J, Nyanaro G, Blat C, Guzé M, Bukusi EA, Cohen CR, Abuogi L, Shade SB. Improvements in pediatric and adolescent HIV testing and identification in western Kenya under the Accelerating Children's HIV/AIDS Treatment initiative. AIDS Care 2021; 34:250-262. [PMID: 33813954 DOI: 10.1080/09540121.2021.1909694] [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: 10/21/2022]
Abstract
Pediatric HIV remains a significant global concern, with 160,000 new infections annually. Accelerating Children's HIV/AIDS Treatment (ACT) provided a strategic response to the "treatment gap" for children. We examined whether activities under ACT increased testing and identification of youth living with HIV (YLWH). Family AIDS Care & Education Services implemented ACT across 130 health facilities in western Kenya between October 2015 and September 2016, providing: HIV-testing counselors and space; training on the Family Information Table (FIT) and chart audits; community outreach testing; and text message reminders for pregnant women. We analyzed the number of youths tested and identified with HIV over time and between intervention and control sites using interrupted time series analysis. We tested 268,312 youths (7,183 infants <18 months; 145,833 children 18 months to 9 years; and 115,296 adolescents 10-14 years). Mean monthly number tested per health facility increased from 2.8 to 7.2 (p < 0.0001) in infants, 44.8-142.0 (p < 0.0001) in children, and 30.1-123.3 (p < 0.0001) in adolescents. Mean monthly number identified with HIV per facility increased from 0.06 to 0.37 (p < 0.0001) in infants; 0.34-0.62 (p = 0.008) in children; and 0.17-0.26 (p = 0.04) in adolescents, resulting in 1,328 diagnoses. Among infants, FIT training was associated with increased HIV testing over time, incidence rate ratio (IRR) = 3.85 (95% confidence interval [CI] 2.16-6.84; p < 0.0001). Text messaging increased testing, IRR = 2.10 (95% CI 1.57-2.80; p < 0.0001) and identification of HIV in infants, IRR = 1.83 (95% CI 1.06-3.18; p = 0.0381) and older children, IRR = 2.25 (95% CI 1.62, 3.13; p < 0.0001). Chart audits increased testing over time among adolescents (IRR = 2.11; 95% CI 1.21-3.66; p = 0.0082). Outreach was associated with identification of adolescents with HIV, IRR = 1.58 (95% CI 1.22-2.06; p = 0.0005). In lower-income settings, targeted interventions effective at reaching YLWH can help optimize resource allocation to address gaps in testing and identification to further reduce HIV-related morbidity and mortality.
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Affiliation(s)
- Nicollate Okoko
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.,Family AIDS Care & Education Services, Kisumu, Kenya
| | - A Rain Mocello
- Family AIDS Care & Education Services, Kisumu, Kenya.,Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Julie Kadima
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.,Family AIDS Care & Education Services, Kisumu, Kenya
| | - Jayne Kulzer
- Family AIDS Care & Education Services, Kisumu, Kenya.,Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - George Nyanaro
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.,Family AIDS Care & Education Services, Kisumu, Kenya
| | - Cinthia Blat
- Family AIDS Care & Education Services, Kisumu, Kenya.,Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Mary Guzé
- Family AIDS Care & Education Services, Kisumu, Kenya.,Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.,Family AIDS Care & Education Services, Kisumu, Kenya
| | - Craig R Cohen
- Family AIDS Care & Education Services, Kisumu, Kenya.,Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Lisa Abuogi
- Family AIDS Care & Education Services, Kisumu, Kenya.,Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Starley B Shade
- Family AIDS Care & Education Services, Kisumu, Kenya.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Yumo H, Nsame D, Kuwoh P, Njabon M, Sieleunou I, Ndenkeh J, Tene G, Memiah P, Kuaban C, Beissner M. Implementation of blanket provider-initiated testing and counselling: Predictors of HIV seropositivity among infants, children and adolescents in Cameroon. PUBLIC HEALTH IN PRACTICE 2020; 1:100025. [PMID: 36101680 PMCID: PMC9461293 DOI: 10.1016/j.puhip.2020.100025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives Study design Methods Results Conclusions Methods to increase the yield of PITC remain unclear. HIV seropositivity predictors could improve PITC yield. Identifying HIV seropositivity predictors among children and adolescents. Targeted HIV testing to improve PITC yield in HIV high burden countries. HIV seropositivity predictors could reduce gap in pediatric and adolescent ART.
