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Wake E, Rosen JG. Heavy alcohol use and the HIV care continuum in Kenya: a population-based study. AIDS Care 2024:1-10. [PMID: 38648525 DOI: 10.1080/09540121.2024.2343587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 02/29/2024] [Indexed: 04/25/2024]
Abstract
Heavy alcohol use (HAU) can destabilize engagement along the HIV care continuum. Population-based studies assessing associations of HAU with HIV treatment outcomes are lacking, especially in sub-Saharan Africa. We leveraged data from the Kenya Population-based HIV Impact Assessment to identify associations of self-reported HAU, assessed using two items measuring the frequency and quantity of past-year alcohol consumption, with serum biomarkers for HIV serostatus unawareness, antiretroviral therapy (ART) non-use, and HIV viremia (≥1000 RNA copies/mL). Overall and sex-stratified survey-weighted logistic regression with jackknife variance estimation modeled adjusted odds ratios (adjOR) of HIV treatment indicators by HAU. Overall, 1491 persons living with HIV aged 15-64 years (68.4% female) were included. The prevalence of HAU was 8.9% (95% confidence interval [95%CI]: 6.8-11.0%) and was significantly more pronounced in males than females (19.6% vs. 4.0%, p < 0.001). In multivariable analysis, HAU was significantly (p < 0.001) associated with HIV serostatus unawareness (adjOR = 3.65, 95%CI: 2.14-6.23), ART non-use (adjOR = 3.81, 95%CI: 2.25-6.43), and HIV viremia (adjOR = 3.13, 95%CI: 1.85-5.32). Incorporating sex-specific alcohol use screening into HIV testing and treatment services in populations where HAU is prevalent could optimize clinical outcomes along the HIV care continuum.
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Affiliation(s)
- Edom Wake
- Division of Gastroenterology and Hepatology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Kadota JL, Packel LJ, Mlowe M, Ulenga N, Mwenda N, Njau PF, Dow WH, Wang J, Sabasaba A, McCoy SI. Rudi Kundini, Pamoja Kundini (RKPK): study protocol for a hybrid type 1 randomized effectiveness-implementation trial using data science and economic incentive strategies to strengthen the continuity of care among people living with HIV in Tanzania. Trials 2024; 25:114. [PMID: 38336793 PMCID: PMC10858527 DOI: 10.1186/s13063-024-07960-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Economic incentives can improve clinical outcomes among in-care people living with HIV (PLHIV), but evidence is limited for their effectiveness among out-of-care PLHIV or those at risk of disengagement. We propose a type 1 hybrid effectiveness-implementation study to advance global knowledge about the use of economic incentives to strengthen the continuity of HIV care and accelerate global goals for HIV epidemic control. METHODS The Rudi Kundini, Pamoja Kundini study will evaluate two implementation models of an economic incentive strategy for supporting two groups of PLHIV in Tanzania. Phase 1 of the study consists of a two-arm, cluster randomized trial across 32 health facilities to assess the effectiveness of a home visit plus one-time economic incentive on the proportion of out-of-care PLHIV with viral load suppression (< 1000 copies/ml) 6 months after enrollment (n = 640). Phase 2 is an individual 1:1 randomized controlled trial designed to determine the effectiveness of a short-term counseling and economic incentive program offered to in-care PLHIV who are predicted through machine learning to be at risk of disengaging from care on the outcome of viral load suppression at 12 months (n = 692). The program includes up to three incentives conditional upon visit attendance coupled with adapted counselling sessions for this population of PLHIV. Consistent with a hybrid effectiveness-implementation study design, phase 3 is a mixed methods evaluation to explore barriers and facilitators to strategy implementation in phases 1 and 2. Results will be used to guide optimization and scale-up of the incentive strategies, if effective, to the larger population of Tanzanian PLHIV who struggle with continuity of HIV care. DISCUSSION Innovative strategies that recognize the dynamic process of lifelong retention in HIV care are urgently needed. Strategies such as conditional economic incentives are a simple and effective method for improving many health outcomes, including those on the HIV continuum. If coupled with other supportive services such as home visits (phase 1) or with tailored counselling (phase 2), economic incentives have the potential to strengthen engagement among the subpopulation of PLHIV who struggle with retention in care and could help to close the gap towards reaching global "95-95-95" goals for ending the AIDS epidemic. TRIAL REGISTRATION Phase 1: ClinicalTrials.gov, NCT05248100 , registered 2/21/2022. Phase 2: ClinicalTrials.gov, NCT05373095 , registered 5/13/2022.
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Affiliation(s)
- Jillian L Kadota
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA.
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA.
| | - Laura J Packel
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Matilda Mlowe
- Health for a Prosperous Nation, Dar Es Salaam, Tanzania
| | - Nzovu Ulenga
- Management and Development for Health, Dar Es Salaam, Tanzania
| | | | | | - William H Dow
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, USA
| | - Jingshen Wang
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Amon Sabasaba
- Health for a Prosperous Nation, Dar Es Salaam, Tanzania
| | - Sandra I McCoy
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
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Tarantino N, Norman B, Enimil A, Osei Asibey S, Martyn-Dickens C, Guthrie K, Kwara A, Bock B, Mimiaga MJ, Brown L. HIV symptom severity and associated factors among young people with HIV in Ghana. AIDS Care 2024:1-9. [PMID: 38184890 DOI: 10.1080/09540121.2023.2299332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
ABSTRACTAdolescents and young adults (young people) with HIV (YPWH) often struggle with treatment self-management. Many have symptoms due to HIV disease, medication side-effects, or comorbid conditions. Our study investigated the severity of HIV-related symptoms among YPWH aged 18-24 with detectable viral loads from an HIV clinic in Ghana (N = 60) and potential correlates of severity across a range of factors. Results indicated that YPWH currently experienced, on average, 13 symptoms (SD = 12.33). Six of the 10 most common symptoms were from two domains: fatigue and psychological. The most common symptoms were headaches (62%), weakness (53%), and fear/worries (52%). No differences were observed in number or severity of symptoms between youth based on HIV transmission status. Bivariate correlates of symptom severity were found with six that remained significant or approached significance in a multivariate model predicting severity: living with a parent/guardian, higher perceived access to HIV care, and higher treatment readiness were associated with lower severity while greater travel time to the HIV clinic, psychological distress, and more missed clinic appointments were associated with higher severity. Our findings suggest that interventions to address symptoms among YPWH should be multilevel and include strategies (e.g., telehealth, home care) to increase access to care.
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Affiliation(s)
- Nicholas Tarantino
- Department of Psychology, Providence College, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Betty Norman
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Enimil
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Kate Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Center for Behavioral and Preventive Medicine, Miriam Hospital, Providence, RI, USA
| | - Awewura Kwara
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL USA
| | - Beth Bock
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Center for Behavioral and Preventive Medicine, Miriam Hospital, Providence, RI, USA
| | - Matthew J Mimiaga
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA, USA
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA
| | - Larry Brown
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA
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Gumede SB, Wensing AMJ, Lalla-Edward ST, de Wit JBF, Francois Venter WD, Tempelman HA, Hermans LE. Predictors of Treatment Adherence and Virological Failure Among People Living with HIV Receiving Antiretroviral Therapy in a South African Rural Community: A Sub-study of the ITREMA Randomised Clinical Trial. AIDS Behav 2023; 27:3863-3885. [PMID: 37382825 PMCID: PMC10598166 DOI: 10.1007/s10461-023-04103-2] [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: 06/02/2023] [Indexed: 06/30/2023]
Abstract
A large proportion of people living with HIV (PLHIV) in sub-Saharan Africa reside in rural areas. Knowledge of enablers and barriers of adherence to antiretroviral treatment (ART) in these populations is limited. We conducted a cohort study of 501 adult PLHIV on ART at a rural South African treatment facility as a sub-study of a clinical trial (ClinicalTrials.gov NCT03357588). Socio-economic, psychosocial and behavioral characteristics were assessed as covariates of self-reported adherence difficulties, suboptimal pill count adherence and virological failure during 96 weeks of follow-up. Male gender was an independent risk factor for all outcomes. Food insecurity was associated with virological failure in males. Depressive symptoms were independently associated with virological failure in both males and females. Household income and task-oriented coping score were protective against suboptimal pill-count adherence. These results underscore the impact of low household income, food insecurity and depression on outcomes of ART in rural settings and confirm other previously described risk factors. Recognition of these factors and targeted adherence support strategies may improve patient health and treatment outcomes.
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Affiliation(s)
- Siphamandla B Gumede
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, 32 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa.
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands.
| | - Annemarie M J Wensing
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Ndlovu Research Consortium, Elandsdoorn, South Africa
| | - Samanta T Lalla-Edward
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, 32 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa
| | - John B F de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - W D Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, 32 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa
| | - Hugo A Tempelman
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, 32 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa
- Ndlovu Research Consortium, Elandsdoorn, South Africa
| | - Lucas E Hermans
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, 32 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Ndlovu Research Consortium, Elandsdoorn, South Africa
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Buh A, Deonandan R, Gomes J, Krentel A, Oladimeji O, Yaya S. Barriers and facilitators for interventions to improve ART adherence in Sub-Saharan African countries: A systematic review and meta-analysis. PLoS One 2023; 18:e0295046. [PMID: 38032918 PMCID: PMC10688728 DOI: 10.1371/journal.pone.0295046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The HIV/AIDS pandemic remains a significant public health issue, with sub-Saharan Africa (SSA) at its epicentre. Although antiretroviral therapy (ART) has been introduced to decrease new infections and deaths, SSA reports the highest incidence of HIV/AIDS, constituting two-thirds of the global new infections. This review aimed to elucidate the predominant barriers and facilitators influencing ART adherence and to identify effective strategies to enhance ART adherence across SSA. METHODS A comprehensive review was conducted on studies examining barriers to ART adherence and interventions to boost adherence among HIV-positive adults aged 15 and above in SSA, published from January 2010 onwards. The research utilized databases like Medline Ovid, CINAHL, Embase, and Scopus. Included were experimental and quasi-experimental studies, randomized and non-randomized controlled trials, comparative before and after studies, and observational studies such as cross-sectional, cohort, prospective and retrospective studies. Two independent reviewers screened the articles, extracted pertinent data, and evaluated the studies' methodological integrity using Joanna Briggs Institute's standardized appraisal tools. The compiled data underwent both meta-analysis and narrative synthesis. RESULTS From an initial pool of 12,538 papers, 45 were selected (30 for narrative synthesis and 15 for meta-analysis). The identified barriers and facilitators to ART adherence were categorized into seven principal factors: patient-related, health system-related, medication-related, stigma, poor mental health, socioeconomic and socio-cultural-related factors. Noteworthy interventions enhancing ART adherence encompassed counselling, incentives, mobile phone short message service (SMS), peer delivered behavioural intervention, community ART delivery intervention, electronic adherence service monitoring device, lay health worker lead group intervention and food assistance. The meta-analysis revealed a statistically significant difference in ART adherence between the intervention and control groups (pooled OR = 1.56, 95%CI:1.35-1.80, p = <0.01), with evidence of low none statistically significant heterogeneity between studies (I2 = 0%, p = 0.49). CONCLUSION ART adherence in SSA is influenced by seven key factors. Multiple interventions, either standalone or combined, have shown effectiveness in enhancing ART adherence. To optimize ART's impact and mitigate HIV's prevalence in SSA, stakeholders must consider these barriers, facilitators, and interventions when formulating policies or treatment modalities. For sustained positive ART outcomes, future research should target specific underrepresented groups like HIV-infected children, adolescents, and pregnant women in SSA to further delve into the barriers, facilitators and interventions promoting ART adherence.
