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Dilixiati D, Waili A, Tuerxunmaimaiti A, Tao L, Zebibula A, Rexiati M. Risk factors for erectile dysfunction in diabetes mellitus: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1368079. [PMID: 38638136 PMCID: PMC11024441 DOI: 10.3389/fendo.2024.1368079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Background Previous studies have established that diabetes mellitus (DM) markedly raises the risk of developing erectile dysfunction (ED). Despite extensive investigations, the risk factors associated with ED in diabetic men have yet to be unequivocally determined, owing to incongruent and inconclusive results reported in various studies. Objective The objective of this systematic review and meta-analysis was to assess the risk factors for ED in men with DM. Methods A comprehensive systematic review was conducted, encompassing studies published in the PubMed, Scopus and Embase databases up to August 24th, 2023. All studies examining the risk factors of ED in patients with DM were included in the analysis. To identify significant variations among the risk factors, odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were employed. The risk of bias was evaluated using the Newcastle-Ottawa Scale(NOS) for longitudinal studies and the Agency for Healthcare Research and Quality Scale(AHRQ) for cross-sectional studies. Results A total of 58 studies, including a substantial participant pool of 66,925 individuals diagnosed with DM, both with or without ED, were included in the meta-analysis. Mean age (OR: 1.31, 95% CI=1.24-1.37), smoking status (OR: 1.32, 95% CI=1.18-1.47), HbA1C (OR: 1.44, 95% CI=1.28-1.62), duration of DM (OR: 1.39, 95% CI=1.29-1.50), diabetic neuropathy (OR: 3.47, 95% CI=2.16-5.56), diabetic retinopathy (OR: 3.01, 95% CI=2.02-4.48), diabetic foot (OR: 3.96, 95% CI=2.87-5.47), cardiovascular disease (OR: 1.92, 95% CI=1.71-2.16), hypertension (OR: 1.74, 95% CI=1.52-2.00), microvascular disease (OR: 2.14, 95% CI=1.61-2.85), vascular disease (OR: 2.75, 95% CI=2.35-3.21), nephropathy (OR: 2.67, 95% CI=2.06-3.46), depression (OR: 1.82, 95% CI=1.04-3.20), metabolic syndrome (OR: 2.22, 95% CI=1.98-2.49), and diuretic treatment (OR: 2.42, 95% CI=1.38-4.22) were associated with increased risk factors of ED in men with DM. Conclusion Our study indicates that in men with DM, several risk factors for ED have been identified, including mean age, HbA1C, duration of DM, diabetic neuropathy, diabetic retinopathy, diabetic foot, cardiovascular disease, hypertension, microvascular disease, vascular disease, nephropathy, depression, metabolic syndrome, and diuretic treatment. By clarifying the connection between these risk factors and ED, clinicians and scientific experts can intervene and address these risk factors, ultimately reducing the occurrence of ED and improving patient management.
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Affiliation(s)
- Diliyaer Dilixiati
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Alapati Waili
- Department of Pancreatic Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Aizihaier Tuerxunmaimaiti
- Department of Cardiac Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Liwen Tao
- Department of Pancreatic Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abudureheman Zebibula
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Mulati Rexiati
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Verstraeten R, Vos‐Seda AG, Boateng D, Scheuermaier K, Tempelman H, Barth RE, Devillé W, Coutinho RA, Venter F, Grobbee DE, Klipstein‐Grobusch K. No Evidence for an Association of HIV and Antiviral Treatment With Changes in Framingham Cardiovascular Risk Score in the Ndlovu Cohort Study. J Am Heart Assoc 2024; 13:e029637. [PMID: 38214319 PMCID: PMC10926821 DOI: 10.1161/jaha.123.029637] [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] [Received: 01/28/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND HIV and antiretroviral therapy (ART) have been associated with increased cardiovascular disease (CVD) risk in high-income countries. The authors studied the longitudinal association between HIV and ART and nonlaboratory Framingham Risk Score (FRS) in a middle-income country. METHODS AND RESULTS This longitudinal analysis of the NCS (Ndlovu Cohort Study), South Africa used baseline to 36-month follow-up data. Demographics, HIV, ART status, and cardiometabolic measures were obtained. FRS was used as a CVD risk measure. Through linear mixed models, FRS trends over time and the association with HIV were studied. Analysis included 1136 participants, with 609 (54%) having HIV, and 495 (81%) taking ART. At baseline, 9.8% of participants had a high FRS. People living with HIV (PLHIV) had a 3.2% lower FRS than HIV-negative participants (P<0.001). FRS increased similarly for both groups over time. Other factors associated with FRS were secondary and higher education (ß value: -0.075, P<0.001; ß value: -0.084, P<0.001) and alcohol consumption (ß value: 0.011, P<0.001). CONCLUSIONS CVD risk increased for all participants over 36 months, suggesting classic risk factors rather than HIV status or ART to be drivers of CVD risk. People living with HIV had a significantly lower FRS than their HIV-negative counterparts, possibly related to HIV itself or a more frequent interaction with healthcare services. No association of HIV and ART with changes in FRS over 36 months was observed, suggesting the need for research using clinical endpoints to elucidate the effects of HIV and ART on CVD risk. Population-based prevention of CVD risk factors in sub-Saharan Africa is warranted, regardless of HIV status.