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Affiliation(s)
- H.A. Yumo
- Research for Development International (R4D International), Yaoundé, Cameroon
- Center for International Health (CIH), Ludwig-Maximilians-University, Munich, Germany
- Corresponding author. R4D International, Opposite Fokou Mendong, PO.BoX: 30883, Yaounde, Cameroon.
| | - D.N. Nsame
- Abong-Mbang District Hospital, Abong-Mbang, Cameroon
- Limbe Regional Hospital, Limbe, Cameroon
| | - P.B. Kuwoh
- Limbe Regional Hospital, Limbe, Cameroon
| | | | - I. Sieleunou
- Research for Development International (R4D International), Yaoundé, Cameroon
- School of Public Health, University of Montreal, Montreal, Canada
| | - J.J.N. Ndenkeh
- Research for Development International (R4D International), Yaoundé, Cameroon
- Center for International Health (CIH), Ludwig-Maximilians-University, Munich, Germany
| | - G. Tene
- Research for Development International (R4D International), Yaoundé, Cameroon
| | - P. Memiah
- Division of Epidemiology and Prevention, University of Maryland School of Medicine, Baltimore, USA
| | - C. Kuaban
- Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - M. Beissner
- Center for International Health (CIH), Ludwig-Maximilians-University, Munich, Germany
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7
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Yindom LM, Simms V, Majonga ED, McHugh G, Dauya E, Bandason T, Vincon H, Rylance J, Munyati S, Ferrand RA, Rowland-Jones SL. Unexpectedly High Prevalence of Cytomegalovirus DNAemia in Older Children and Adolescents With Perinatally Acquired Human Immunodeficiency Virus Infection. Clin Infect Dis 2020; 69:580-587. [PMID: 30828710 PMCID: PMC6669294 DOI: 10.1093/cid/ciy961] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Indexed: 12/12/2022] Open
Abstract
Background Older children and adolescents with perinatally acquired human immunodeficiency virus (PHIV) infection in Africa experience multiple comorbidities that are not typical of HIV-associated opportunistic infections, including growth impairment and chronic lung disease. We examined associations between plasma cytomegalovirus (CMV) DNA and lung function and growth. Methods Plasma CMV DNA loads were measured children aged 6–16 years with PHIV (n = 402) and HIV-uninfected controls (n = 224). The HIV-infected children were either newly diagnosed or known HIV infected and stable on antiretroviral therapy (ART) for >6 months. CMV DNA loads were measured using quantitative polymerase chain reaction. CMV DNAemia was modeled as a time-varying outcome using longitudinal mixed-effects logistic regression. Results At enrollment, CMV DNAemia ≥1000 copies/mL (defined as “clinically significant”) was detected in 5.8% of uninfected children, 14.7% of HIV-infected participants stable on ART, and 22.6% of HIV-infected ART-naive children (χ2 = 23.8, P < .001). The prevalence of CMV DNAemia ≥1000 copies/mL was associated with CD4 counts <350 cells/µL. Among HIV-infected ART-naive children, the presence of CMV DNAemia of ≥1000 copies/mL was independently associated with reduced lung function (adjusted odds ratio [aOR] = 3.23; 95% confidence interval [CI], 1.23–8.46; P = .017). Among ART-treated children, stunting was associated with CMV DNAemia of ≥1000 copies/mL (aOR = 2.79; 95% CI, 0.97–8.02; P = .057). Conclusions Clinically significant levels of CMV DNAemia were common in older children with PHIV, even those on ART, suggesting a role for inadequately controlled CMV infection in the pathogenesis of PHIV comorbidities in Africa.