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Affiliation(s)
- Amos Buh
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Raywat Deonandan
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - James Gomes
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Alison Krentel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Olanrewaju Oladimeji
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, Eastern Cape, South Africa
- Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
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Azia IN, Nyembezi A, Carelse S, Mukumbang FC. Understanding the role of religious beliefs in adherence to antiretroviral therapy among Pentecostal Christians living with HIV in sub-Saharan Africa: a scoping review. BMC Public Health 2023; 23:1768. [PMID: 37697279 PMCID: PMC10494378 DOI: 10.1186/s12889-023-16616-5] [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: 02/15/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Optimum adherence to antiretroviral therapy (ART) is crucial in managing HIV. However, some people's religious beliefs can influence how they deal with HIV and the psychosocial factors influencing their adherence to ART, such as disclosure, acceptance of HIV status, belief in ART, and depression. In sub-Saharan Africa (SSA), the role of religious beliefs in ART adherence is underexplored. We aimed to identify and conceptualize the literature on religious beliefs concerning ART adherence among Pentecostal Christians living with HIV in SSA. METHODS We conducted a scoping review of the literature on religious beliefs and ART adherence. We searched papers from PubMed, Web of Science, Medline, Sabinet, Academic Search Complete, CINAHL Plus, Health Source/Nursing Academic, Scopus, and Google Scholar and published papers from conference proceedings and dissertations. Data were extracted according to a predetermined population, concept, context framework, and eligibility criteria for selecting or rejecting studies. We used a narrative synthesis to summarize the data on evidence and the impact of religious beliefs on ART adherence. RESULTS Seven papers published between January 2010 and February 2022 met the inclusion criteria. Nineteen aspects of religious beliefs were identified as negatively influencing ART adherence, while eight aspects facilitated optimal adherence. "Being saved" or "born again" enhanced coping strategies for optimal adherence through actions such as less alcohol use, fidelity to a sexual partner(s), disclosure, acceptance of HIV status, reduced depression, and facilitated PLHIV to access social support from church members or other institutions. CONCLUSION Religious beliefs are integral to Pentecostal Christians living with HIV and affect their adherence to ART. While some Pentecostal Christians living with HIV on ART use their religious beliefs and practices to access psychosocial support from other church members or organizations and achieve good clinical outcomes, others apply their religious beliefs and practices differently and compromise their commitments to taking ART as prescribed, thus experiencing poor viral suppression and clinical outcomes. However, more research is required to understand and theorize how religious beliefs impact ART adherence among Pentecostals living with HIV to inform guidelines for practitioners.
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Affiliation(s)
- Ivo Nchendia Azia
- School of Public Health, University of the Western Cape, Robert Sobukwe Road Private Bag X17, Cape Town, 7535 Bellville South Africa
| | - Anam Nyembezi
- School of Public Health, University of the Western Cape, Robert Sobukwe Road Private Bag X17, Cape Town, 7535 Bellville South Africa
| | - Shernaaz Carelse
- Department of Social Works, University of the Western Cape, Cape Town, South Africa
| | - Ferdinand C. Mukumbang
- School of Public Health, University of the Western Cape, Robert Sobukwe Road Private Bag X17, Cape Town, 7535 Bellville South Africa
- Department of Global Health, University of Washington, Seattle, USA
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Masresha SA, Kidie AA, Alen GD, Mulaw GF, Feleke FW, Kassaw MW, Dejene TM. Virological failure and its predictors among human immunodeficiency virus infected individuals on second line antiretroviral treatment in North-East Ethiopia, 2021. Pharmacoepidemiol Drug Saf 2023; 32:978-987. [PMID: 36974512 DOI: 10.1002/pds.5625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 02/25/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Acquired immune deficiency syndrome (AIDS) becomes a manageable chronic disease due to the presence of effective prevention, diagnosis, treatment, and care accesses. Viral load cascade analyses are important to identify gaps in human immunodeficiency virus (HIV)/AIDS treatment and care for quality improvements. OBJECTIVE Time to Virological Failure and its Predictors among HIV Infected Individuals on Second Line Antiretroviral Treatment (SLART) in North-East Ethiopia, 2021. METHODS Institution-based retrospective follow-up study was conducted on 474 HIV-infected individuals who were on SLART between September 2016 and April 2020. A universal sampling technique was used to recruit study participants. Data were entered by EpiData-3.3.1 and analyzed by STATA-14. Cox proportional hazard assumptions were checked to determine the effect of predictor variables on virological failure (VF). The study was conducted from February 1 to April 30, 2021. RESULTS The rate of VF in this study was 15.4% with an incidence rate of 4.93 per 100 person-years. As participants' age and duration of ART use increased by 1 year the hazards of VF was reduced by 2.9% (AHR: 0.971, 95% CI: 0.945, 0.995) and 10.6% (AHR: 0.894, 95% CI: 0.828, 0.963), respectively. The hazards of VF were twice higher among those who were on a non-protease inhibitor-based regimen. Individuals who had a history of making enhanced adherence counseling (EAC) sessions during SLART had three times more risk to develop VF (AHR: 3.374, 95% CI: 1.790, 6.361). CONCLUSION AND RECOMMENDATIONS The rate of VF among SLART users was high. Keeping SLART users on PI-based regimens may improve virological outcomes in HIV care and treatment. Making EAC sessions effective in promoting better ART adherence might reduce VF.
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Affiliation(s)
| | | | - Gedefaw Diress Alen
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
| | | | | | | | - Tadesse Mamo Dejene
- Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia
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Odhiambo JA, Weiser SD, Frongillo EA, Burger RL, Weke E, Wekesa P, Bukusi EA, Cohen CR. Comparing the effect of a multisectoral agricultural intervention on HIV-related health outcomes between widowed and married women. Soc Sci Med 2023; 330:116031. [PMID: 37390805 PMCID: PMC10645573 DOI: 10.1016/j.socscimed.2023.116031] [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: 02/08/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023]
Abstract
INTRODUCTION Widowed women make up 18-40% of the 12 million women living with HIV in eastern and southern Africa. Widowhood has also been associated with greater HIV morbidity and mortality. We compared the effectiveness of a multisectoral climate adaptive agricultural livelihood intervention (called Shamba Maisha) on food insecurity, and HIV related health outcomes among widowed and married women living with HIV in western Kenya. METHODS We implemented Shamba Maisha (NCT02815579) using a cluster-randomized control trial design. The intervention arm received an US$175 in-kind loan to purchase a micro-irrigation pump, seeds, and fertilizer, and received eight training sessions on sustainable agriculture and financial management. Study outcomes were measured every 6 months over a 24-month follow-up period and trends in outcomes assessed using multilevel mixed-effects models. RESULTS The trial enrolled 232 (61.5%) married and 145 (38.5%) widowed women. Widowed women (mean age 42.8 ± 8.4 years) were older than married women (35.8 ± 9.0 years) (p < 0.01). Almost all widowed women (97.2%) self-identified as household heads compared to 10.8% of married women. Comparing widowed vs married women, reduction in food insecurity (-3.13, 95%CI -4.42, -1.84 vs. -3.08, 95%CI -4.15, -2.02), depressive symptoms (-0.21, 95%CI -0.36, -0.07 vs. -0.19, 95%CI -0.29, -0.08), internalized stigma (-0.33, 95%CI -0.55, -0.11 vs. -0.38, 95%CI -0.57, -0.19), and anticipated stigma (-0.46 95%CI -0.65, -0.28 vs. -0.35, 95%CI -0.50, -0.21) was similar for both groups. In contrast, improvements in social support (-2.22, 95%CI -3.85, -0.59 vs. -4.00, 95%CI -5.16, -2.84; p = 0.08) and reduction in enacted stigma (0.01, 95%CI -0.06, 0.08 vs. -0.14, 95%CI -0.20, -0.09; p < 0.01) were weaker for widowed than married women. CONCLUSIONS Our study is among the first comparing the effect of a livelihood intervention on HIV health outcomes among widowed and married women. Widowed women experienced similar benefits as married women on individual-level outcomes, but weaker benefit on outcomes dependent on their external environment like enacted stigma and social support. Future trials and programs targeting widowed women should bolster stigma reduction and social support.
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Affiliation(s)
- Jackline A Odhiambo
- School of Public Health and Community Development, Maseno University, Maseno, Kenya; Nyanam Widows Rising, Kisumu, Kenya.
| | - Sheri D Weiser
- Department of Medicine, University of California San Francisco, CA, USA
| | | | - Rachel L Burger
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, CA, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Kenya
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Kenya
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, CA, USA
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Shrestha S, Chataut S, Kc B, Acharya K, Pradhan SK, Shrestha S. Knowledge, Attitude, Practice, and Adherence to Antiretroviral Therapy among People Living with HIV in Nepal. AIDS Res Treat 2023; 2023:7292115. [PMID: 37492128 PMCID: PMC10365915 DOI: 10.1155/2023/7292115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/25/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023] Open
Abstract
Introduction Patient's knowledge and attitude towards their treatment avert stereotypical misconceptions about the disease and its treatment, as well as aid in attaining optimal adherence. This study investigated the knowledge, attitude, practice, and adherence of antiretroviral therapy (ART) clients in Nepal. Method A cross-sectional study was conducted among 165 ART clients visiting five ART sites in the far western region and the capital city of Nepal. The convenience sampling method was employed, and the data were collected through interviews with ART clients using a validated questionnaire. Binary logistic regression was used to identify associated factors. Result Approximately 80.7% had adequate knowledge and 55% had a positive attitude towards ART. Stigmatization was associated with ARV by only 4.2%. Half of the participants (50.3%) revealed that they had surreptitiously stored their ART medication, diverging from the recommended storage guidelines. A significant proportion of respondents (33.3%) chose to repackage the medication as a strategy to prevent unintended disclosure of their HIV status. Many (59.3%) believed that ART does not prolong life. Nevertheless, they advocated the regular use of ART rather than taking it only when the health deteriorates (81.8%). The majority (97.6%) were found to be adherent to their ART. There was a significant association of age with a level of knowledge and attitude (p < 0.05). A significant association was also found between knowledge and attitude towards ART (p < 0.05). None of the variables had a significant association with adherence (p > 0.05). Conclusion Overall, adequate knowledge was demonstrated, whereas efforts are still needed to improve the attitude of ART clients towards ART. A need for counseling regarding the storage practices of ART is needed. A focus on ensuring the perfect translation of adequate knowledge and a positive attitude to the practice of ART clients is essential. Whether adequate ART knowledge and attitude scores will lead to near-perfect ART adherence needs further investigation.