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Affiliation(s)
- Rita Verstraeten
- Julius Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center, Utrecht UniversityUtrechtThe Netherlands
- BionamiX, Department of Data Analysis and Mathematical ModellingGhent UniversityGhentBelgium
| | - Alinda G. Vos‐Seda
- Julius Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center, Utrecht UniversityUtrechtThe Netherlands
- Ezintsha, Faculty of Health SciencesUniversity of WitwatersrandJohannesburgSouth Africa
| | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center, Utrecht UniversityUtrechtThe Netherlands
- School of Public HealthKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Karine Scheuermaier
- Julius Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center, Utrecht UniversityUtrechtThe Netherlands
- Wits Sleep Laboratory, Brain Function Research Group, School of Physiology, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | - Roos E. Barth
- Department of Infectious DiseaseUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Walter Devillé
- Julius Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center, Utrecht UniversityUtrechtThe Netherlands
| | - Roel A. Coutinho
- Julius Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center, Utrecht UniversityUtrechtThe Netherlands
- PharmAccess FoundationAmsterdamThe Netherlands
| | - Francois Venter
- Ezintsha, Faculty of Health SciencesUniversity of WitwatersrandJohannesburgSouth Africa
| | - Diederick E. Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center, Utrecht UniversityUtrechtThe Netherlands
| | - Kerstin Klipstein‐Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center, Utrecht UniversityUtrechtThe Netherlands
- Institute of Tropical Medicine, University of TübingenTübingenGermany
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
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Otieno P, Agyemang C, Wao H, Wambiya E, Ng'oda M, Mwanga D, Oguta J, Kibe P, Asiki G. Effectiveness of integrated chronic care models for cardiometabolic multimorbidity in sub-Saharan Africa: a systematic review and meta-analysis. BMJ Open 2023; 13:e073652. [PMID: 37369405 PMCID: PMC10410889 DOI: 10.1136/bmjopen-2023-073652] [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] [Received: 03/14/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES This review aimed at identifying the elements of integrated care models for cardiometabolic multimorbidity in sub-Saharan Africa (SSA) and their effects on clinical or mental health outcomes including systolic blood pressure (SBP), blood sugar, depression scores and other patient-reported outcomes such as quality of life and medication adherence. DESIGN Systematic review and meta-analysis using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach. DATA SOURCES We systematically searched PubMed, Embase, Scopus, Web of Science, Global Health CINAHL, African Journals Online, Informit, PsycINFO, ClinicalTrials.gov, Pan African Clinical Trials Registry and grey literature from OpenSIGLE for studies published between 1999 and 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included randomised controlled trial studies featuring integrated care models with two or more elements of Wagner's chronic care model. DATA EXTRACTION AND SYNTHESIS Two independent reviewers used standardised methods to search and screen included studies. Publication bias was assessed using the Doi plot and Luis Furuya Kanamori Index. Meta-analysis was conducted using random effects models. RESULTS In all, we included 10 randomised controlled trials from 11 publications with 4864 participants from six SSA countries (South Africa, Kenya, Nigeria, Eswatini, Ghana and Uganda). The overall quality of evidence based on GRADE criteria was moderate. A random-effects meta-analysis of six studies involving 1754 participants shows that integrated compared with standard care conferred a moderately lower mean SBP (mean difference=-4.85 mm Hg, 95% CI -7.37 to -2.34) for people with cardiometabolic multimorbidity; Hedges' g effect size (g=-0.25, (-0.39 to -0.11). However, integrated care compared with usual care showed mixed results for glycated haemoglobin, depression, medication adherence and quality of life. CONCLUSION Integrated care improved SBP among patients living with cardiometabolic multimorbidity in SSA. More studies on integrated care are required to improve the evidence pool on chronic care models for multimorbidity in SSA. These include implementation studies and cost-effectiveness studies. PROSPERO REGISTRATION NUMBER CRD42020187756.