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Affiliation(s)
| | - Victoria Simms
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Edith D Majonga
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, United Kingdom.,Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Grace McHugh
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, United Kingdom.,Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Helene Vincon
- University of Oxford, Nuffield Department of Medicine, United Kingdom
| | - Jamie Rylance
- Department of Clinical Research, Liverpool School of Tropical Medicine, United Kingdom
| | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rashida A Ferrand
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, United Kingdom.,Biomedical Research and Training Institute, Harare, Zimbabwe
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8
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Haider MR, Brown MJ, Karim S, Siddiqi KA, Olatosi B, Li X. Factors associated with self-reported HIV testing in the Dominican Republic. Int J STD AIDS 2020; 31:560-567. [PMID: 32281487 PMCID: PMC7269088 DOI: 10.1177/0956462420913443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Human immunodeficiency virus (HIV) testing is important for controlling the epidemic in low- and middle-income countries such as the Dominican Republic (DR) – a country in the Caribbean. This study aimed to examine factors associated with HIV testing in the DR. The study used HIV test data in the 2013 DR Demographic and Health Survey. HIV data were collected from 18,614 individuals aged 15–59 years. Wealth status, HIV-related stigma, and knowledge scales were constructed using factor analysis. Survey-weighted logistic regression was used to identify correlates of HIV testing in the DR. Results show that almost two-thirds (62.4%) of the participants reported ever having an HIV test. In the multivariable analysis, older age, higher education, female gender, richest wealth status, health insurance, married, higher HIV-knowledge, and lower HIV-related stigma increased the likelihood of getting an HIV test in the DR. People living in Norte/Cibao, which had a higher HIV prevalence, had a lower chance of having an HIV test than people living in the Este/Sureste region. Although HIV testing has increased in recent times, it is not yet satisfactory in the DR. Specific interventions building HIV awareness targeting specific sub-populations and regions will increase knowledge on HIV and reduce HIV-related stigma, and may increase HIV testing.
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Affiliation(s)
- Mohammad R Haider
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Monique J Brown
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sabrina Karim
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Khairul A Siddiqi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Health, Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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9
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Kizito S, Katamba A, Marquez C, Turimumahoro P, Ayakaka I, Davis JL, Cattamanchi A. Quality of care in childhood tuberculosis diagnosis at primary care clinics in Kampala, Uganda. Int J Tuberc Lung Dis 2019; 22:1196-1202. [PMID: 30236188 DOI: 10.5588/ijtld.18.0043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To assess the quality of routine childhood tuberculosis (TB) evaluation in Kampala, Uganda. SETTING AND DESIGN This was a cross-sectional study of children aged <15 years attending six government-run clinics from November 2015 to December 2016. Clinicians completed a standardized patient record form for all child visits. We assessed the following performance indicators of TB evaluation developed based on the Desk Guide of the International Union Against Tuberculosis and Lung Disease, an evidence-based decision aid on childhood TB diagnosis and management for clinicians: proportion screened for TB symptoms or contact history, proportion referred for laboratory evaluation if screen-positive, and proportion treated for TB if test-positive or meeting clinical criteria. RESULTS Of 24 566 consecutive children enrolled, 11 614 (47%) were fully screened for TB symptoms. Of 1747 (15%) children who screened positive, 360 (21%) had sputum examined, including 159 (44%) using smear microscopy, 244 (67%) using Xpert® MTB/RIF, and 52 (14%) using both techniques. Treatment was initiated in 18/20 (80%) children who tested positive. An additional 65 screen-positive children met the clinical criteria for TB; none were initiated on treatment. CONCLUSIONS Large gaps exist along the pathway to diagnosis and treatment of childhood TB. There is an urgent need for enhanced implementation of evidence-based approaches to TB diagnosis to improve outcomes in childhood TB.