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Affiliation(s)
- Sweta Shrestha
- Department of Pharmacy, School of Science, Kathmandu University, Dhulikhel, Kavre, Nepal
| | - Subodh Chataut
- Department of Pharmacy, School of Science, Kathmandu University, Dhulikhel, Kavre, Nepal
| | - Badri Kc
- Department of Pharmacy, School of Science, Kathmandu University, Dhulikhel, Kavre, Nepal
| | - Khagendra Acharya
- Department of Management Informatics and Communication, School of Management, Kathmandu University, Dhulikhel, Kavre, Nepal
| | - Sait Kumar Pradhan
- Department of Clinical Physiology, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
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Musanje K, Kamya MR, Kasujja R, Hooper N, Katahoire AR, White RG, Kimera E, Getahun M, Sinclair DL, Ojiambo D, Camlin CS. Acceptability of an adapted mindfulness and acceptance-based intervention to support adolescents with HIV: A qualitative study with Ugandan health care providers. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023; 29:160-168. [PMID: 37519920 PMCID: PMC10373499 DOI: 10.1016/j.jcbs.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
While the adaptation of evidence-based psychosocial support tailors the intervention components to the targeted context, minimizing the associated costs of developing new interventions for low-income contexts, the acceptability of such adapted interventions is important for augmenting successful implementation and sustainability. Given that psychosocial support to persons living with HIV is mostly rendered by healthcare providers, their acceptance of adapted interventions before implementation is crucial. This study explored healthcare providers' acceptance of an adapted mindfulness and acceptance-based intervention supporting adolescents with HIV. Ten healthcare providers at two urban clinics in Kampala, Uganda attended a three-day training on using the adapted intervention and gave feedback on its appropriateness during in-depth interviews conducted thereafter. Semi-structured interviews were based on the Theoretical Framework of Acceptability and findings were analyzed abductively within the seven components of the framework. Overall, the adapted intervention was perceived to be acceptable and appropriate for use with adolescents. Benefits included the intervention offering support beyond a focus on adherence to drugs, refocusing adolescents on aspects in their lives that matter most, and being easy to integrate into providers' work processes. Providers however expressed concern about the time the intervention requires and the possibility of increasing their workload. These findings will support further adaptation and implementation.
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Affiliation(s)
- Khamisi Musanje
- Department of Educational, Social and Organizational Psychology, Makerere University, Uganda
- Clinical Epidemiology Unit, Makerere University, Uganda
| | | | - Rosco Kasujja
- Department of Mental Health and Community Psychology, Makerere University, Uganda
| | - Nic Hooper
- School of Psychology, Cardiff University, Wales, UK
| | | | - Ross G. White
- School of Psychology, Queens University, Belfast, Northern Ireland
| | - Emanuel Kimera
- Department of Public Health, Mountain of the Moon University, Uganda
| | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | | | - Deborah Ojiambo
- Department of Mental Health and Community Psychology, Makerere University, Uganda
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences. University of California, San Francisco, USA
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Toska E, Zhou S, Chen-Charles J, Gittings L, Operario D, Cluver L. Factors Associated with Preferences for Long-Acting Injectable Antiretroviral Therapy Among Adolescents and Young People Living with HIV in South Africa. AIDS Behav 2023; 27:2163-2175. [PMID: 36622486 PMCID: PMC9827015 DOI: 10.1007/s10461-022-03949-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/10/2023]
Abstract
Long-acting injectable anti-retroviral therapy (LAART) may overcome barriers to long-term adherence and improve the survival of adolescents and young people living with HIV (AYLHIV). Research on the acceptability of LAART for this age-group is limited. We asked 953 AYLHIV about their preferred (theoretical) ART mode of delivery (pill, injectable, or other) in 2017-2018, before LAART was available or known to AYLHIV in South Africa. One in eight (12%) AYLHIV preferred LAART over single or multiple pill regimens. In multivariate analyses, six factors were associated with LAART preference: medication stock-outs (aOR = 2.56, 95% CI 1.40-4.68, p = 0.002), experiencing side-effects (aOR = 1.84, 95% CI 1.15-2.97, p = 0.012), pill-burden (aOR = 1.88, 95% CI 1.20-2.94, p = 0.006), past-year treatment changes (aOR = 1.63, 95% CI 1.06-2.51, p = 0.025), any HIV stigma (aOR = 2.22, 95% CI 1.39-3.53, p ≤ 0.001) and recent ART initiation (aOR = 2.02, 95% CI 1.09-3.74, p = 0.025). In marginal effects modelling, 66% of adolescents who experienced all factors were likely to prefer LAART, highlighting the potential high acceptability of LAART among adolescents and young people living with HIV struggling to adhere and have good HIV treatment outcomes. Adolescent boys who reported high ART pill burden were more likely to prefer LAART than their female peers in moderation analyses, suggesting that LAART may be particularly important to improve treatment outcomes among male AYLHIV as they become older. Adding LAART to existing treatment options for AYLHIV, particularly higher risk groups, would support AYLHIV to attain and sustain viral suppression-the third 95, and reduce their risk of AIDS-related mortality.
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Affiliation(s)
- Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.
- Department of Sociology, University of Cape Town, Cape Town, South Africa.
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
- Centre for Social Science Research, Leslie Social Sciences Building, University of Cape Town, 4.89, Rondebosch, Cape Town, 7700, South Africa.
| | - Siyanai Zhou
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jenny Chen-Charles
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Lesley Gittings
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- School of Health Studies, Faculty of Health Sciences, Western University, London, Canada
| | - Don Operario
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, UK
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Perngmark P, Sahawiriyasin O, Holroyd E. Experiences of Thai-Muslim patients regarding inconsistent antiretroviral therapy adherence: An exploratory descriptive qualitative study. BELITUNG NURSING JOURNAL 2023; 9:253-261. [PMID: 37492759 PMCID: PMC10363971 DOI: 10.33546/bnj.2426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/13/2022] [Accepted: 04/03/2023] [Indexed: 07/27/2023] Open
Abstract
Background Antiretroviral therapy (ART) has played a crucial role in saving countless lives of patients with HIV/AIDS across the world. However, despite its effectiveness, ART adherence still falls short globally, and non-adherence remains the primary cause of treatment failure. In the rural areas of southern Thailand, where the population is predominantly conservative Muslims, there has been an observed increase in ART non-adherence. Objective This study aimed to explore experiences of inconsistent ART adherence among Thai-Muslim patients with HIV/AIDS (PWHAs) in southern Thailand. In addition, the perspectives of healthcare providers were also sought. Methods Data were collected by conducting semi-structured in-depth interviews with ten Thai-Muslim PWHAs and five healthcare providers at a Voluntary Counseling-and-Testing Clinic. A content analysis approach was utilized to analyze the data. Results Inconsistent ART adherence was reported. Religion/spiritual imperatives, forgetfulness, inadequate knowledge (of drug side effects and drug regime), misunderstandings (about being symptom-free and feeling well), boredom from long-term drug-taking regimes, as well as poor transportation and lack of family support (arising from non-disclosure of one's HIV-serostatus due to HIV stigma) were emergent themes derived from the interviews with Thai-Muslim PWHAs. The healthcare providers' interview data revealed their need for the integration of Islamic beliefs to provide better care. Conclusion It is essential for healthcare teams to work collaboratively with patients' religious beliefs to enhance ART adherence. Clinical nurses can contribute to the promotion of HIV-care services by integrating Islamic beliefs and Muslim culture into their practice, thus increasing patients' knowledge and motivation for ART adherence. This could entail utilizing Islamic prayer rituals as drug reminders, elaborating on Islamic moral beliefs concerning sickness and healing, and integrating the cultural imperatives of self-care in the Muslim community into ongoing care delivery. Cross-cultural nursing education and specialized training in HIV care should incorporate knowledge about Islamic and Muslim cultural beliefs.
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Affiliation(s)
| | | | - Eleanor Holroyd
- Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand
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Mandlate FM, Greene MC, Pereira LF, Gouveia ML, Mari JJ, Cournos F, Duarte CS, Oquendo MA, Mello MF, Wainberg ML. Association between mental disorders and adherence to antiretroviral treatment in health facilities in two Mozambican provinces in 2018: a cross-sectional study. BMC Psychiatry 2023; 23:274. [PMID: 37081470 PMCID: PMC10116733 DOI: 10.1186/s12888-023-04782-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/13/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION Lower adherence to antiretroviral treatment (ART) has been found among people with HIV (PWH) who have comorbid mental disorders like depression and alcohol use in Sub-Saharan African. However, there has been less exploration with regards to other mental disorders. METHODS This study assessed the association of multiple mental disorders and adherence to ART based on the data from primary/tertiary health care facilities in Maputo and Nampula, Mozambique. We administered a sociodemographic questionnaire, Mini International Neuropsychiatric Interview (MINI) Plus 4.0.0 adapted for use in Mozambique to assess mental conditions, and a 3-item self-report to measure ART adherence. RESULTS 395 HIV-positive (self-report) participants on ART, with an average age of 36.7 years (SD = 9.8), and 30.4% were male. The most common mental disorders were major depressive disorder (27.34%) followed by psychosis (22.03%), suicidal ideation/behavior (15.44%), and alcohol-use disorder (8.35%). Higher odds of missing at least one dose in the last 30 days (OR = 1.45, 95% CI: 1.01, 2.10) were found in participants with any mental disorder compared to those without a mental disorder. The highest levels of non-adherence were observed among those with drug use disorders and panic disorder. CONCLUSIONS In Mozambique, PWH with any co-occurring mental conditions had a lower probability of ART adherence. Integrating comprehensive mental health assessment and treatment and ART adherence interventions tailored to PWH with co-occurring mental disorders is necessary to attain optimal ART adherence and reach the UNAIDS ART target.