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Affiliation(s)
- Peter Otieno
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
- Department of Public & Occupational Health, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development (AIGHD), AHTC, Amsterdam, Netherlands
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Hesborn Wao
- Research and Related Capacity Strengthening, African Population and Health Research Center, Nairobi, Kenya
| | - Elvis Wambiya
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
- African Network of Research Scientists, Nairobi, Kenya
| | - Maurine Ng'oda
- Emerging and Re-emerging infectious Diseases Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Daniel Mwanga
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - James Oguta
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
- African Network of Research Scientists, Nairobi, Kenya
| | - Peter Kibe
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
- African Network of Research Scientists, Nairobi, Kenya
| | - Gershim Asiki
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
- Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Highton PJ, Cassambai S, Jessen N, Agot GN, Hadjiconstantinou M, Davies M, Seidu S, Njoroge PK, Olenja JM, Godia P, Damasceno A, Lamptey R, Khunti K. Cardiometabolic disease and multiple long-term condition healthcare provision in Sub-Saharan Africa: Opportunities for new models of care in the post-COVID era. Diabetes Metab Syndr 2023; 17:102681. [PMID: 36521305 DOI: 10.1016/j.dsx.2022.102681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Patrick J Highton
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; National Institute for Health Research Applied Research Collaboration East Midlands, Leicester, UK.
| | - Shabana Cassambai
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Neusa Jessen
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - George N Agot
- Department of Public and Global Health, Faculty of Health Sciences, University of Nairobi, Kenya
| | | | - Melanie Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Samuel Seidu
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; National Institute for Health Research Applied Research Collaboration East Midlands, Leicester, UK
| | - Peter K Njoroge
- Department of Public and Global Health, Faculty of Health Sciences, University of Nairobi, Kenya
| | - Joyce Muhenge Olenja
- Department of Public and Global Health, Faculty of Health Sciences, University of Nairobi, Kenya
| | - Pamela Godia
- Department of Public and Global Health, Faculty of Health Sciences, University of Nairobi, Kenya
| | | | - Roberta Lamptey
- Family Medicine Department, Korle Bu Teaching Hospital, Accra Ghana & Department of Community Health, University of Ghana, Legon, Ghana
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; National Institute for Health Research Applied Research Collaboration East Midlands, Leicester, UK
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Hlongwana SI, Gray AL. Barriers and facilitators to medicine collection through the CCMDD programme at a Durban Hospital. Health SA 2022; 27:1906. [PMID: 36262925 PMCID: PMC9575334 DOI: 10.4102/hsag.v27i0.1906] [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: 01/07/2022] [Accepted: 06/08/2022] [Indexed: 11/06/2022] Open
Abstract
Background South Africa has rekindled health reform efforts through the implementation of the Centralised Chronic Medicine Dispensing and Distribution (CCMDD) programme, as a precursor towards achieving envisioned National Health Insurance (NHI). The CCMDD programme enables stable patients to collect chronic medicines dispensed centrally from designated pick-up-points (PuPs). Barriers and facilitators of chronic medicine collection exist at different levels. Aim To identify barriers and facilitators associated with patients’ characteristics and noncollection of CCMDD patient medicine parcels (PMPs). Setting The study was conducted at a regional public sector hospital which provides support for 19 primary facilities. Methods An observational cross-sectional comparative study was conducted. Results There was no statistically significant difference in collection status in terms of most of the variables compared. Patients who had been on treatment longer or who were receiving multiple items were more likely to collect medication, as were patients with arthritis, HIV and AIDS, but the association was no longer significant after adjusting for other confounders. Patients using internal PuPs were significantly more likely to collect their PMPs than patients using external PuPs, and this may have implications for achieving CCMDD objectives. Conclusion This study has revealed that recently diagnosed patients are enrolled onto the CCMDD programme whilst the chronic condition stability is not yet attained. Patients were also enrolled onto the programme at the referral facility instead of being down-referred. Contribution This study makes a case for evaluation research to further assess the CCMDD programme implementation, in order to improve uptake and cost-effectiveness.
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Affiliation(s)
- Simangele I. Hlongwana
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa,Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa,King Edward VIII Hospital, Durban, South Africa
| | - Andrew L. Gray
- Division of Pharmacology, Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
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Thomas LS, Buch E, Pillay Y, Jordaan J. Effectiveness of a large-scale, sustained and comprehensive community health worker program in improving population health: the experience of an urban health district in South Africa. HUMAN RESOURCES FOR HEALTH 2021; 19:153. [PMID: 34930328 PMCID: PMC8686370 DOI: 10.1186/s12960-021-00696-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 12/05/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION South Africa is an upper middle-income country with wide wealth inequality. It faces a quadruple burden of disease and poor health outcomes, with access to appropriate and adequate health care a challenge for millions of South Africans. The introduction of large-scale, comprehensive community health worker (CHW) programs in the country, within the context of implementing universal health coverage, was anticipated to improve population health outcomes. However, there is inadequate local (or global) evidence on whether such programs are effective, especially in urban settings. METHODS This study is part of a multi-method, quasi-experimental intervention study measuring effectiveness of a large-scale CHW program in a health district in an urban province of South Africa, where CHWs now support approximately one million people in 280,000 households. Using interviewer administered questionnaires, a 2019 cross-sectional survey of 417 vulnerable households with long-term CHW support (intervention households) are compared to 417 households with no CHW support (control households). Households were selected from similar vulnerable areas from all sub-levels of the Ekurhuleni health district. RESULTS The 417 intervention and control households each had good health knowledge. Compared to controls, intervention households with long-term comprehensive CHW support were more likely to access early care, get diagnosed for a chronic condition, be put on treatment and be well controlled on chronic treatment. They were also more likely to receive a social grant, and have a birth certificate or identity document. The differences were statistically significant for social support, health seeking behavior, and health outcomes for maternal, child health and chronic care. CONCLUSION A large-scale and sustained comprehensive CHW program in an urban setting improved access to social support, chronic and minor acute health services at household and population level through better health-seeking behavior and adherence to treatment. Direct evidence from households illustrated that such community health worker programs are therefore effective and should be part of health systems in low- and middle-income countries.