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Affiliation(s)
- S Kizito
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - A Katamba
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - C Marquez
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California
| | - P Turimumahoro
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - I Ayakaka
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - J L Davis
- Pulmonary, Critical Care, & Sleep Medicine Section, School of Medicine and Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
| | - A Cattamanchi
- Division of Pulmonary and Critical Care Medicine and Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, and Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA
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Bochner AF, Tippett Barr BA, Makunike B, Gonese G, Wazara B, Mashapa R, Meacham E, Nyika P, Ncube G, Balachandra S, Levine R, Petracca F, Apollo T, Downer A, Wiktor SZ. Strengthening provider-initiated testing and counselling in Zimbabwe by deploying supplemental providers: a time series analysis. BMC Health Serv Res 2019; 19:351. [PMID: 31159809 PMCID: PMC6547585 DOI: 10.1186/s12913-019-4169-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 05/20/2019] [Indexed: 11/16/2022] Open
Abstract
Background Expansion of provider-initiated testing and counselling (PITC) is one strategy to increase accessibility of HIV testing services. Insufficient human resources was identified as a primary barrier to increasing PITC coverage in Zimbabwe. We evaluated if deployment of supplemental PITC providers at public facilities in Zimbabwe was associated with increased numbers of individuals tested and diagnosed with HIV. Methods From July 2016 to May 2017, International Training and Education Center for Health (I-TECH) deployed 138 PITC providers to supplement existing ministry healthcare workers offering PITC at 249 facilities. These supplemental providers were assigned to facilities on a weekly basis. Each week, I-TECH providers reported the number of HIV tests and positive diagnoses they performed. Using routine reporting systems, we obtained from each facility the number of clients tested and diagnosed with HIV per month. Including data both before and during the intervention period, and utilizing the weekly variability in placement locations of the supplemental PITC providers, we employed generalized estimating equations to assess if the placement of supplemental PITC providers at a facility was associated with a change in facility outputs. Results Supplemental PITC providers performed an average of 62 (SD = 52) HIV tests per week and diagnosed 4.4 (SD = 4.9) individuals with HIV per week. However, using facility reports from the same period, we found that each person-week of PITC provider deployment at a facility was associated with an additional 16.7 (95% CI, 12.2–21.1) individuals tested and an additional 0.9 (95% CI, 0.5–1.2) individuals diagnosed with HIV. We also found that staff placement at clinics was associated with a larger increase in HIV testing than staff placement at polyclinics or hospitals (24.0 vs. 9.8; p < 0.001). Conclusions This program resulted in increased numbers of individuals tested and diagnosed with HIV. The discrepancy between the average weekly HIV tests conducted by supplemental PITC providers (62) and the increase in facility-level HIV tests associated with one week of PITC provider deployment (16.7) suggests that supplemental PITC providers displaced existing staff who may have been reassigned to fulfil other duties at the facility.
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Affiliation(s)
- Aaron F Bochner
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA. .,Department of Epidemiology, University of Washington, 325 9th Ave, Box 359932, Seattle, WA, 98104, USA.
| | | | - Batsirai Makunike
- International Training and Education Center for Health (I-TECH), Harare, Zimbabwe
| | - Gloria Gonese
- International Training and Education Center for Health (I-TECH), Harare, Zimbabwe
| | - Blessing Wazara
- International Training and Education Center for Health (I-TECH), Harare, Zimbabwe
| | - Richard Mashapa
- International Training and Education Center for Health (I-TECH), Harare, Zimbabwe
| | - Elizabeth Meacham
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA
| | - Ponesai Nyika
- U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | | | | | - Ruth Levine
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA
| | - Frances Petracca
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Ann Downer
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA
| | - Stefan Z Wiktor
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA
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Yumo HA, Ajeh RA, Beissner M, Ndenkeh JN, Sieleunou I, Jordan MR, Sam-Agudu NA, Kuaban C. Effectiveness of symptom-based diagnostic HIV testing versus targeted and blanket provider-initiated testing and counseling among children and adolescents in Cameroon. PLoS One 2019; 14:e0214251. [PMID: 31059507 PMCID: PMC6502453 DOI: 10.1371/journal.pone.0214251] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/08/2019] [Indexed: 12/17/2022] Open
Abstract
Objectives The concurrent implementation of targeted (tPITC) and blanket provider-initiated testing and counselling (bPITC) is recommended by the World Health Organization (WHO) for HIV case-finding in generalized HIV epidemics. This study assessed the effectiveness of this intervention compared to symptom-based diagnostic HIV testing (DHT) in terms of HIV testing uptake, case detection and antiretroviral therapy (ART) enrollment among children and adolescents in Cameroon, where estimated HIV prevalence is relatively low at 3.7%. Methods In three hospitals where DHT was the standard practice before, tPITC and bPITC were implemented by inviting HIV-positive parents in care at the ART clinics to have their biological children (6 weeks-19 years) tested for HIV (tPITC). Concurrently, at the outpatient departments, similarly-age children/adolescents were systematically offered HIV testing via accompanying parents/guardians. The mean monthly number of children tested for HIV, identified HIV-positive and ART-enrolled were used to compare the outcomes of different HIV testing strategies before and after the intervention. Results In comparing DHT to bPITC, there was a significant increase in the mean monthly number of children/adolescents tested for HIV (223.0 vs 348.3, p = 0.0073), but with no significant increase in the mean monthly number of children/adolescents: testing HIV-positive (10.5 vs 9.7, p = 0.7574) and ART- enrolled (7.3 vs 6.3, p = 0.5819). In comparing DHT to tPITC, there was no significant difference in the mean monthly number of children/adolescents: tested for HIV (223 vs 193.8, p = 0.4648); tested HIV-positive (10.5 vs 10.6, p = 0.9544), and ART-enrolled (7.3 vs 5.8, p = 0.4672). When comparing DHT versus bPITC+tPITC, there was a significant increase in the mean monthly number of children/adolescents: tested for HIV (223.0 to 542.2, p<0.0001), testing HIV-positive (10.5 vs 20.3, p = 0.0256), and ART-enrolled (7.3 vs 12.2, p = 0.0388). Conclusions These findings suggest that concurrent implementation of bPITC+tPITC was more effective compared to DHT in terms of HIV testing uptake, case detection and ART enrolment. However, considering that DHT and bPITC had comparable outcomes with regards to case detection and ART enrolment, bPITC+tPITC may not be efficient. Thus, this finding does not support concurrent bPITC+tPITC implementation as recommended by WHO. Rather, continued DHT+tPITC could effectively and efficiently accelerate HIV case detection and ART coverage among children and adolescents in Cameroon and similar low-prevalence context.