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Affiliation(s)
- Flavio M. Mandlate
- Department of Mental Health, Ministry of Health, Eduardo Mondlane Avenue, nr 1008, Postal Code 264 Maputo, Mozambique
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - M. Claire Greene
- Program on Forced Migration and Health, Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, USA
| | - Luis F. Pereira
- New York State Psychiatric Institute, Columbia University, New York, USA
| | - Maria Lidia Gouveia
- Department of Mental Health, Ministry of Health, Eduardo Mondlane Avenue, nr 1008, Postal Code 264 Maputo, Mozambique
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Jair Jesus Mari
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Francine Cournos
- New York State Psychiatric Institute, Columbia University, New York, USA
| | | | - Maria A. Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Marcelo Feijó Mello
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Milton L. Wainberg
- New York State Psychiatric Institute, Columbia University, New York, USA
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Stecher C, Palimaru AI, Odiit M, Lunkuse L, Walukaga S, Linnemayr S. Barriers and facilitators of antiretroviral therapy (ART) adherence habit formation in Sub-Saharan Africa: Evidence from a qualitative study in Kampala, Uganda. Soc Sci Med 2023; 317:115567. [PMID: 36459789 PMCID: PMC9839633 DOI: 10.1016/j.socscimed.2022.115567] [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: 11/03/2021] [Revised: 10/12/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022]
Abstract
RATIONALE In 2020, nearly 40 million people lived with HIV/AIDS (PLWHA) worldwide, of whom 70% were receiving antiretroviral therapy (ART). Two-thirds of PLWHA reside in Sub-Saharan Africa (SSA), where rates of viral load suppression are often suboptimal and frequently attributed to low ART adherence. Strong pill-taking habits are often reported as a key strategy among those who successfully maintain medication adherence, yet not enough is known about the barriers and facilitators in SSA to pill-taking in response to the same contextual cue, which is a necessary step in the habit formation process. OBJECTIVE To address this knowledge gap and to inform a subsequent intervention to promote context-dependent repetition, called anchoring, we used a formative qualitative approach to collect in-depth narratives about barriers and facilitators of the anchoring intervention for establishing ART pill-taking habits at the Mildmay Hospital in Kampala, Uganda. METHODS We conducted interviews with 25 randomly selected patients starting ART, 5 expert patients, and 10 providers at Mildmay, and performed a rapid analysis to inform the intervention in a timely manner. RESULTS We found that pill taking in response to the same contextual cue, or anchor, was threatened by stigma and food insecurity and that the COVID-19 pandemic exacerbated these barriers. We also determined that important linguistic changes were needed to the instructional materials and reminder messages in the subsequent intervention to avoid words and phrases with negative connotations for this target population. CONCLUSIONS Several important barriers and facilitators to context-dependent pill taking in Uganda were identified through our formative research that helped to inform important revisions to our subsequent intervention. These findings underscore the importance of understanding local barriers and facilitators when designing and planning interventions, particularly when implementing theory-based intervention approaches that have yet to be tested in a new setting.
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Affiliation(s)
- Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
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Macleod D, Shanaube K, Skalland T, Limbada M, Mandla N, Bwalya J, Schaap A, Yang B, Donnell D, Piwowar-Manning E, Eshleman SH, Hoddinott G, Bond V, Moore A, Griffith S, Bock P, Ayles H, Fidler S, Hayes R, Floyd S. Viral suppression and self-reported ART adherence after 3 years of universal testing and treatment in the HPTN 071 (PopART) community-randomised trial in Zambia and South Africa: a cross-sectional analysis. Lancet HIV 2022; 9:e751-e759. [PMID: 36332652 PMCID: PMC9646982 DOI: 10.1016/s2352-3018(22)00237-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 07/25/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In 2014, UNAIDS set the target that 90% of individuals on antiretroviral therapy (ART) be virally suppressed. Here, we use data from the HPTN 071 (PopART) trial to report whether the introduction of universal testing and treatment has affected viral suppression or treatment adherence among individuals who self-reported they were taking ART, and identify risk factors for these outcomes. METHODS This was a cross-sectional study nested within the randomly selected population cohort of the PopART trial. The trial took place in 21 communities in Zambia and South Africa. Analyses included 3570 HIV-positive participants who were seen at the second follow-up visit in 2016-17 and who self-reported that they were currently taking ART. Viral suppression was defined as HIV RNA of less than 400 copies per mL from a blood sample collected during the cohort visit, and ART adherence was measured using self-reporting (reported as no missed pills in last 7 days). Prevalences of these outcomes were compared across three trial arms using a two-stage approach suitable for clustered data. Each arm consisted of seven communities, with one arm receiving a combination HIV prevention package including immediate ART initiation, one receiving a combination HIV prevention package excluding immediate ART initiation and one arm receving standard of care. Risk factors for each of the outcomes were assessed using logistic regression. FINDINGS Among the 3570 participants who self-reported that they were currently on ART, 416 (11·7%) of 3554 were not virally suppressed (16 were missing viral suppression status) and 345 (9·7%) of 3566 reported being non-adherent to ART (four were missing adherence status). The proportion not virally suppressed was higher in communities in South Africa (195 [16·4%] of 1191) than in Zambia (221 [9·4%] of 2363). There was no evidence that the prevalence of the outcomes differed between trial arms. There was evidence that men, younger individuals, individuals who reported participating in harmful alcohol use, and those who reported internalised stigma were more likely to be non-adherent, and not virally suppressed. INTERPRETATION The results assuaged concerns that early ART initiation in a universal testing and treatment setting could lead to reduced adherence and viral suppression. FUNDING US National Institute of Allergy and Infectious Diseases (which is a part of the National Institutes of Health), the International Initiative for Impact Evaluation with support from the Bill & Melinda Gates Foundation, US President's Emergency Plan for AIDS Relief, and Medical Research Council UK.
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Affiliation(s)
- David Macleod
- International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Kwame Shanaube
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Mohammed Limbada
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Nomtha Mandla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Justin Bwalya
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Ab Schaap
- International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Blia Yang
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Deborah Donnell
- HPTN Statistical and Data Management Centre, Seattle, WA, USA
| | | | - Susan H Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Virginia Bond
- Global Health and Development Department, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Ayana Moore
- FHI 360, HIV Prevention Trials Network, Durham, NC, USA
| | - Sam Griffith
- FHI 360, HIV Prevention Trials Network, Durham, NC, USA
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Helen Ayles
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Sarah Fidler
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Richard Hayes
- International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sian Floyd
- International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Beja H, Daisy N, Edek MT, Kobusinge V, Akaki O, Owachgiu IO, Udho S. Barriers and Facilitators to Successful Intensive Adherence Counseling in Rural Northern Uganda: An Exploratory Interview with HIV-Positive Clients Using the COM-B Framework. HIV/AIDS - RESEARCH AND PALLIATIVE CARE 2022; 14:553-563. [DOI: 10.2147/hiv.s393093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022]
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Mhungu A, Sixsmith J, Burnett E. Adolescent Girls and Young Women's Experiences of Living with HIV in the Context of Patriarchal Culture in Sub-Saharan Africa: A Scoping Review. AIDS Behav 2022; 27:1365-1379. [PMID: 36318422 PMCID: PMC10129999 DOI: 10.1007/s10461-022-03872-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 04/28/2023]
Abstract
Adolescent girls and young women (AGYW) in sub-Saharan Africa are disproportionately affected by the human immunodeficiency virus (HIV) due to socio-cultural gender, power, and economic disparities. This scoping review examined the literature to explore what is known about AGYW's everyday personal, relational, and social experiences of HIV to help shape future protective HIV policy and practice. Six databases were searched: Medline, CINAHL, Scopus, ASSIA, Google Scholar, and ProQuest, resulting in a total of 12,581 articles. Of these, 40 articles were included in the review. Key themes generated from the thematic analysis were relational and psychosocial challenges, inhibiting sexual expression, poverty, stigma, and discrimination; managing health in everyday life; agency and resilience; and personal space and social support. In conclusion, the review found a lack of understanding of AGYW's everyday experiences of living with HIV from their own perspectives. There was also little consideration of the role of patriarchal culture and how this constrains AGYW's ability to negotiate their relationships. Further research is needed to reveal AGYW's perspectives on living with HIV in sub-Saharan Africa.
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Affiliation(s)
- Alington Mhungu
- School of Health Sciences, University of Dundee, 11 Arlie Place, DD1 4HN, Dundee, Scotland.
| | - Judith Sixsmith
- School of Health Sciences, University of Dundee, 11 Arlie Place, DD1 4HN, Dundee, Scotland
| | - Emma Burnett
- School of Health Sciences, University of Dundee, 11 Arlie Place, DD1 4HN, Dundee, Scotland
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Simelane PT, Simelane MS, Amoateng AY. Barriers and facilitators to adherence for antiretroviral therapy: the perspectives of patients from a wellness center in the Mpumalanga Province, South Africa. Afr Health Sci 2022; 22:455-462. [PMID: 36910408 PMCID: PMC9993319 DOI: 10.4314/ahs.v22i3.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Patients' non-adherence to antiretroviral treatment remains a public health concern in many developing countries, especially in South Africa. Objectives The objective of the study was to explore the barriers and facilitators of patients' ART adherence in one health care facility in Mpumalanga Province, South Africa. Methods A qualitative, exploratory, and descriptive design was employed to collect data using a semi-structured interview guide through individual in-depth interviews among twenty (20) purposively selected patients. The thematic analysis approach was used to generate themes from the data. Results A majority of the participants were female (n=12, 60%), married (n=13, 65%), and employed (n=12, 60%). Barriers to ART adherence include insufficient medical staff at the health center and waiting time being too long. Facilitators included service providers' positive attitude, clear instructions for taking medication, benefits of adhering to ART, and dangers of defaulting treatment. Conclusion Barriers and facilitators for adherence included several factors related to the health system, health care workers, and the patients. Achievement of optimal adherence to ART requires the commitment of both patients and providers.
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Affiliation(s)
- Portia T Simelane
- Department of Demography and Population Studies, Northwest University, Mafikeng, Northwest Province, South Africa
| | - Maswati S Simelane
- Department of Statistics and Demography, Faculty of Social Sciences, University of Eswatini, Eswatini
| | - Acheampong Y Amoateng
- School of Research Studies, Northwest University, Mafikeng Campus, Northwest Province, South Africa
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Akankunda S, Nambi Najjuma J, Tayebwa S, Byamugisha B, Ariho S, Bahati R. The Role of Mass Media Campaigns in Improving Adherence to Antiretroviral Therapy Among Adolescents Living with HIV in Southwestern Uganda. HIV AIDS (Auckl) 2022; 14:397-407. [PMID: 36039117 PMCID: PMC9419725 DOI: 10.2147/hiv.s375789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Sandra Akankunda
- Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
| | | | - Sandra Tayebwa
- Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Benjamen Byamugisha
- Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Sabastian Ariho
- Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Ronald Bahati
- Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Correspondence: Ronald Bahati, Bishop Stuart University, Faculty of Nursing and Health Sciences, P. o Box 09, Mbarara City, Uganda, Tel +256701512551, Email
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Mhlanga TT, Jacobs BKM, Decroo T, Govere E, Bara H, Chonzi P, Sithole N, Apollo T, Van Damme W, Rusakaniko S, Lynen L, Makurumidze R. Virological outcomes and risk factors for non-suppression for routine and repeat viral load testing after enhanced adherence counselling during viral load testing scale-up in Zimbabwe: analytic cross-sectional study using laboratory data from 2014 to 2018. AIDS Res Ther 2022; 19:34. [PMID: 35810317 PMCID: PMC9270749 DOI: 10.1186/s12981-022-00458-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since the scale-up of routine viral load (VL) testing started in 2016, there is limited evidence on VL suppression rates under programmatic settings and groups at risk of non-suppression. We conducted a study to estimate VL non-suppression (> 1000 copies/ml) and its risk factors using "routine" and "repeat after enhanced adherence counselling (EAC)" VL results. METHODS We conducted an analytic cross-sectional study using secondary VL testing data collected between 2014 and 2018 from a centrally located laboratory. We analysed data from routine tests and repeat tests after an individual received EAC. Our outcome was viral load non-suppression. Bivariable and multivariable logistic regression was performed to identify factors associated with having VL non-suppression for routine and repeat VL. RESULTS We analysed 103,609 VL test results (101,725 routine and 1884 repeat test results) collected from the country's ten provinces. Of the 101,725 routine and 1884 repeat VL tests, 13.8% and 52.9% were non-suppressed, respectively. Only one in seven (1:7) of the non-suppressed routine VL tests had a repeat test after EAC. For routine VL tests; males (vs females, adjusted odds ratio (aOR) = 1.19, [95% CI 1.14-1.24]) and adolescents (10-19 years) (vs adults (25-49 years), aOR = 3.11, [95% CI 2.9-3.31]) were more at risk of VL non-suppression. The patients who received care at the secondary level (vs primary, aOR = 1.21, [95% CI 1.17-1.26]) and tertiary level (vs primary, aOR = 1.63, [95% CI 1.44-1.85]) had a higher risk of VL non-suppression compared to the primary level. Those that started ART in 2014-2015 (vs < 2010, aOR = 0.83, [95% CI 0.79-0.88]) and from 2016 onwards (vs < 2010, aOR = 0.84, [95% CI 0.79-0.89]) had a lower risk of VL non-suppression. For repeat VL tests; young adults (20-24 years) (vs adults (25-49 years), (aOR) = 3.48, [95% CI 2.16 -5.83]), adolescents (10-19 years) (vs adults (25-49 years), aOR = 2.76, [95% CI 2.11-3.72]) and children (0-9 years) (vs adults (25-49 years), aOR = 1.51, [95% CI 1.03-2.22]) were at risk of VL non-suppression. CONCLUSION Close to 90% suppression in routine VL shows that Zimbabwe is on track to reach the third UNAIDS target. Strategies to improve the identification of clients with high routine VL results for repeating testing after EAC and ART adherence in subpopulations (men, adolescents and young adolescents) at risk of viral non-suppression should be prioritised.