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Affiliation(s)
- L. S. Thomas
- Gauteng Department of Health, School of Public Health, University of Witwatersrand, Bophelo Rd, Prinshof 349-Jr, Pretoria, 0084 Gauteng South Africa
- School of Health Systems and Public Health, University of Pretoria and Colleges of Medicine, Pretoria, South Africa
| | - E. Buch
- School of Health Systems and Public Health, University of Pretoria and Colleges of Medicine, Pretoria, South Africa
| | - Y. Pillay
- Clinton Health Access Initiative, Pretoria, South Africa
| | - J. Jordaan
- Department of Statistics, University of Pretoria, Pretoria, South Africa
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Patient-Centered, Sustainable Hypertension Care: The Case for Adopting a Differentiated Service Delivery Model for Hypertension Services in Low- and Middle-Income Countries. Glob Heart 2021; 16:59. [PMID: 34692383 PMCID: PMC8415184 DOI: 10.5334/gh.978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 08/09/2021] [Indexed: 11/29/2022] Open
Abstract
Expanding hypertension services in low- and middle-income countries requires efficient and effective service delivery approaches that meet the needs and expectations of people living with hypertension within the resource constraints of existing national health systems. Ideally, a hypertension program will extend treatment coverage while maintaining service quality, maximizing efficient resource utilization and improving clinical outcomes. In this article, we discuss lessons learned from HIV differentiated service delivery initiatives, and make the case that the same approach should be adopted for hypertension programs.
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Geldsetzer P, Sauer A, Francis JM, Mboggo E, Lwezaula S, Sando D, Fawzi W, Ulenga N, Bärnighausen T. Willingness to pay for community delivery of antiretroviral treatment in urban Tanzania: a cross-sectional survey. Health Policy Plan 2021; 35:1300-1308. [PMID: 33083837 PMCID: PMC7886440 DOI: 10.1093/heapol/czaa088] [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] [Accepted: 07/15/2020] [Indexed: 11/23/2022] Open
Abstract
Community health worker (CHW)-led community delivery of HIV antiretroviral therapy (ART) could increase ART coverage and decongest healthcare facilities. It is unknown how much patients would be willing to pay to receive ART at home and, thus, whether ART community delivery could be self-financing. Set in Dar es Salaam, this study aimed to determine patients’ willingness to pay (WTP) for CHW-led ART community delivery. We sampled ART patients living in the neighbourhoods surrounding each of 48 public-sector healthcare facilities in Dar es Salaam. We asked participants (N = 1799) whether they (1) preferred ART community delivery over standard facility-based care, (2) would be willing to pay for ART community delivery and (3) would be willing to pay each of an incrementally increasing range of prices for the service. 45.0% (810/1799; 95% CI: 42.7—47.3) of participants preferred ART community delivery over standard facility-based care and 51.5% (417/810; 95% CI: 48.1—55.0) of these respondents were willing to pay for ART community delivery. Among those willing to pay, the mean and median amount that participants were willing to pay for one ART community delivery that provides a 2-months’ supply of antiretroviral drugs was 3.61 purchasing-power-parity-adjusted dollars (PPP$) (95% CI: 2.96–4.26) and 1.27 PPP$ (IQR: 1.27–2.12), respectively. An important limitation of this study is that participants all resided in neighbourhoods within the catchment area of the healthcare facility at which they were interviewed and, thus, may incur less costs to attend standard facility-based ART care than other ART patients in Dar es Salaam. While there appears to be a substantial WTP, patient payments would only constitute a minority of the costs of implementing ART community delivery. Thus, major co-financing from governments or donors would likely be required.