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Affiliation(s)
- Habakkuk A. Yumo
- R4D International Foundation, Yaoundé, Cameroon
- Center for International Health, Ludwig-Maximilians-Universität of Munich, Munich Germany
- * E-mail:
| | - Rogers A. Ajeh
- R4D International Foundation, Yaoundé, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Marcus Beissner
- Center for International Health, Ludwig-Maximilians-Universität of Munich, Munich Germany
| | - Jackson N. Ndenkeh
- R4D International Foundation, Yaoundé, Cameroon
- Center for International Health, Ludwig-Maximilians-Universität of Munich, Munich Germany
| | - Isidore Sieleunou
- R4D International Foundation, Yaoundé, Cameroon
- School of Public Health, University of Montreal, Montreal, Canada
| | - Michael R. Jordan
- Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Nadia A. Sam-Agudu
- Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, United States of America
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12
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Barriers to, and emerging strategies for, HIV testing among adolescents in sub-Saharan Africa. Curr Opin HIV AIDS 2019; 13:257-264. [PMID: 29401121 DOI: 10.1097/coh.0000000000000452] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW HIV/AIDS is one of the leading causes of death among adolescents in sub-Saharan Africa and 40% of new HIV infections worldwide occur in this group. HIV testing and counselling (HTC) is the critical first step to accessing HIV treatment. The prevalence of undiagnosed HIV infection is substantially higher in adolescents compared with adults. We review barriers to HTC for adolescents and emerging HTC strategies appropriate to adolescents in sub-Saharan Africa. RECENT FINDINGS There are substantial individual, health system and legal barriers to HTC among adolescents, and stigma by providers and communities remains an important obstacle. There has been progress made in recent years in developing strategies that address some of these barriers, increase uptake of HTC and yield of HIV. These include targeted approaches focused on provision of HTC among those higher risk of being infected, for example, index-linked HTC and use of screening tools to identify those at risk of HIV. Community-based HIV-testing approaches including HIV self-testing and incentives have also been shown to increase uptake of HTC. SUMMARY In implementing HTC strategies, consideration must be given to scalability and cost-effectiveness. HTC approaches must be coupled with linkage to appropriate care and prevention services.
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Abstract
The acceptability of financial incentives for pediatric HIV testing was evaluated in Kenya. Sixty HIV-positive women with children of unknown status were randomized to receive $5, $10 or $15 conditional upon HIV testing. Forty-four (73%) completed child testing, with similar rates across arms. Uptake was significantly higher than a cohort with similar procedures but no incentives (73% vs. 14%, P < 0.001).
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Kidia K, Machando D, Mangezi W, Hendler R, Crooks M, Abas M, Chibanda D, Thornicroft G, Semrau M, Jack H. Mental health in Zimbabwe: a health systems analysis. Lancet Psychiatry 2017. [PMID: 28625876 DOI: 10.1016/s2215-0366(17)30128-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There has been little external analysis of Zimbabwe's mental health system. We did a systems analysis to identify bottlenecks and opportunities for mental health service improvement in Zimbabwe and to generate cost-effective, policy-relevant solutions. We combined in-depth interviews with a range of key stakeholders in health and mental health, analysis of mental health laws and policies, and publicly available data about mental health. Five themes are key to mental health service delivery in Zimbabwe: policy and law; financing and resources; criminal justice; workforce, training, and research; and beliefs about mental illness. We identified human resources, rehabilitation facilities, psychotropic medication, and community mental health as funding priorities. Moreover, we found that researchers should prioritise measuring the economic impact of mental health and exploring substance use, forensic care, and mental health integration. Our study highlights forensic services as a central component of the mental health system, which has been a neglected concept. We also describe a tailored process for mental health systems that is transferable to other low-income settings and that garners political will, builds capacity, and raises the profile of mental health.