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Affiliation(s)
| | | | - Tom Decroo
- Institute of Tropical Medicine, Antwerp, Belgium.,Research Foundation of Flanders, Brussels, Belgium
| | - Emma Govere
- Harare City Council, Department of Health, Harare, Zimbabwe
| | - Hilda Bara
- Harare City Council, Department of Health, Harare, Zimbabwe
| | - Prosper Chonzi
- Harare City Council, Department of Health, Harare, Zimbabwe
| | - Ngwarai Sithole
- AIDS & TB Unit, Ministry of Health & Child Care, Harare, Zimbabwe
| | - Tsitsi Apollo
- AIDS & TB Unit, Ministry of Health & Child Care, Harare, Zimbabwe
| | - Wim Van Damme
- Institute of Tropical Medicine, Antwerp, Belgium.,Gerontology, Faculty of Medicine & Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | | | - Richard Makurumidze
- Institute of Tropical Medicine, Antwerp, Belgium. .,Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe. .,Gerontology, Faculty of Medicine & Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
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21
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Moyo I, Tshivhase L, Mavhandu-Mudzusi AH. Utilisation of HIV services by female sex workers in Zimbabwe during the COVID-19 pandemic: a descriptive phenomenological study. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2022; 21:183-193. [PMID: 35901301 DOI: 10.2989/16085906.2022.2101934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
This study focuses on female sex workers as a key population group that suffers a degree of vulnerability according to the World Health Organisation (WHO). Key populations refer to people at heightened risk of contracting the human immunodeficiency virus (HIV) due to specific behaviours and social and legal environments which increase their vulnerability to the virus. Key populations are disproportionately affected by HIV, yet they have less access to HIV services compared to the general population. The coronavirus (COVID-19) lockdown and its restrictive measures have further widened the inequalities and gaps in accessing HIV services for this group. A descriptive phenomenological study was undertaken to explore female sex workers' experiences of utilisation of HIV services during COVID-19. The study setting was the Bulawayo Metropolitan Province, Zimbabwe. Data were collected through in-depth individual interviews with 10 female sex workers. Purposive sampling coupled with snowballing was utilised for recruiting participants. Data were analysed guided by the seven-step Colaizzi technique. Rigour was ensured through adhering to Lincoln and Guba's trustworthiness criteria. The study found that the COVID-19 pandemic adversely affected the livelihoods of sex workers and their utilisation of HIV services. There was limited access to HIV services due to an initial lack of travel authorisation letters and financial challenges experienced by study participants. In addition, the quality of care in health care facilities was further compromised by poor screening processes and reduced provider-client interactions. Maintaining access to HIV services for female sex workers during pandemics is critical for the country to attain HIV epidemic control.
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Affiliation(s)
- Idah Moyo
- Department of HIV Services, Populations Solutions for Health, Harare, Zimbabwe
- Department of Health Studies, University of South Africa, Pretoria, South Africa
| | - Livhuwani Tshivhase
- Department of Nursing Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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22
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Saya U, MacCarthy S, Mukasa B, Wabukala P, Lunkuse L, Wagner Z, Linnemayr S. "The one who doesn't take ART medication has no wealth at all and no purpose on Earth" - a qualitative assessment of how HIV-positive adults in Uganda understand the health and wealth-related benefits of ART. BMC Public Health 2022; 22:1056. [PMID: 35619119 PMCID: PMC9137215 DOI: 10.1186/s12889-022-13461-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Increases in life expectancy from antiretroviral therapy (ART) may influence future health and wealth among people living with HIV (PLWH). What remains unknown is how PLWH in care perceive the benefits of ART adherence, particularly in terms of improving health and wealth in the short and long-term at the individual, household, and structural levels. Understanding future-oriented attitudes towards ART may help policymakers tailor care and treatment programs with both short and long-term-term health benefits in mind, to improve HIV-related outcomes for PLWH. METHODS In this qualitative study, we conducted semi-structured interviews among a subsample of 40 PLWH in care at a clinic in Uganda participating in a randomized clinical trial for treatment adherence in Uganda (clinicaltrials.gov: NCT03494777). Interviews were transcribed verbatim and translated from Luganda into English. Two co-authors independently reviewed transcripts, developed a detailed codebook, achieved 93% agreement on double-coded interviews, and analyzed data using inductive and deductive content analysis. Applying the social-ecological framework at the individual, household, and structural levels, we examined how PLWH perceived health and wealth-related benefits to ART. RESULTS Our findings revealed several benefits of ART expressed by PLWH, going beyond the short-term health benefits to also include long-term economic benefits. Such benefits largely focused on the ability of PLWH to live longer and be physically and mentally healthy, while also fulfilling responsibilities at the individual level pertaining to themselves (especially in terms of positive long-term habits and motivation to work harder), at the household level pertaining to others (such as improved relations with family and friends), and at the structural level pertaining to society (in terms of reduced stigma, increased comfort in disclosure, and higher levels of civic responsibility). CONCLUSIONS PLWH consider short and long-term health benefits of ART. Programming designed to shape ART uptake and increase adherence should emphasize the broader benefits of ART at various levels. Having such benefits directly integrated into the design of clinic-based HIV interventions can be useful especially for PLWH who face competing interests to increase medication adherence. These benefits can ultimately help providers and policymakers better understand PLWH's decision-making as it relates to improving ART-related outcomes.
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Affiliation(s)
- Uzaib Saya
- Pardee RAND Graduate School, Santa Monica, CA, 90401, USA.
- RAND Corporation, Santa Monica, CA, 90401, USA.
| | - Sarah MacCarthy
- Department of Health Behavior, University of Alabama at Birmingham School of Public Health, 227, Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL, 35233, USA
| | | | | | | | - Zachary Wagner
- Pardee RAND Graduate School, Santa Monica, CA, 90401, USA
- RAND Corporation, Santa Monica, CA, 90401, USA
| | - Sebastian Linnemayr
- Pardee RAND Graduate School, Santa Monica, CA, 90401, USA
- RAND Corporation, Santa Monica, CA, 90401, USA
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23
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Azia I, Mukumbang FC, Shernaaz C, Nyembezi A. Role of religious beliefs on antiretroviral treatment adherence among Pentecostal Christians in sub-Saharan Africa: a scoping review protocol. BMJ Open 2022; 12:e052750. [PMID: 35365516 PMCID: PMC8977748 DOI: 10.1136/bmjopen-2021-052750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Sub-Saharan Africa continues to be disproportionately affected by HIV/AIDS. As such, several countries in sub-Saharan Africa are implementing the UNAIDS' recommendation to test and treat people living with HIV (PLHIV) irrespective of their CD4 count. However, most of the antiretroviral treatment (ART) programmes, in this region, continue to struggle with poor adherence to treatment stemming from patient-related factors including their religious beliefs. Unfortunately, the role of religious beliefs on ART adherence has been underexplored in the literature. In this study protocol, we propose the steps of a scoping review to explore, identify and map the literature on the impact of religious beliefs on adherence to ART among Pentecostals living with HIV in sub-Saharan Africa. METHODS AND ANALYSIS We will use Arksey and O'Malley's framework and the Joanna Briggs Institute methodology guidelines to conduct this scoping review. The following databases will be searched for relevant literature: Web of Science, PubMed/Medline, Psych-ARTICLES, Academic Search Complete, Cumulative Index of Nursing, Allied Health, Google Scholar and published articles from conference proceedings. Studies published between January 2010 and February 2022 will be eligible. The identified literature will be independently screened for eligibility by two reviewers based on predetermined inclusion and exclusion criteria. An Excel form will be designed to electronically capture data from studies that meet the inclusion criteria. Finally, we will use a narrative synthesis to summarise the data extracted to report on the nature of existing evidence and the impact of religious beliefs on ART adherence. ETHICS AND DISSEMINATION Ethical approval will not be required for the scoping review since it will entail synthesising information from already published articles and conference proceedings. The study findings will be disseminated through publication in a scientific journal and presented at conferences and workshops aimed at improving adherence to ART in PLHIV.
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Affiliation(s)
- Ivo Azia
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa
| | - Ferdinand C Mukumbang
- Department of Global Health, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA
| | - Carelse Shernaaz
- Department of Social Work, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa
| | - Anam Nyembezi
- School of Public Health, University of the Western Cape, Cape Town, Western Cape, South Africa
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24
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Zhang JY, Zhang Y, Bender AT, Sullivan BP, Olanrewaju AO, Lillis L, Boyle D, Drain PK, Posner JD. HIV pre-exposure prophylaxis adherence test using reverse transcription isothermal amplification inhibition assay. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2022; 14:1361-1370. [PMID: 35297917 PMCID: PMC8991996 DOI: 10.1039/d2ay00008c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Current HIV antiretroviral therapy (ART) or pre-exposure prophylaxis (PrEP) therapy adherence monitoring relies on either patient self-reported adherence or monitored drug dispensing, which are not reliable. We report a proof-of-concept adherence monitoring assay which directly measures nucleotide reverse transcriptase inhibitor (NRTI) concentration using a reverse transcription isothermal amplification inhibition assay. We measure the concentration of Tenofovir diphosphate (TFV-DP) - an NRTI that functions as a deoxyadenosine triphosphate (dATP) analog and long-term adherence marker for PrEP - by measuring the inhibition of the reverse transcription of an RNA template. The completion or inhibition of reverse transcription is evaluated by recombinase polymerase amplification (RPA), an isothermal nucleic acid amplification assay commonly used for point-of-care diagnostics. We present and validate a model that predicts the amplification probability as a function of dATP and TFV-DP concentrations, nucleotide insertion sites on the RNA template, and RNA template concentration. The model can be used to rationally design and optimize the assay to operate at clinically relevant TFV-DP concentrations. We provide statistical analysis that demonstrates how the assay may be used as a qualitative or semi-quantitative tool for measuring adherence to NRTI drugs and used to support patient compliance. Due to its simple instrumentation and short runtime (<1 hour), this assay has the potential for implementation in low-complexity laboratories or point-of-care settings, which may improve access to ART and PrEP adherence monitoring.