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Affiliation(s)
- Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA 94305, USA.,Heidelberg Institute of Global Health (HIGH), Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Alexander Sauer
- Department of Statistics, University of Oxford, 24-29 St Giles', Oxford OX1 3LB, UK
| | - Joel M Francis
- Department of Family Medicine and Primary Care, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Eric Mboggo
- Management and Development for Health, Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
| | - Sharon Lwezaula
- National AIDS Control Program, Lithuli Street, Dar es Salaam, P.O. Box 11857, Tanzania
| | - David Sando
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Nzovu Ulenga
- Management and Development for Health, Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Africa Health Research Institute (AHRI), Africa Centre Building, Via R618 to Hlabisa, Somkhele, P.O. Box 198, Mtubatuba 3935, South Africa
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9
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Angwenyi V, Bunders‐Aelen J, Criel B, Lazarus JV, Aantjes C. An evaluation of self-management outcomes among chronic care patients in community home-based care programmes in rural Malawi: A 12-month follow-up study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:353-368. [PMID: 32671938 PMCID: PMC7983972 DOI: 10.1111/hsc.13094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/02/2020] [Accepted: 06/12/2020] [Indexed: 05/08/2023]
Abstract
This paper investigates the impact of community home-based care (CHBC) on self-management outcomes for chronically ill patients in rural Malawi. A pre- and post-evaluation survey was administered among 140 chronically ill patients with HIV and non-communicable diseases, newly enrolled in four CHBC programmes. We translated, adapted and administered scales from the Stanford Chronic Disease Self-Management Programme to evaluate patient's self-management outcomes (health status and self-efficacy), at four time points over a 12-month period, between April 2016 and May 2017. The patient's drop-out rate was approximately 8%. Data analysis included descriptive statistics, tests of associations, correlations and pairwise comparison of outcome variables between time points, and multivariate regression analysis to explore factors associated with changes in self-efficacy following CHBC interventions. The results indicate a reduction in patient-reported pain, fatigue and illness intrusiveness, while improvements in general health status and quality of life were not statistically significant. At baseline, the self-efficacy mean was 5.91, which dropped to 5.1 after 12 months. Factors associated with this change included marital status, education, employment and were condition-related; whereby self-efficacy for non-HIV and multimorbid patients was much lower. The odds for self-efficacy improvement were lower for patients with diagnosed conditions of longer duration. CHBC programme support, regularity of contact and proximal location to other services influenced self-efficacy. Programmes maintaining regular home visits had higher patient satisfaction levels. Our findings suggest that there were differential changes in self-management outcomes following CHBC interventions. While self-management support through CHBC programmes was evident, CHBC providers require continuous training, supervision and sustainable funding to strengthen their contribution. Furthermore, sociodemographic and condition-related factors should inform the design of future interventions to optimise outcomes. This study provides a systematic evaluation of self-management outcomes for a heterogeneous chronically ill patient population and highlights the potential and relevant contribution of CHBC programmes in improving chronic care within sub-Saharan Africa.
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Affiliation(s)
- Vibian Angwenyi
- Athena Institute for Research on Innovation and Communication in Health and Life SciencesFaculty of SciencesVrije Universiteit AmsterdamAmsterdamthe Netherlands
- Unit of Equity and HealthDepartment of Public HealthInstitute of Tropical MedicineAntwerpBelgium
- Barcelona Institute for Global Health (ISGlobal)Hospital ClínicUniversity of BarcelonaBarcelonaSpain
| | - Joske Bunders‐Aelen
- Athena Institute for Research on Innovation and Communication in Health and Life SciencesFaculty of SciencesVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Bart Criel
- Unit of Equity and HealthDepartment of Public HealthInstitute of Tropical MedicineAntwerpBelgium
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal)Hospital ClínicUniversity of BarcelonaBarcelonaSpain
| | - Carolien Aantjes
- Health Economics and HIV/AIDS Research Division (HEARD)University of KwaZulu‐NatalDurbanSouth Africa
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Herbst AG, Olds P, Nuwagaba G, Okello S, Haberer J. Patient experiences and perspectives on hypertension at a major referral hospital in rural southwestern Uganda: a qualitative analysis. BMJ Open 2021; 11:e040650. [PMID: 33408202 PMCID: PMC7789452 DOI: 10.1136/bmjopen-2020-040650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Novel care models are needed to address the large burden of hypertension globally. We aimed to explore how patients in rural Uganda experience and perceive hypertension in order to understand factors that may inform development of a patient-centred care model for hypertension management in this setting. DESIGN We conducted one-time, in-depth qualitative interviews focusing on participants' experiences and perceptions of the meaning and management of hypertension. SETTING Outpatient clinic at Mbarara Regional Referral Hospital in Uganda. PARTICIPANTS We enrolled patients who had hypertension and had used antihypertensive medication for at least 1 month. We used purposive sampling to recruit 30 participants with similar representation by gender and by absence or presence of comorbid conditions. RESULTS Participants had been diagnosed and initiated care at various clinical stages of hypertension, which impacted their understanding of hypertension. Several participants saw hypertension as a chronic disease that can lead to complications if not controlled, while others attributed symptoms typically associated with other diseases to hypertension. Participants described inconsistent access to antihypertensive medications and difficulty with transport to the clinic (time needed and expense) as the major barriers to access to care. Initiation and maintenance of care were facilitated by family support and ready access to health facilities. Many participants identified an understanding of the important lifestyle and dietary changes required to control hypertension. CONCLUSIONS Patients with hypertension in rural Uganda demonstrated a varied understanding and experience with hypertension. Interventions leveraging family support may help with patient education and clinical management. Integration of patient perspectives into the care model, patient-centred care, may serve as a successful model for hypertension and potentially delivery of care for other non-communicable diseases in Uganda and other similar resource-limited settings.