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Affiliation(s)
- Khameer Kidia
- Kushinga, Harare, Zimbabwe; Arnhold Institute for Global Health, Icahn School of Medicine, New York, NY, USA.
| | | | - Walter Mangezi
- Department of Psychiatry, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Reuben Hendler
- Kushinga, Harare, Zimbabwe; Arnhold Institute for Global Health, Icahn School of Medicine, New York, NY, USA
| | - Megan Crooks
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Melanie Abas
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dixon Chibanda
- Department of Psychiatry, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Maya Semrau
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Helen Jack
- Kushinga, Harare, Zimbabwe; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Harvard Medical School, Boston, MA, USA
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Hickey MD, Odeny TA, Petersen M, Neilands TB, Padian N, Ford N, Matthay Z, Hoos D, Doherty M, Beryer C, Baral S, Geng EH. Specification of implementation interventions to address the cascade of HIV care and treatment in resource-limited settings: a systematic review. Implement Sci 2017; 12:102. [PMID: 28784155 PMCID: PMC5547499 DOI: 10.1186/s13012-017-0630-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 07/17/2017] [Indexed: 01/23/2023] Open
Abstract
Background The global response to HIV has started over 18 million persons on life-saving antiretroviral therapy (ART)—the vast majority in low- and middle-income countries (LMIC)—yet substantial gaps remain: up to 40% of persons living with HIV (PLHIV) know their status, while another 30% of those who enter care are inadequately retained after starting treatment. Identifying strategies to enhance use of treatment is urgently needed, but the conceptualization and specification of implementation interventions is not always complete. We sought to assess the completeness of intervention reporting in research to advance uptake of treatment for HIV globally. Methods We carried out a systematic review to identify interventions targeting the adult HIV care cascade in LMIC dating from 1990 to 2017. We identified components of each intervention as “intervention types” to decompose interventions into common components. We grouped “intervention types” into a smaller number of more general “implementation approaches” to aid summarization. We assessed the reporting of six intervention characteristics adapted from the implementation science literature: the actor, action, action dose, action temporality, action target, and behavioral target in each study. Findings In 157 unique studies, we identified 34 intervention “types,” which were empirically grouped into six generally understandable “approaches.” Overall, 42% of interventions defined the actor, 64% reported the action, 41% specified the intervention “dose,” 43% reported action temporality, 61% defined the action target, and 69% reported a target behavior. Average completeness of reporting varied across approaches from a low of 50% to a high of 72%. Dimensions that involved conceptualization of the practices themselves (e.g., actor, dose, temporality) were in general less well specified than consequences (e.g., action target and behavioral target). Implications The conceptualization and Reporting of implementation interventions to advance treatment for HIV in LMIC is not always complete. Dissemination of standards for reporting intervention characteristics can potentially promote transparency, reproducibility, and scientific accumulation in the area of implementation science to address HIV in low- and middle-income countries. Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0630-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthew D Hickey
- Division of General Internal Medicine, San Francisco General Hospital, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | | | - Maya Petersen
- Department of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Department of Medicine, UCSF, San Francisco, CA, USA
| | - Nancy Padian
- Department of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Nathan Ford
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | | | - David Hoos
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Meg Doherty
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Chris Beryer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elvin H Geng
- Division of ID HIV and Global Medicine, San Francisco General Hospital, Department of Medicine, UCSF, Building 80, 6th Floor, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.