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Affiliation(s)
- Jane Y Zhang
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA.
| | - Yu Zhang
- Department of Chemical Engineering, University of Washington, Seattle, WA, USA
| | - Andrew T Bender
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA.
| | - Benjamin P Sullivan
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA.
| | | | | | | | - Paul K Drain
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jonathan D Posner
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA.
- Department of Chemical Engineering, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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25
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Ferreira CMSD, Leite ICG. Epidemiological characteristics and adherence of a cohort of elderly people with HIV/AIDS in the Public Health System. EINSTEIN-SAO PAULO 2022; 20:eAO6474. [PMID: 35352767 PMCID: PMC8932733 DOI: 10.31744/einstein_journal/2022ao6474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/08/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To characterize the epidemiological profile of patients aged 50 years or older diagnosed as HIV/AIDS, in a Specialized Service of the Public Health System. Methods A retrospective cohort study using secondary data from medical records in the period 2014 to 2018. Sociodemographic and clinical characteristics, and features related to treatment adherence were organized in a database. Quantitative variables were expressed as mean (or median) ± standard deviation (or interquartile range), and categorical variables expressed as number and percentage of patients. The Kaplan-Meier method was applied to assess the probability of overall specific survival. Results Of the 241 initially eligible patients, 149 patients were evaluated, registering 19 deaths in the studied period. There was a predominance of males aged 50-59 years, with severe immunodeficiency upon admission (29.7%), and with a CD4+ T lymphocyte count below 200 cells in 62 (46.3%) of patients. Elderly people aged 61 or over were more adherent. There was an increase in the CD4+ T lymphocyte count by an average of 139.63 in the first 6 months, and 50.51 from the first 6 months to 12 months of follow-up, with an average increase in the first 12 months of 157.63 cells. Specific overall survival in the period was 85%. Conclusion Patients older than 50 years had an immune response and no viral load detection in the 12-month period, deserving further studies to improve survival.
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26
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Woolf-King SE, Sheinfil AZ, Ramos J, Foley JD, Moskal D, Firkey M, Kellen D, Maisto SA. A conceptual model of alcohol use and adherence to antiretroviral therapy: systematic review and theoretical implications for mechanisms of action. Health Psychol Rev 2022; 16:104-133. [PMID: 32757813 PMCID: PMC8972079 DOI: 10.1080/17437199.2020.1806722] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Alcohol consumption is one of the most prevalent correlates of antiretroviral therapy (ART) adherence, yet causal processes underlying this association remain largely unexplored. The goal of this systematic review was to develop a conceptual model that describes the causal effect of alcohol consumption on ART nonadherence. We reviewed 230 studies that examined the association between alcohol consumption and ART adherence with three primary aims: (1) to replicate and extend previous reviews of the literature, (2) to summarize and critique study designs capable of answering questions about temporal overlap and (3) to summarize potential mechanisms of action. A model of alcohol-associated ART nonadherence was proposed to guide future work, integrating general theories of ART adherence and theory on the psychological and behavioral effects of alcohol intoxication. The conceptual model describes two mechanistic processes-prospective memory impairment and interactive toxicity beliefs/avoidance behaviors-involved in alcohol-associated intentional and unintentional nonadherence, respectively. This model can be used to guide future research on the causal processes involved in the frequently observed correlation between alcohol consumption and adherence.
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Affiliation(s)
| | - Alan Z. Sheinfil
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jeremy Ramos
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jacklyn D. Foley
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Dezarie Moskal
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Madison Firkey
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - David Kellen
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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27
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Hémono R, Kelly NK, Fahey CA, Hassan K, Msasa J, Mfaume RS, Njau PF, Dow WH, McCoy SI. Financial incentives to improve re-engagement in HIV care: results from a randomized pilot study. AIDS Care 2022; 35:935-941. [PMID: 35187992 PMCID: PMC9388698 DOI: 10.1080/09540121.2022.2041164] [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: 10/19/2022]
Abstract
OBJECTIVE Determine the feasibility, acceptability, and preliminary effectiveness of financial incentives to motivate re-engagement in HIV care in Shinyanga, Tanzania. METHODS Out-of-care people living with HIV (PLHIV) were identified from medical records in four clinics and home-based care providers (HBCs) from April 13, 2018 to March 3, 2020. Shinyanga Region residents, ≥18 years, who were disengaged from care were randomized 1:1 to a financial incentive (∼$10 USD) or the standard of care (SOC), stratified by site, and followed for 180 days. Primary outcomes were feasibility (located PLHIV who agreed to discuss the study), acceptability (enrollment among eligibles), and re-engagement in care (clinic visit within 90 days). RESULTS HBCs located 469/1,309 (35.8%) out-of-care PLHIV. Of these, 215 (45.8%) were preliminarily determined to be disengaged from care, 201 (93.5%) agreed to discuss the study, and 157 eligible (100%) enrolled. Within 90 days, 71 (85.5%) PLHIV in the incentive arm re-engaged in care vs. 58 (78.4%) in the SOC (Adjusted Risk Difference [ARD] = 0.08, 95% CI: -0.03, 0.19, p = 0.09). A higher proportion of incentivized PLHIV completed an additional (unincentivized) visit between 90-180 days (79.5% vs. 71.6%, ARD = 0.10, 95% CI: -0.03, 0.24, p = 0.13) and remained in care at 180 days (57.8% vs. 51.4%, ARD = 0.07, 95% CI: -0.09, 0.22, p = 0.40). CONCLUSIONS Short-term financial incentives are feasible, acceptable, and have the potential to encourage re-engagement in care, warranting further study of this approach.
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Affiliation(s)
- Rebecca Hémono
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Nicole K Kelly
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Carolyn A Fahey
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Kassim Hassan
- Health for a Prosperous Nation, Dar es Salaam, Tanzania
| | - Janeth Msasa
- Health for a Prosperous Nation, Dar es Salaam, Tanzania
| | - Rashid S Mfaume
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Prosper F Njau
- Health for a Prosperous Nation, Dar es Salaam, Tanzania.,Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - William H Dow
- Division of Health Policy and Management, University of California, Berkeley, CA, USA
| | - Sandra I McCoy
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
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28
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Peprah E, Myers B, Kengne AP, Peer N, El-Shahawy O, Ojo T, Mukasa B, Ezechi O, Iwelunmor J, Ryan N, Sakho F, Patena J, Gyamfi J. Using a Syndemics Framework to Understand How Substance Use Contributes to Morbidity and Mortality among People Living with HIV in Africa: A Call to Action. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031097. [PMID: 35162121 PMCID: PMC8834153 DOI: 10.3390/ijerph19031097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 02/04/2023]
Abstract
Substance use is increasing throughout Africa, with the prevalence of alcohol, tobacco, cannabis, and other substance use varying regionally. Concurrently, sub-Saharan Africa bears the world’s largest HIV burden, with 71% of people living with HIV (PWH) living in Africa. Problematic alcohol, tobacco, and other substance use among PWH is associated with multiple vulnerabilities comprising complex behavioral, physiological, and psychological pathways that include high-risk behaviors (e.g., sexual risk-taking), HIV disease progression, and mental health problems, all of which contribute to nonadherence to antiretroviral therapy. Physiologically, severe substance use disorders are associated with increased levels of biological markers of inflammation; these, in turn, are linked to increased mortality among PWH. The biological mechanisms that underlie the increased risk of substance use among PWH remain unclear. Moreover, the biobehavioral mechanisms by which substance use contributes to adverse health outcomes are understudied in low- and middle-income countries (LMIC). Syndemic approaches to understanding the co-occurrence of substance use and HIV have largely been limited to high-income countries. We propose a syndemic coupling conceptual model to disentangle substance use from vulnerabilities to elucidate underlying disease risk for PWH. This interventionist perspective enables assessment of biobehavioral mechanisms and identifies malleable targets of intervention.
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Affiliation(s)
- Emmanuel Peprah
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
- Correspondence:
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia;
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7925, South Africa
| | - Andre-Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; (A.-P.K.); (N.P.)
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; (A.-P.K.); (N.P.)
| | - Omar El-Shahawy
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
- Center for the Prevention of Heart Disease, John Hopkins Hospital, Baltimore, MD 21287, USA
| | - Temitope Ojo
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| | | | - Oliver Ezechi
- Nigerian Institute of Medical Research, Yaba, Lagos 101245, Nigeria;
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Department of Behavioral Science and Health Education, Saint Louis University, St. Louis, MO 63104, USA;
| | - Nessa Ryan
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| | - Fatoumata Sakho
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| | - John Patena
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| | - Joyce Gyamfi
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
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29
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Humphries H, Upfold M, Mahlase G, Mdladla M, Gengiah TN, Abdool Karim Q. Implants for HIV prevention in young women: Provider perceptions and lessons learned from contraceptive implant provision. PLoS One 2022; 17:e0262043. [PMID: 35025908 PMCID: PMC8758078 DOI: 10.1371/journal.pone.0262043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/15/2021] [Indexed: 12/05/2022] Open
Abstract
Preventing new HIV infections, especially amongst young women, is key to ending the HIV epidemic especially in sub-Saharan Africa. Potent antiretroviral (ARV) drugs used as pre-exposure prophylaxis (PrEP) are currently being formulated as long-acting implantable devices, or nanosuspension injectables that release drug at a sustained rate providing protection from acquiring HIV. PrEP as implants (PrEP Implants) offers an innovative and novel approach, expanding the HIV prevention toolbox. Feedback from providers and future users in the early clinical product development stages may identify modifiable characteristics which can improve acceptability and uptake of new technologies. Healthcare workers (HCWs) perspectives and lessons learned during the rollout of contraceptive implants will allow us to understand what factors may impact the roll-out of PrEP implants. We conducted eighteen interviews with HCWs (9 Nurses and 9 Community Healthcare Workers) in rural KwaZulu-Natal, South Africa. HCWs listed the long-acting nature of the contraceptive implant as a key benefit, helping to overcome healthcare system barriers like heavy workloads and understaffing. However, challenges like side effects, migration of the implant, stakeholder buy-in and inconsistent training on insertion and removal hampered the roll-out of the contraceptive implant. For PrEP implants, HCWs preferred long-acting products that were palpable and biodegradable. Our findings highlighted that the characteristics of PrEP implants that are perceived to be beneficial by HCWs may not align with that of potential users, potentially impacting the acceptability and uptake of PrEP implants. Further our data highlight the need for sustained and multi-pronged approaches to training HCWs and introducing new health technologies into communities. Finding a balance between the needs of HCWs that accommodate their heavy workloads, limited resources at points of delivery of care and the needs and preferences of potential users need to be carefully considered in the development of PrEP implants.