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Affiliation(s)
| | - Peter Olds
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gabriel Nuwagaba
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Samson Okello
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jessica Haberer
- Harvard Medical School, Boston, Massachusetts, USA
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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11
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Frequency and Predictors of HIV-Related Cognitive Impairment in East Africa: The Africa Cohort Study (AFRICOS). J Acquir Immune Defic Syndr 2020; 83:157-164. [PMID: 31904698 DOI: 10.1097/qai.0000000000002242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Medication adherence is a critical issue in achieving viral suppression targets, particularly in resource-limited countries. As HIV-related cognitive impairment (CI) impacts adherence, we examined frequency and predictors of CI in the African Cohort Study. SETTING Cross-sectional examination of enrollment data from President's Emergency Plan for AIDS Relief supported clinic sites. METHODS In a 30-minute cognitive assessment, CI was defined as -1SD on 2 tests or -2SD on one, as compared with 429 controls. We performed univariable and multivariable logistic and linear models examining clinical and demographic factors associated with CI and global neuropsychological performance (NP-6). RESULTS Two thousand four hundred seventy-two HIV+ participants from Kenya (n = 1503), Tanzania (n = 469), and Uganda (n = 500). The mean (SD) age was 39.7 (10.7) years, and 1452 (59%) were women. The majority reported completing or partially completing primary school (n = 1584, 64%). Mean (SD) current and nadir CD4 count were 463 (249) and 204 (221) cells/mm, respectively; 1689 (68%) were on combination antiretroviral therapy. Nine hundred thirty-nine (38%) HIV+ versus 113 (26%) HIV- individuals showed CI: (P < 0.001). We found significant effects of literacy [odds ratio (OR): 0.3; 95% CI: 0.2 to 0.4; P < 0.001] and World Health Organization stage 4 (OR: 1.5; 95% CI: 1.0 to 2.q; P = 0.046) on CI. Tanzanians (OR: 3.2; 95% CI: 2.4 to 4.3; P < 0.001) and Kenyans (OR: 2.0; 95% CI: 1.6 to 2.6; P < 0.001) had higher risk of CI compared with Ugandans. Results were relatively unchanged in predictive models of NP-6, with the only difference being an additional significant effect of current CD4 cell count (coeff: 0.0; 95% CI: 0.0 to 0.0; P = 0.005). CONCLUSIONS Literacy, country, World Health Organization stage, and current CD4 cell count were associated with increased risk of cognitive dysfunction. Our findings help optimize care practices in Africa, illustrating the importance of strategies for early and effective viral-immunological control.
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12
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Genberg B, Wachira J, Kafu C, Wilson I, Koech B, Kamene R, Akinyi J, Knight J, Braitstein P, Ware N. Health System Factors Constrain HIV Care Providers in Delivering High-Quality Care: Perceptions from a Qualitative Study of Providers in Western Kenya. J Int Assoc Provid AIDS Care 2020; 18:2325958218823285. [PMID: 30798666 PMCID: PMC6503317 DOI: 10.1177/2325958218823285] [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] [Indexed: 11/18/2022] Open
Abstract
The burden on health systems due to increased volume of patients with HIV continues to rapidly increase. The goal of this study was to examine the experiences of HIV care providers in a high patient volume HIV treatment and care program in eastern Africa. Sixty care providers within the Academic Model Providing Access to Healthcare program in western Kenya were recruited into this qualitative study. We conducted in-depth interviews focused on providers’ perspectives on health system factors that impact patient engagement in HIV care. Results from thematic analysis demonstrated that providers perceive a work environment that constrained their ability to deliver high-quality HIV care and encouraged negative patient–provider relationships. Providers described their roles as high strain, low control, and low support. Health system strengthening must include efforts to improve the working environment and easing burden of care providers tasked with delivering antiretroviral therapy to increasing numbers of patients in resource-constrained settings.