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Community burden of undiagnosed HIV infection among adolescents in Zimbabwe following primary healthcare-based provider-initiated HIV testing and counselling: A cross-sectional survey. PLoS Med 2017; 14:e1002360. [PMID: 28742829 PMCID: PMC5526522 DOI: 10.1371/journal.pmed.1002360] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/16/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Children living with HIV who are not diagnosed in infancy often remain undiagnosed until they present with advanced disease. Provider-initiated testing and counselling (PITC) in health facilities is recommended for high-HIV-prevalence settings, but it is unclear whether this approach is sufficient to achieve universal coverage of HIV testing. We aimed to investigate the change in community burden of undiagnosed HIV infection among older children and adolescents following implementation of PITC in Harare, Zimbabwe. METHODS AND FINDINGS Over the course of 2 years (January 2013-January 2015), 7 primary health clinics (PHCs) in southwestern Harare implemented optimised, opt-out PITC for all attendees aged 6-15 years. In February 2015-December 2015, we conducted a representative cross-sectional survey of 8-17-year-olds living in the 7 communities served by the study PHCs, who would have had 2 years of exposure to PITC. Knowledge of HIV status was ascertained through a caregiver questionnaire, and anonymised HIV testing was carried out using oral mucosal transudate (OMT) tests. After 1 participant taking antiretroviral therapy was observed to have a false negative OMT result, from July 2015 urine samples were obtained from all participants providing OMTs and tested for antiretroviral drugs to confirm HIV status. Children who tested positive through PITC were identified from among survey participants using gender, birthdate, and location. Of 7,146 children in 4,251 eligible households, 5,486 (76.8%) children in 3,397 households agreed to participate in the survey, and 141 were HIV positive. HIV prevalence was 2.6% (95% CI 2.2%-3.1%), and over a third of participants with HIV were undiagnosed (37.7%; 95% CI 29.8%-46.2%). Similarly, among the subsample of 2,643 (48.2%) participants with a urine test result, 34.7% of those living with HIV were undiagnosed (95% CI 23.5%-47.9%). Based on extrapolation from the survey sample to the community, we estimated that PITC over 2 years identified between 18% and 42% of previously undiagnosed children in the community. The main limitation is that prevalence of undiagnosed HIV was defined using a combination of 3 measures (OMT, self-report, and urine test), none of which were perfect. CONCLUSIONS Facility-based approaches are inadequate in achieving universal coverage of HIV testing among older children and adolescents. Alternative, community-based approaches are required to meet the Joint United Nations Programme on HIV/AIDS (UNAIDS) target of diagnosing 90% of those living with HIV by 2020 in this age group.
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17
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Ahmed S, Sabelli RA, Simon K, Rosenberg NE, Kavuta E, Harawa M, Dick S, Linzie F, Kazembe PN, Kim MH. Index case finding facilitates identification and linkage to care of children and young persons living with HIV/AIDS in Malawi. Trop Med Int Health 2017; 22:1021-1029. [PMID: 28544728 PMCID: PMC5575466 DOI: 10.1111/tmi.12900] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Evaluation of a novel index case finding and linkage-to-care programme to identify and link HIV-infected children (1-15 years) and young persons (>15-24 years) to care. METHODS HIV-infected patients enrolled in HIV services were screened and those who reported untested household members (index cases) were offered home- or facility-based HIV testing and counselling (HTC) of their household by a community health worker (CHW). HIV-infected household members identified were enrolled in a follow-up programme offering home and facility-based follow-up by CHWs. RESULTS Of the 1567 patients enrolled in HIV services, 1030 (65.7%) were screened and 461 (44.8%) identified as index cases; 93.5% consented to HIV testing of their households and of those, 279 (64.7%) reported an untested child or young person. CHWs tested 711 children and young persons, newly diagnosed 28 HIV-infected persons (yield 4.0%; 95% CI: 2.7-5.6), and identified an additional two HIV-infected persons not enrolled in care. Of the 30 HIV-infected persons identified, 23 (76.6%) were linked to HIV services; 18 of the 20 eligible for ART (90.0%) were initiated. Median time (IQR) from identification to enrolment into HIV services was 4 days (1-8) and from identification to ART start was 6 days (1-8). CONCLUSIONS Almost half of HIV-infected patients enrolled in treatment services had untested household members, many of whom were children and young persons. Index case finding, coupled with home-based testing and tracked follow-up, is acceptable, feasible and facilitates the identification and timely linkage to care of HIV-infected children and young persons.