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Affiliation(s)
- Hilton Humphries
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Michele Upfold
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Gethwana Mahlase
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Makhosazana Mdladla
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Tanuja N. Gengiah
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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de Oliveira França P, Ayres LR, Pimassoni LH, Cerutti Junior C. Health-Related Quality of Life and Coping Strategies in a Cohort Study of Highly Active Antiretroviral Therapy Naïve Patients Adherence. Int J Clin Pract 2022; 2022:8341638. [PMID: 35685558 PMCID: PMC9159168 DOI: 10.1155/2022/8341638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The main objective of this study was to describe the perceived quality of life (QoL) in patients living with AIDS (PLWA) and their chosen coping strategies in a cohort of individuals managed with HAART. METHODS This is a prospective cohort study conducted at the Medication Dispensing Unit of a university hospital (MDU-UH) located in southeastern Brazil. Study population comprised HIV/AIDS patients starting antiretroviral treatment at MDU. The final sample comprised 99 participants. Patients were followed up for 24 months from their recruitment. We used a face-to-face questionnaire to determine sociodemographic and behavioural variables. Quality of life (QoL) and coping strategies (CS) were measured through validated instruments. RESULTS Regarding the QoL dimensions, the general perception of QoL among these participants was considered good. Regarding CS, the adherent patients scored higher than the nonadherents. CONCLUSIONS The present study revealed that the perceived QoL can be maintained in individuals treated for HIV/AIDS. There is an association between high score of coping strategies and adherence to HAART.
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Affiliation(s)
- Patricia de Oliveira França
- Post-Graduate Program of Infectious Diseases, Federal University of Espirito Santo, Vitória, Espirito Santo, Brazil
| | - Lorena Rocha Ayres
- Department of Pharmaceutical Sciences, Federal University of Espirito Santo, Vitória, Espirito Santo, Brazil
| | - Lúcia Helena Pimassoni
- School of Medicine, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Vitoria, Espirito Santo, Brazil
| | - Crispim Cerutti Junior
- Post-Graduate Program of Infectious Diseases, Federal University of Espirito Santo, Vitória, Espirito Santo, Brazil
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Lowane MP, Lebese RT. Missing appointments by patients on antiretroviral therapy: Professional nurses’ perspective. Curationis 2022; 45:e1-e7. [PMID: 35144432 PMCID: PMC8831935 DOI: 10.4102/curationis.v45i1.2213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 10/26/2021] [Accepted: 11/21/2021] [Indexed: 11/01/2022] Open
Abstract
Background: Missed appointments for medicine pick-ups are regarded as a predictor of poor adherence, and should trigger immediate questions about issues that may affect follow-up visits to healthcare settings.Objectives: The study explored and described professional nurses’ perspectives about the factors that contribute to missing appointments by people living with Human Immunodeficiency Virus (PLWHIV) on antiretroviral therapy (ART) at Mopani and Vhembe district in Limpopo Province.Method: A qualitative explorative contextual approach was used for the study. Non-probability, purposive sampling was used to select 14 professional nurses who met the inclusion criteria. Data were collected through face-to-face unstructured interviews. One central question was asked and probing questions were based on the participants’ responses to the central question. Thematic analysis of the findings was carried out. Trustworthiness was ensured through intercoder agreement, audio recording, triangulation, bracketing, and member checking. Required permission, approval, and ethical clearance were also ensured.Results: Organisational health system and management of the healthcare facility were found to be the barriers that negatively impacted on the ability of the PLWHIV on ART to maintain clinic visits appointments. Lack of patient involvement, stereotyped appointment dates selection, poor patient-provider relationships, errors of recording appointment dates and long waiting times came up as sub-themes derived from the main theme.Conclusion: The results suggest that there is a need to increase and improve mutual trust in patient-provider relationships, improve nurses working conditions, develop proper booking systems and reduce clinic waiting hours.
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Affiliation(s)
- Mygirl P Lowane
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria.
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Nakamanya S, Kawuma R, Kibuuka D, Kusemererwa S, McCormack S, Ruzagira E, Seeley J. Assessing acceptability of pre-exposure prophylaxis (PrEP) among participants in an HIV vaccine preparedness study in southwestern Uganda. PLoS One 2022; 17:e0271104. [PMID: 35905052 PMCID: PMC9337655 DOI: 10.1371/journal.pone.0271104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/24/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Daily oral pre-exposure prophylaxis (PrEP) use is highly effective against HIV infection. However, the uptake of PrEP among individuals at high-risk of HIV acquisition in sub-Saharan Africa varies because of availability and acceptability. We assessed the acceptability of PrEP among participants in a prospective HIV vaccine preparedness study in Masaka, southwestern Uganda. METHODS From November 2018 to August 2019, 20 participants (10 female) were purposively selected for in-depth interviews (IDIs) at 3 and 9 months' post-enrolment in the vaccine preparedness study. Four focus group discussions (FGD) (two among men) were conducted with 29 individuals categorized as: younger (18-24 years) men, younger (18-24 years) women, older (≥30 years) men, and older (≥30 years) women. Apart from IDI specific questions on recent life history including work experience, relationship history and places lived, topics for IDIs and FGDs included knowledge of HIV, perceptions of HIV risk (including own risk), knowledge of and use of PrEP. The Theoretical Framework of Acceptability was used to structure a thematic framework approach for data analysis. RESULTS Participants understood that PrEP was an oral pill taken daily by HIV negative individuals to prevent acquisition of HIV. Overall, interest in and acceptability of PrEP was high, more than half expressed positivity towards PrEP but were not ready to initiate taking it citing the burden of daily oral pill taking, related side effects, stigma and distrust of PrEP. Fourteen participants (from IDI and FGD) initiated PrEP, although some (one FGD and two IDI participants) stopped taking it due to side effects or perceived reduced risk. CONCLUSION We observed a keen interest in PrEP initiation among our study participants. However, a limited understanding of PrEP and associated concerns impeded uptake and sustained use. Hence, interventions are needed to address end-user challenges to increase uptake and support adherence.
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Affiliation(s)
- Sarah Nakamanya
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda
- * E-mail:
| | - Rachel Kawuma
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Denis Kibuuka
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Sylvia Kusemererwa
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda
| | | | - Eugene Ruzagira
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Abraham SA, Berchie GO, Doe PF, Agyare E, Addo SA, Obiri-Yeboah D. Effects of COVID-19 pandemic on ART Service delivery: perspectives of healthcare workers in a Teaching Hospital in Ghana. BMC Health Serv Res 2021; 21:1295. [PMID: 34856995 PMCID: PMC8637519 DOI: 10.1186/s12913-021-07330-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/17/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Ghana has a generalized HIV epidemic and efforts have been made to curb the spread and reverse its effects on the general population. In the wake of COVID-19 pandemic, the health system was unsettled and antiretroviral therapy (ART) care has been impacted in diverse ways. The study sought to explore the effects of COVID-19 on ART service provision in Ghana from the perspectives of the healthcare workers. METHODS An exploratory-descriptive qualitative approach was employed in this study. Using maximum variation sampling method, fifteen healthcare workers; nurses, data managers and pharmacists were recruited from an ART clinic in a Teaching Hospital in Ghana. In-depth interviews were conducted and analysed using Braun and Clarke thematic approach. RESULTS Three themes emerged from the data; "… And the pandemic struck", "Impact of the pandemic on ART service delivery"; "Effecting the needed change". The healthcare workers' initial reactions to the pandemic and their show of commitment in ensuring continued ART service was evident. COVID-19 impacted service delivery in three main ways; (1) clients' clinic attendance was erratic at various stages of the pandemic, (2) irregular resource availability as shortage was reported due to affected last mile delivery as a result of the lockdown in Accra, and (3) the health worker-patient interaction became less engaging because of established COVID-19 protocols. The healthcare workers however instituted strategies such as adjusting the patient appointment schedule, health professionals' work schedule, establishing several work stations, task-shifting, and ensuring the implementation of all the COVID-19 protocols within the ART unit to ensure consistent service delivery as well as patient and staff safety. The study also found a decline in the implementation of several strategies established in the ART clinic during the initial phases of the pandemic such as a decline in the supply of Personal Protective Equipment (PPEs) by hospital management. CONCLUSIONS Although several strategies were implemented to manage the effects of the pandemic on ART care, there is a need to establish pathways of support for healthcare workers within the ART clinic and to consolidate as well as institutionalise the changes that ensured continuous but safe service delivery.
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Affiliation(s)
- Susanna Aba Abraham
- Department of Adult Health, School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Gifty Osei Berchie
- Maternal and Child Health Department, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Patience Fakornam Doe
- Department of Adult Health, School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Elizabeth Agyare
- Clinical Microbiology/Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Stephen Ayisi Addo
- Programme Manager, National HIV/AIDS Control Programme, Korle-Bu, Accra, Ghana
| | - Dorcas Obiri-Yeboah
- Clinical Microbiology/Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Microbiology and Immunology Department, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
- Directorate of Research Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana
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Schensul SL, Ha T, Schensul JJ, Grady J, Burleson JA, Gaikwad S, Joshi K, Malye R, Sarna A. Multilevel and Multifactorial Interventions to Reduce Alcohol Consumption and Improve ART Adherence and Related Factors Among HIV Positive Men in Mumbai, India. AIDS Behav 2021; 25:290-301. [PMID: 34014429 DOI: 10.1007/s10461-021-03303-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 01/19/2023]
Abstract
Alcohol use has a deleterious effect on the health status of persons living with HIV, negatively affecting antiretroviral adherence and increasing the risk of transmission. Alcohol use is not an isolated behavior but intimately linked to stigma and poor psychological status among other factors. This paper utilizes a crossover design to test the efficacy of three multilevel interventions, individual counselling (IC), group intervention (GI) and collective advocacy (CA) for change, among HIV positive males who consume alcohol, treated at five ART Centers in urban Maharashtra, India. While GI shows a significant effect on the largest number of outcome variables, IC through its psychosocial emphasis demonstrated a significant impact over time on stigma and depression, and CA with its emphasis on societal change showed positive impact on stigma and advocacy for self and others. Each of the interventions had variable effects on CD4 count and viral load.Clinical Registration Number: NCT03746457; Clinical Trial.Gov.
