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Cholette F, Lazarus L, Macharia P, Walimbwa J, Kuria S, Bhattacharjee P, Musyoki H, Mugambi M, Ongaro MK, Olango K, Musimbi J, Emmanuel F, Isac S, Pickles M, Becker ML, Mishra S, McKinnon LR, Blanchard J, Ho J, Henry O, Fabia R, Sandstrom P, Lorway R, Shaw SY. HIV phylogenetic clusters point to unmet hiv prevention, testing and treatment needs among men who have sex with men in kenya. BMC Infect Dis 2024; 24:1323. [PMID: 39567884 PMCID: PMC11580190 DOI: 10.1186/s12879-024-10052-5] [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: 07/09/2024] [Accepted: 10/03/2024] [Indexed: 11/22/2024] Open
Abstract
BACKGROUND The HIV epidemic in Kenya remains a significant public health concern, particularly among gay, bisexual, and other men who have sex with men (GBMSM), who continue to bear a disproportionate burden of the epidemic. This study's objective is to describe HIV phylogenetic clusters among different subgroups of Kenyan GBMSM, including those who use physical hotspots, virtual spaces, or a combination of both to find male sexual partners. METHODS Dried blood spots (DBS) were collected from GBMSM in Kisumu, Mombasa, and Kiambu counties, Kenya, in 2019 (baseline) and 2020 (endline). HIV pol sequencing was attempted on all seropositive DBS. HIV phylogenetic clusters were inferred using a patristic distance cutoff of ≤ 0.02 nucleotide substitutions per site. We used descriptive statistics to analyze sociodemographic characteristics and risk behaviors stratified by clustering status. RESULTS Of the 2,450 participants (baseline and endline), 453 (18.5%) were living with HIV. Only a small proportion of seropositive DBS specimens were successfully sequenced (n = 36/453; 7.9%), likely due to most study participants being virally suppressed (87.4%). Among these sequences, 13 (36.1%) formed eight distinct clusters comprised of seven dyads and one triad. The clusters mainly consisted of GBMSM seeking partners online (n = 10/13; 76.9%) and who tested less frequently than recommended by Kenyan guidelines (n = 11/13; 84.6%). CONCLUSIONS Our study identified HIV phylogenetic clusters among Kenyan GBMSM who predominantly seek sexual partners online and test infrequently. These findings highlight potential unmet HIV prevention, testing, and treatment needs within this population. Furthermore, these results underscore the importance of tailoring HIV programs to address the diverse needs of GBMSM in Kenya across different venues, including both physical hotspots and online platforms, to ensure comprehensive prevention and care strategies.
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Affiliation(s)
- François Cholette
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at J.C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada.
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada.
| | - Lisa Lazarus
- Institute for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Pascal Macharia
- Health Options for Young Men On HIV/AIDS and STIs, Nairobi, Kenya
| | | | | | - Parinita Bhattacharjee
- Institute for Global Public Health, University of Manitoba, Winnipeg, Canada
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Helgar Musyoki
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Mary Mugambi
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | | | | | - Janet Musimbi
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Faran Emmanuel
- Institute for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Shajy Isac
- Institute for Global Public Health, University of Manitoba, Winnipeg, Canada
- India Health Action Trust, New Delhi, India
| | - Michael Pickles
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Marissa L Becker
- Institute for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Lyle R McKinnon
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - James Blanchard
- Institute for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - John Ho
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at J.C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Omari Henry
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at J.C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Rissa Fabia
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at J.C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Paul Sandstrom
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at J.C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Robert Lorway
- Institute for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Souradet Y Shaw
- Institute for Global Public Health, University of Manitoba, Winnipeg, Canada
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Kemp CG, Edwards AJ, White L, Kore G, Thurman PJ, Gaines T, King PT, Cole M, Orellana ER. Implementation Science for HIV Prevention and Treatment in Indigenous Communities: a Systematic Review and Commentary. Curr HIV/AIDS Rep 2024; 21:237-256. [PMID: 39120668 PMCID: PMC11377631 DOI: 10.1007/s11904-024-00706-z] [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] [Accepted: 07/19/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE OF REVIEW We systematically reviewed implementation research conducted in Indigenous communities in the Americas and the Pacific that focused on improving delivery of HIV preventive or treatment services. We highlight strengths and opportunities in the literature and outline principles for Indigenous-led, HIV-related implementation science. RECENT FINDINGS We identified 31 studies, revealing a consistent emphasis on cultural tailoring of services to Indigenous communities. Common barriers to implementation included stigma, geographic limitations, confidentiality concerns, language barriers, and mistrust. Community involvement in intervention development and delivery emerged as a key facilitator, and nearly half of the studies used community-based participatory research methods. While behavioral HIV prevention, especially among Indigenous youth, was a major focus, there was limited research on biomedical HIV prevention and treatment. No randomized implementation trials were identified. The findings underscore the importance of community engagement, the need for interventions developed within Indigenous communities rather than merely adapted, and the value of addressing the social determinants of implementation success. Aligned to these principles, an indigenized implementation science could enhance the acceptability and reach of critical HIV preventive and treatment services in Indigenous communities while also honoring their knowledge, wisdom, and strength.