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Affiliation(s)
- Becky Genberg
- 1 Department of Health Services, Policy & Practice, Brown University, Providence, RI, USA.,2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Juddy Wachira
- 3 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,4 Department of Behavioral Science, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya
| | - Catherine Kafu
- 3 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ira Wilson
- 1 Department of Health Services, Policy & Practice, Brown University, Providence, RI, USA
| | - Beatrice Koech
- 3 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Regina Kamene
- 3 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jacqueline Akinyi
- 3 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jennifer Knight
- 1 Department of Health Services, Policy & Practice, Brown University, Providence, RI, USA
| | - Paula Braitstein
- 3 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,4 Department of Behavioral Science, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya.,5 Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,6 Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.,7 Regenstrief Institute, Indianapolis, IN, USA
| | - Norma Ware
- 8 Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,9 Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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13
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Angwenyi V, Aantjes C, Bunders-Aelen J, Lazarus JV, Criel B. Patient-provider perspectives on self-management support and patient empowerment in chronic care: A mixed-methods study in a rural sub-Saharan setting. J Adv Nurs 2019; 75:2980-2994. [PMID: 31225662 PMCID: PMC6900026 DOI: 10.1111/jan.14116] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 04/10/2019] [Accepted: 04/30/2019] [Indexed: 12/22/2022]
Abstract
AIM To explore how provision of self-management support to chronically-ill patients in resource-limited settings contributes to patient empowerment in chronic care. DESIGN Concurrent descriptive mixed methods research. METHODS A survey of 140 patients with chronic conditions administered at four time-points in 12 months. We conducted 14 interviews and four focus-group discussions with patients (N = 31); 13 healthcare provider interviews; and observations of four patient-support group meetings. Data were collected between April 2016 - May 2017 in rural Malawi. Qualitative data were analysed using a thematic approach and descriptive statistical analysis performed on survey data. RESULTS Healthcare professionals facilitated patient empowerment through health education, although literacy levels and environmental factors affected self-management guidance. Information exchanged during patient-provider interactions varied and discussions centred around medical aspects and health promoting behaviour. Less than 40% of survey patients prepared questions prior to clinic consultations. Health education was often unstructured and delegated to non-physician providers, mostly untrained in chronic care. Patients accessed psychosocial support from volunteer-led community home-based care programmes. HIV support-groups regularly interacted with peers and practical skills exchanged in a supportive environment, reinforcing patient's self-mangement competence and proactiveness in health care. CONCLUSION For optimal self-management, reforms at inter-personal and organizational level are needed including; mutual patient-provider collaboration, diversifying access to self-management support resources and restructuring patient support-groups to cater to diverse chronic conditions. IMPACT Our study provides insights and framing of self-management support and empowerment for patients in long-term care in sub-Saharan Africa. Lessons drawn could feed into designing and delivering responsive chronic care interventions.
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Affiliation(s)
- Vibian Angwenyi
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Unit of Equity and Health, Department of Public Health, Institute of Tropical Medicine. Nationalestraat, Antwerp, Belgium.,Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Carolien Aantjes
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Joske Bunders-Aelen
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Bart Criel
- Unit of Equity and Health, Department of Public Health, Institute of Tropical Medicine. Nationalestraat, Antwerp, Belgium
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14
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Perriat D, Balzer L, Hayes R, Lockman S, Walsh F, Ayles H, Floyd S, Havlir D, Kamya M, Lebelonyane R, Mills LA, Okello V, Petersen M, Pillay D, Sabapathy K, Wirth K, Orne-Gliemann J, Dabis F. Comparative assessment of five trials of universal HIV testing and treatment in sub-Saharan Africa. J Int AIDS Soc 2019; 21. [PMID: 29314658 PMCID: PMC5810333 DOI: 10.1002/jia2.25048] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/27/2017] [Indexed: 02/03/2023] Open
Abstract
Design Universal voluntary HIV counselling and testing followed by prompt initiation of antiretroviral therapy (ART) for all those diagnosed HIV‐infected (universal test and treat, UTT) is now a global health standard. However, its population‐level impact, feasibility and cost remain unknown. Five community‐based trials have been implemented in sub‐Saharan Africa to measure the effects of various UTT strategies at population level: BCPP/YaTsie in Botswana, MaxART in Swaziland, HPTN 071 (PopART) in South Africa and Zambia, SEARCH in Uganda and Kenya and ANRS 12249 TasP in South Africa. This report describes and contrasts the contexts, research methodologies, intervention packages, themes explored, evolution of study designs and interventions related to each of these five UTT trials. Methods We conducted a comparative assessment of the five trials using data extracted from study protocols and collected during baseline studies, with additional input from study investigators. We organized differences and commonalities across the trials in five categories: trial contexts, research designs, intervention packages, trial themes and adaptations. Results All performed in the context of generalized HIV epidemics, the trials highly differ in their social, demographic, economic, political and health systems settings. They share the common aim of assessing the impact of UTT on the HIV epidemic but differ in methodological aspects such as study design and eligibility criteria for trial populations. In addition to universal ART initiation, the trials deliver a wide range of biomedical, behavioural and structural interventions as part of their UTT strategies. The five studies explore common issues, including the uptake rates of the trial services and individual health outcomes. All trials have adapted since their initiation to the evolving political, economic and public health contexts, including adopting the successive national recommendations for ART initiation. Conclusions We found substantial commonalities but also differences between the five UTT trials in their design, conduct and multidisciplinary outputs. As empirical literature on how UTT may improve efficiency and quality of HIV care at population level is still scarce, this article provides a foundation for more collaborative research on UTT and supports evidence‐based decision making for HIV care in country and internationally.