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Affiliation(s)
- Saeed Ahmed
- Abbott Fund Children's Clinical Center of Excellence, Baylor College of Medicine, Lilongwe, Malawi.,Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Rachael A Sabelli
- Abbott Fund Children's Clinical Center of Excellence, Baylor College of Medicine, Lilongwe, Malawi
| | - Katie Simon
- Abbott Fund Children's Clinical Center of Excellence, Baylor College of Medicine, Lilongwe, Malawi.,Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | | | - Elijah Kavuta
- Abbott Fund Children's Clinical Center of Excellence, Baylor College of Medicine, Lilongwe, Malawi
| | - Mwelura Harawa
- Abbott Fund Children's Clinical Center of Excellence, Baylor College of Medicine, Lilongwe, Malawi
| | - Spencer Dick
- Abbott Fund Children's Clinical Center of Excellence, Baylor College of Medicine, Lilongwe, Malawi
| | | | - Peter N Kazembe
- Abbott Fund Children's Clinical Center of Excellence, Baylor College of Medicine, Lilongwe, Malawi.,Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Maria H Kim
- Abbott Fund Children's Clinical Center of Excellence, Baylor College of Medicine, Lilongwe, Malawi.,Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Implementation and Operational Research: Active Referral of Children of HIV-Positive Adults Reveals High Prevalence of Undiagnosed HIV. J Acquir Immune Defic Syndr 2017; 73:e83-e89. [PMID: 27846074 DOI: 10.1097/qai.0000000000001184] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Few routine systems exist to test older, asymptomatic children for HIV. Testing all children in the population has high uptake but is inefficient, whereas testing only symptomatic children increases efficiency but misses opportunities to optimize outcomes. Testing children of HIV-infected adults in care may efficiently identify previously undiagnosed HIV-infected children before symptomatic disease. METHODS HIV-infected parents in HIV care in Nairobi, Kenya were systematically asked about their children's HIV status and testing history. Adults with untested children ≤12 years old were actively referred and offered the choice of pediatric HIV testing at home or clinic. Testing uptake and HIV prevalence were determined, as were bottlenecks in pediatric HIV testing cascade. RESULTS Of 10,426 HIV-infected adults interviewed, 8,287 reported having children, of whom 3,477 (42%) had children of unknown HIV status, and 611 (7%) had children ≤12 years of unknown HIV status. After implementation of active referral, the rate of pediatric HIV testing increased 3.8-fold from 3.5 to 13.6 children tested per month (Relative risk: 3.8, 95% confidence interval: 2.3 to 6.1). Of 611 eligible adults, 279 (48%) accepted referral and were screened, and 74 (14%) adults completed testing of 1 or more children. HIV prevalence among 108 tested children was 7.4% (95% confidence interval: 3.3 to 14.1%) and median age was 8 years (interquartile range: 2-11); 1 child was symptomatic at testing. CONCLUSIONS Referring HIV-infected parents in care to have their children tested revealed many untested children and significantly increased the rate of pediatric testing; prevalence of HIV was high. However, despite increases in pediatric testing, most adults did not complete testing of their children.
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Takarinda KC, Harries AD, Mutasa-Apollo T. Critical considerations for adopting the HIV 'treat all' approach in Zimbabwe: is the nation poised? Public Health Action 2016; 6:3-7. [PMID: 27051603 DOI: 10.5588/pha.15.0072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 01/14/2016] [Indexed: 12/31/2022] Open
Abstract
While the advent of antiretroviral therapy (ART) has increased survival and reduced the number of acquired immune-deficiency syndrome (AIDS) related deaths among people living with the human immunodeficiency virus (HIV) virus (PLHIV), HIV/AIDS remains a global health problem and sub-Saharan Africa continues to bear the greatest burden of disease. There are also major challenges in the HIV response: as of December 2013, only 36% of PLHIV globally were on ART, and for every individual started on ART there were two new PLHIV diagnosed. This has led to considerable debate around adopting an HIV 'treat all' approach aimed at greatly escalating the number of PLHIV initiated and retained on ART, regardless of CD4 cell count or World Health Organization (WHO) clinical stage, with the intended goal of achieving viral suppression which should in turn reduce HIV transmission, morbidity and mortality in affected individuals. This paper examines the issues being discussed in Zimbabwe, a low-income country with a high burden of HIV/AIDS, about the implications and opportunities of adopting an HIV 'treat all' approach, along with pertinent operational research questions that need to be answered to move the agenda forward. These discussions are timely, given the recent WHO recommendations advising ART for all PLHIV, regardless of CD4 cell count.
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Affiliation(s)
- K C Takarinda
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe ; Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A D Harries
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France ; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - T Mutasa-Apollo
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
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