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Affiliation(s)
- Christopher G Kemp
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Abagail J Edwards
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lauren White
- Joint Program for Social Work and Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Gauri Kore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Tommi Gaines
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Paula Toko King
- Te Rōpū Rangahau Hauora a Eru Pōmare, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Marama Cole
- Te Rōpū Rangahau Hauora a Eru Pōmare, Department of Public Health, University of Otago, Wellington, New Zealand
| | - E Roberto Orellana
- Indigenous Wellness Research Institute, University of Washington, Seattle, WA, USA
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Cholette F, Périnet S, Neufeld B, Bryson M, Macri J, Sibley KM, Kim J, Driedger SM, Becker ML, Sandstrom P, Meyers AFA, Paquette D. Validity of dried blood spot testing for sexually transmitted and blood-borne infections: A narrative systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003320. [PMID: 38875246 PMCID: PMC11178196 DOI: 10.1371/journal.pgph.0003320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 05/15/2024] [Indexed: 06/16/2024]
Abstract
Testing for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) using dried blood spot (DBS) specimens has been an integral part of bio-behavioural surveillance in Canada for almost two decades, though less is known regarding the use of DBS in surveillance of other sexually transmitted and blood-borne infections (STBBI). A systematic review was conducted using a peer-reviewed search strategy to assess the current evidence regarding the validity of STBBI testing using DBS specimens. Eligibility criteria included studies reporting use of DBS specimens for STBBI testing with either commercially available or "in-house" tests in populations 15 years of age or older. Studies reporting a measure of validity such as sensitivity, specificity, positive and negative predictive values were eligible for inclusion. Quality of studies and risk of bias were assessed using the QUADAS-2 tool. A total of 7,132 records were identified. Of these, 174 met the criteria for inclusion. Among the studies that reported validity measures, a substantial proportion demonstrated high sensitivity (≥90%) in 62.5% of cases (N = 334/534 sensitivity measurements), and high specificity (≥90%) was observed in 84.9% of instances (N = 383/451 specificity measurements). However, the quality of the studies varied greatly. Our findings support the validity of the use of DBS specimens in STBBI testing where sufficient evidence was available, but validity is highly dependent on thorough method development and validation.