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Affiliation(s)
- Delphine Perriat
- Inserm, Bordeaux Population Health Research Center, UMR 1219, University Bordeaux, Bordeaux, France.,Inserm, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France.,Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa (ANRS TasP trial)
| | - Laura Balzer
- University of California San Francisco, San Francisco, CA, USA (SEARCH trial).,University of Massachusetts Amherst, Amherst, MA, USA
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom (PopART trial)
| | - Shahin Lockman
- Harvard School of Public Health, Boston, MA, USA (BCPP trial).,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana (BCPP trial).,Brigham and Women's Hospital, Boston, MA, USA (BCPP trial)
| | - Fiona Walsh
- Clinton Health Access Initiative, Boston, MA, USA (MaxART trial)
| | - Helen Ayles
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom (PopART trial).,Zambart, Lusaka, Zambia
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom (PopART trial)
| | - Diane Havlir
- University of California San Francisco, San Francisco, CA, USA (SEARCH trial)
| | - Moses Kamya
- Makerere University School of Medicine, Uganda (SEARCH trial)
| | | | - Lisa A Mills
- Centers for Disease Control, Gaborone, Botswana (BCPP trial)
| | - Velephi Okello
- Ministry of Health, Kingdom of Swaziland, Mbabane, Swaziland (MaxART trial)
| | - Maya Petersen
- University of California Berkeley School of Public Health, Berkeley, CA, USA (SEARCH trial)
| | - Deenan Pillay
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa (ANRS TasP trial).,Department of Infection, University College London, London, United Kingdom (ANRS TasP trial)
| | - Kalpana Sabapathy
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom (PopART trial)
| | - Kathleen Wirth
- Department of Infection, University College London, London, United Kingdom (ANRS TasP trial)
| | - Joanna Orne-Gliemann
- Inserm, Bordeaux Population Health Research Center, UMR 1219, University Bordeaux, Bordeaux, France.,Inserm, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France.,Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa (ANRS TasP trial)
| | - François Dabis
- Inserm, Bordeaux Population Health Research Center, UMR 1219, University Bordeaux, Bordeaux, France.,Inserm, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France.,Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa (ANRS TasP trial)
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15
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Geldsetzer P, Bärnighausen T. Late-stage research for diabetes and related NCDs receives little funding: evidence from the NIH RePORTER tool. Lancet Diabetes Endocrinol 2017; 5:91-92. [PMID: 27993513 PMCID: PMC5902680 DOI: 10.1016/s2213-8587(16)30421-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 12/06/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Pascal Geldsetzer
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Institute of Public Health, Heidelberg University, 69120 Heidelberg, Germany; Africa Health Research Institute, Mtubatuba, South Africa.
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16
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Bärnighausen T, Bloom DE, Humair S. Human Resources for Treating HIV/AIDS: Are the Preventive Effects of Antiretroviral Treatment a Game Changer? PLoS One 2016; 11:e0163960. [PMID: 27716813 PMCID: PMC5055321 DOI: 10.1371/journal.pone.0163960] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 09/16/2016] [Indexed: 11/19/2022] Open
Abstract
Shortages of human resources for treating HIV/AIDS (HRHA) are a fundamental barrier to reaching universal antiretroviral treatment (ART) coverage in developing countries. Previous studies suggest that recruiting HRHA to attain universal ART coverage poses an insurmountable challenge as ART significantly increases survival among HIV-infected individuals. While new evidence about ART's prevention benefits suggests fewer infections may mitigate the challenge, new policies such as treatment-as-prevention (TasP) will exacerbate it. We develop a mathematical model to analytically study the net effects of these countervailing factors. Using South Africa as a case study, we find that contrary to previous results, universal ART coverage is achievable even with current HRHA numbers. However, larger health gains are possible through a surge-capacity policy that aggressively recruits HRHA to reach universal ART coverage quickly. Without such a policy, TasP roll-out can increase health losses by crowding out sicker patients from treatment, unless a surge capacity exclusively for TasP is also created.
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Affiliation(s)
- Till Bärnighausen
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Africa Health Research Institute (AHRI), Mtubatuba, KwaZulu Natal, South Africa
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - David E. Bloom
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Salal Humair
- Amazon.com, Inc., Seattle, Washington, United States of America
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