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Affiliation(s)
- François Cholette
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at the J. C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Simone Périnet
- Sexually Transmitted and Blood Borne Infection Surveillance Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Canada
| | - Bronwyn Neufeld
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at the J. C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Maggie Bryson
- Horizontal Surveillance Operations Division, Centre for Corporate Surveillance Coordination, Public Health Agency of Canada, Ottawa, Canada
| | - Jennifer Macri
- Public Health Data Science and Systems, Data Management, Innovation and Analytics, Public Health Agency of Canada, Ottawa, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - John Kim
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at the J. C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Marissa L Becker
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Paul Sandstrom
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at the J. C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Adrienne F A Meyers
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at the J. C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Office of Population and Public Health, Indigenous Services Canada, Ottawa, Canada
| | - Dana Paquette
- Horizontal Surveillance Operations Division, Centre for Corporate Surveillance Coordination, Public Health Agency of Canada, Ottawa, Canada
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Menza TW, Berry SA, Dombrowski JC, Cachay E, Crane HM, Mayer KH. Estimating the Proportion of People Living With HIV Who May Benefit From the Reverse Algorithm for the Diagnosis of Incident Syphilis. Sex Transm Dis 2024; 51:e26-e29. [PMID: 38733975 PMCID: PMC11090411 DOI: 10.1097/olq.0000000000001955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
ABSTRACT Among 8455 people engaged in HIV care in 4 US cities, 4925 (58%) had treponemal testing at care entry. Of the 4925 tested, 3795 (77%) had a nonreactive result and might benefit from the reverse algorithm for a future incident syphilis diagnosis. Furthermore, low-barrier treponemal testing as a first step in the reverse algorithm may increase syphilis screening and decrease time to treatment.
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Affiliation(s)
- Timothy W. Menza
- Oregon Health and Science University, Portland, Oregon, USA
- Oregon Health Authority, Portland, Oregon, USA
| | | | | | - Edward Cachay
- University of California – San Diego School of Medicine, San Diego, CA, USA
| | - Heidi M. Crane
- University of Washington School of Medicine, Seattle, WA, USA
| | - Kenneth H. Mayer
- Harvard Medical School, Boston, MA, USA
- Fenway Community Health Center, Boston, MA, USA
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Lafferty L, Beadman M, Ward J, Flynn E, Hosseini-Hooshyar S, Martinello M, Treloar C. Patient and healthcare provider perceptions of acceptability of fingerstick point-of-care hepatitis C testing at Aboriginal Community Controlled Health Services in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 125:104335. [PMID: 38342050 DOI: 10.1016/j.drugpo.2024.104335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/13/2023] [Accepted: 01/21/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Hepatitis C (HCV) is highly prevalent in First Nations communities globally. Barriers in the uptake of testing and treatment create challenges to realise elimination of HCV in these communities. In efforts to reduce barriers to testing and treatment, the SCALE-C study implemented an HCV test-and-treat intervention integrating point-of-care HCV testing and FibroScan®. SCALE-C was carried out at four Aboriginal Community Controlled Health Services (ACCHS; renowned for providing culturally safe care) in four regional towns in Australia. This qualitative analysis sought to understand healthcare provider and patient perceptions of acceptability of a community-based HCV test-and-treat intervention within ACCHS. METHODS Semi-structured interviews were undertaken with 23 patient participants and 14 healthcare personnel (including Aboriginal Health Workers/Practitioners, nurses, general practitioners, and practice managers) from across the four ACCHS involved in SCALE-C. A coding framework was developed among study authors and informed by Sekhon's Theoretical Framework of Acceptability. RESULTS The SCALE-C intervention enabled opportunities for healthcare providers to listen to patients, and for patients to feel heard (affective attitude). HCV testing was opportunistic and often occurred outside of the allocated SCALE-C clinical hours (burden). For patients, HCV testing within SCALE-C was viewed as a moral responsibility and ensured protection of self and others (ethicality). For personnel, SCALE-C (including following up visits) was regarded as an opportunity to engage with patients especially those with complex health needs which may be unrelated to HCV risk factors (ethicality). Patients and personnel widely regarded the SCALE-C intervention to be effective, and the test-and-treat model was preferable for both patients and personnel. CONCLUSION The SCALE-C intervention was broadly perceived to be acceptable among both healthcare providers and patients within ACCHS. Whilst the prioritisation of HCV was viewed as increasing patient engagement, it was also regarded as an opportunity for addressing other healthcare needs within Aboriginal communities. HCV test-and-treat models of care delivered by ACCHS simplify the HCV care pathway and ensure all HCV care is provided in a culturally safe setting (e.g., patients did not need to attend external services such as pathology).
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Affiliation(s)
- Lise Lafferty
- Centre for Social Research in Health, UNSW Sydney, Australia; The Kirby Institute, UNSW Sydney, Australia.
| | | | - James Ward
- Poche Centre for Indigenous Health, The University of Queensland, Toowong, Australia
| | - Erin Flynn
- Poche Centre for Indigenous Health, The University of Queensland, Toowong, Australia; Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | | | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Australia
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Gmitroski KL, Hastings KG, Legault G, Barbic S. Métis health in Canada: a scoping review of Métis-specific health literature. CMAJ Open 2023; 11:E884-E893. [PMID: 37788865 PMCID: PMC10558240 DOI: 10.9778/cmajo.20230006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Métis are a culturally unique and distinct population, yet little research has evaluated their health separate from the broader Indigenous population. We sought to explore current literature regarding the health of Métis Peoples in Canada and identify potential trends and gaps. METHODS Using the Arksey-O'Malley, 5-stage, scoping review method, we searched PubMed, MEDLINE, iPortal Indigenous Articles Portal Research Tool and pertinent reference lists using the terms "Métis," "health" and "Canada." Two reviewers conducted the initial searches independently, including English articles from 2012 to 2022, and focused on only Métis populations' health within Canada. We described characteristics of the articles and themes for discussion. RESULTS Of the 572 articles we identified, we included a total of 28 articles in this scoping review, of which 16 were quantitative, 9 were qualitative and 3 used mixed methods. Thirteen articles used consultation with Métis communities as part of their methods, and 8 extracted data from national surveys. One article focused on children, while all other articles focused on adults. Nine articles used data from across Canada, 6 were based in Ontario, 5 in Alberta and 4 each in British Columbia and Manitoba. Themes included health, well-being and spirituality; mental health and substance use; health conditions and risk factors; access to adequate health resources; and experiences in health care. INTERPRETATION Métis-specific health research is lacking in Canada, with a gap in volume, subject matter and diversity in the demographics studied. This review illustrates the need for more research with strong community engagement to further explore Métis health and health service needs.
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Affiliation(s)
- Krysta-Leigh Gmitroski
- Faculty of Medicine (Gmitroski, Barbic), and School of Population and Public Health (Hastings), University of British Columbia; Foundry (Hastings, Barbic), Vancouver, BC; Department of Community, Culture, and Global Studies (Legault), University of British Columbia Okanagan, Kelowna, BC; Department of Occupational Science and Occupational Therapy (Barbic), University of British Columbia; Providence Research (Barbic); Centre for Health Evaluation & Outcome Sciences (Barbic), Vancouver, BC
| | - Katherine G Hastings
- Faculty of Medicine (Gmitroski, Barbic), and School of Population and Public Health (Hastings), University of British Columbia; Foundry (Hastings, Barbic), Vancouver, BC; Department of Community, Culture, and Global Studies (Legault), University of British Columbia Okanagan, Kelowna, BC; Department of Occupational Science and Occupational Therapy (Barbic), University of British Columbia; Providence Research (Barbic); Centre for Health Evaluation & Outcome Sciences (Barbic), Vancouver, BC
| | - Gabrielle Legault
- Faculty of Medicine (Gmitroski, Barbic), and School of Population and Public Health (Hastings), University of British Columbia; Foundry (Hastings, Barbic), Vancouver, BC; Department of Community, Culture, and Global Studies (Legault), University of British Columbia Okanagan, Kelowna, BC; Department of Occupational Science and Occupational Therapy (Barbic), University of British Columbia; Providence Research (Barbic); Centre for Health Evaluation & Outcome Sciences (Barbic), Vancouver, BC
| | - Skye Barbic
- Faculty of Medicine (Gmitroski, Barbic), and School of Population and Public Health (Hastings), University of British Columbia; Foundry (Hastings, Barbic), Vancouver, BC; Department of Community, Culture, and Global Studies (Legault), University of British Columbia Okanagan, Kelowna, BC; Department of Occupational Science and Occupational Therapy (Barbic), University of British Columbia; Providence Research (Barbic); Centre for Health Evaluation & Outcome Sciences (Barbic), Vancouver, BC
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