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Affiliation(s)
- Stephen L Schensul
- Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA.
| | - Toan Ha
- Department of Infectious Diseases, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - James Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA
| | - Joseph A Burleson
- Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA
| | - Sushma Gaikwad
- T.N. Medical College and B.Y.L. Nair Ch. Hospital, Mumbai, India
| | | | - Rupal Malye
- Lokmanya Tilak Muncicipal Medical College, Mumbai, India
| | - Avina Sarna
- Population Council, India Country Office, New Delhi, India
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Ortíz DW, Roberts-Sano O, Marroquin HE, Larson L, Franco KB, Spec A, Melendez JR, Pinzón R, Samayoa AJ, Mejia-Chew C, O Halloran JA. Factors associated with viremia in people living with HIV on antiretroviral therapy in Guatemala. AIDS Res Ther 2021; 18:79. [PMID: 34706742 PMCID: PMC8554948 DOI: 10.1186/s12981-021-00400-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/06/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Viral suppression prevents HIV transmission and disease progression, but socio-economic and clinical factors can hinder the goal of suppression. We evaluated factors associated with viral non suppression (VNS) and persistent viremia (PV) in people living with HIV (PLHIV) receiving antiretroviral therapy (ART) in Guatemala. METHODS We conducted a cross sectional analysis using data from an ongoing cohort of PLHIV attending the largest HIV clinic in Guatemala. Univariable and multivariable analyses were conducted between PLHIV with viral suppression and detectable viremia. VNS was defined as most recent HIV RNA ≥ 200 copies/ml and PV as two consecutive HIV RNA ≥ 200 copies/ml. RESULTS Of 664 participants, 13.3% had VNS and 7.1% had PV. In univariable analysis disaggregated by gender, low income, poor education, perceived difficulty attending healthcare, and alcohol use were associated with VNS in men while low CD4 at diagnosis, multiple prior ART regimens and treatment interruptions were significant in both genders. Multiple prior ART regimens (adjusted Odds Ratio (aOR) 2.82, [95% confidence interval (CI) 1.59, 4.99], p < 0.01), treatment interruptions (aOR 4.51, [95% CI 2.13, 9.58], p < 0.01), excessive alcohol consumption (aOR 2.56, [95% CI 1.18, 5.54], p < 0.05) perceived difficulty attending healthcare (aOR 2.07, [ 95% CI 1.25, 3.42], p < 0.01) and low CD4 at diagnosis (aOR 2.34, 95% [CI 1.30, 4.20], p < 0.01) were independently associated with VNS on multivariable regression. CONCLUSIONS We conclude that socio-economic and clinical factors influence viral suppression in our cohort and vary between men and women. Gender specific approaches are necessary to achieve the 90% suppression goal.
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Affiliation(s)
- Dean W Ortíz
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala.
| | - Olivia Roberts-Sano
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Hugo E Marroquin
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Lindsey Larson
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Katherine B Franco
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Andrej Spec
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Johanna R Melendez
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Rodolfo Pinzón
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Ana J Samayoa
- Unidad de Atención Integral del VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Calzada Roosevelt, 5ta. Calle, zona 11, Guatemala City, Guatemala
| | - Carlos Mejia-Chew
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
| | - Jane A O Halloran
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, USA
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Kikaire B, Ssemanda M, Asiimwe A, Nakanwagi M, Rwegyema T, Seruwagi G, Lawoko S, Asiimwe E, Wamundu C, Musinguzi A, Lugada E, Turesson E, Laverentz M, Bwayo D. HIV viral load suppression following intensive adherence counseling among people living with HIV on treatment at military-managed health facilities in Uganda. Int J Infect Dis 2021; 112:45-51. [PMID: 34481969 DOI: 10.1016/j.ijid.2021.08.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Uniformed service personnel have an increased risk of poor viral load suppression (VLS). This study was performed to evaluate the outcomes of interventions to improve VLS in the 28 military health facilities in Uganda. METHODS This operational research was conducted between October 2018 and September 2019, among people living with HIV (PLHIV) in the 28 health facilities managed by the military in Uganda. Patients with a viral load (VL) >1000 copies/ml received three sessions of intensive adherence counselling (IAC), 1 month apart, after which a repeat VL was done. The main outcome was the proportion with a suppressed VL following IAC. RESULTS Of the 965 participants included in this analysis, 592 (61.4%) were male and 367 (38.3%) were female. Average age was 35.5 ± 13.7 years, and 87.8% had at least one IAC session. At least 48.2% had a suppressed repeat VL. IAC increased the odds of VLS by 82% (P = 0.004), with adjusted OR of 1.56 (P = 0.054). An initial VL >10 000 copies/ml, being on antiretroviral therapy for at least 2 years, being male, and being <18 years of age were associated with repeat VL non-suppression. CONCLUSIONS IAC marginally improved VL suppression. There is a need to improve IAC in military health facilities.
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Affiliation(s)
- Bernard Kikaire
- Makerere University College of Health Sciences, Kampala, Uganda.
| | - Michael Ssemanda
- University Research Co., LLC, Department of Defense HIV/AIDS Prevention Program (DHAPP), Kampala, Uganda
| | - Alex Asiimwe
- University Research Co., LLC, Department of Defense HIV/AIDS Prevention Program (DHAPP), Kampala, Uganda; Directorate of HIV, Uganda Peoples Defense Force (UPDF), Kampala, Uganda
| | - Miriam Nakanwagi
- University Research Co., LLC, Department of Defense HIV/AIDS Prevention Program (DHAPP), Kampala, Uganda
| | - Twaha Rwegyema
- University Research Co., LLC, Department of Defense HIV/AIDS Prevention Program (DHAPP), Kampala, Uganda
| | - Gloria Seruwagi
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Evarlyne Asiimwe
- Directorate of HIV, Uganda Peoples Defense Force (UPDF), Kampala, Uganda
| | - Cassette Wamundu
- Directorate of HIV, Uganda Peoples Defense Force (UPDF), Kampala, Uganda
| | - Ambrose Musinguzi
- Directorate of HIV, Uganda Peoples Defense Force (UPDF), Kampala, Uganda
| | - Eric Lugada
- University Research Co., LLC, Department of Defense HIV/AIDS Prevention Program (DHAPP), Kampala, Uganda
| | - Elizabeth Turesson
- University Research Co., LLC, Department of Defense HIV/AIDS Prevention Program (DHAPP), Kampala, Uganda
| | - Marni Laverentz
- University Research Co., LLC, Department of Defense HIV/AIDS Prevention Program (DHAPP), Kampala, Uganda
| | - Denis Bwayo
- University Research Co., LLC, Department of Defense HIV/AIDS Prevention Program (DHAPP), Kampala, Uganda
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Tumwine C, Aggleton P, Bell S. Interface between biomedical and traditional systems of treatment and care among HIV positive fisher folk in two fishing communities on Lake Victoria, Uganda. Afr Health Sci 2021; 21:1040-1047. [PMID: 35222565 PMCID: PMC8843253 DOI: 10.4314/ahs.v21i3.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Fisherfolk have been identified as a key population in the HIV response in Uganda due to high HIV prevalence and low engagement in HIV services. While studies have examined lifestyles and risk, much remains to be understood about help and health seeking experiences, including the combined use of biomedical and traditional health care. Objective To examine the use of biomedical and traditional health care in two fishing communities around Lake Victoria in Uganda. Methods Exploratory, in-depth qualitative study involving semi-structured interviews with 42 HIV positive fisherfolk. Results Prior to HIV diagnosis, participants who described becoming ill sought different forms of help including biomedical treatment prescribed by health workers or self-prescribed; biomedical and herbal medicines together; herbal medicines only; or no form of treatment. Following HIV diagnosis, the majority of participants used ART exclusively, while a smaller number used both ART and traditional care strategies, or reported times when they used alternative therapies instead of ART. Prior to HIV diagnosis, fisherfolk's health care seeking practices inhibited engagement with HIV testing and access to biomedical HIV treatment and care. After HIV diagnosis, most resorted only to using ART. Conclusion Study findings provide insight into how fisherfolk's use of biomedical and traditional care prior to diagnosis influences subsequent engagement with HIV treatment. Efforts are needed to reach fisherfolk through everyday health seeking networks to ensure HIV is diagnosed and treated as early as possible.
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Affiliation(s)
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.,School of Sociology, The Australian National University, Canberra, Australia.,Centre for Gender and Global Health, UCL, London, UK
| | - Stephen Bell
- UQ Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Australia.,Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.,School of Public Health, The University of Queensland, Brisbane, Australia
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Madiba S, Mohlabane N. Attendance of psychosocial teen clubs and self-reported antiretroviral medication adherence: a cross section study of adolescents with perinatal HIV in the Kingdom of Lesotho. AIMS Public Health 2021; 8:541-552. [PMID: 34395704 PMCID: PMC8334641 DOI: 10.3934/publichealth.2021044] [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: 05/16/2021] [Accepted: 07/05/2021] [Indexed: 11/18/2022] Open
Abstract
Background To address the problem of poor adherence among adolescents with perinatal HIV (PHIV), all clinics in Lesotho offer adolescent-friendly services and psychosocial support to improve their overall health outcomes and adherence. As a result, most adolescents with PHIV attend Teen Clubs as part of the package of youth-friendly HIV services. This study set out to determine whether attending Teen Clubs facilitates treatment adherence among adolescents with PHIV. Methods In this cross-sectional study, data were collected from 130 adolescents aged 10–19 years who were aware of their HIV status and had attended three or more Teen Club sessions in selected clinics in rural district in Lesotho. Adherence was measured through self-report of last pills missed, based on the 7-days recall of pills taken. Descriptive statistics were used to analyse the data. Results The median age of adolescents was 15 years, 56% were female, 37.7% were orphans, 41% were being cared for by their grandparents, 6.9% were living with siblings with no adult figure, and two were living on their own. The majority (93%) reported optimal adherence, 92% had not missed a clinic appointment in the past 30 days, and 74.4% knew that if they skipped doses, the viral load would increase and they would get sick. Over half (56%) had been reminded by their caregivers to take their medication and 96% talked to their caregivers regularly about their medication. Conclusion A supportive environment provided through the Teen Clubs and in the home were the main facilitators for adherence. Strategies to improve adherence among adolescents should consider the importance of the involvement of caregivers in the adolescents' visits to their clinic.
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Affiliation(s)
- Sphiwe Madiba
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Ntaoleng Mohlabane
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Shared Decision Making Between Patients and Healthcare Providers and its Association with Favorable Health Outcomes Among People Living with HIV. AIDS Behav 2021; 25:1384-1395. [PMID: 32748158 PMCID: PMC7397451 DOI: 10.1007/s10461-020-02973-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We assessed patient-provider communication in HIV care; data were from the 2019 Positive Perspectives Survey of people living with HIV (PLHIV) from 25 countries (n = 2389). A significantly greater proportion of recently diagnosed individuals were interested in being involved when it comes to decisions about their HIV treatment compared with any other group (72.8% [399/548], 63.1% [576/913], and 62.6% [581/928], diagnosis year: 2017–2019, 2010–2016, and pre-2010 respectively) but reported less understanding of their treatment compared with those reporting the longest duration (66.8% [366/548], 68.6% [626/913], and 77.3% [717/928], respectively). One-third of PLHIV with salient treatment-related concerns were uncomfortable discussing with providers. Of participants who felt that their HIV medication limited their life but did not discuss their concerns with their provider (n = 203), top reasons for not discussing were: perception nothing could be done (49.3% [100/203]), provider never brought up the issue (37.9% [77/203]), and not wanting to appear difficult (30.5% [62/203]). To continue to identify and address unmet treatment needs among PLHIV, providers need to ensure that there is ongoing open dialogue.
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Musana H, Ssensamba JT, Nakafeero M, Mugerwa H, Kiweewa FM, Serwadda D, Ssali F. Predictors of failure on second-line antiretroviral therapy with protease inhibitor mutations in Uganda. AIDS Res Ther 2021; 18:17. [PMID: 33882938 PMCID: PMC8059285 DOI: 10.1186/s12981-021-00338-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Failure on second-line antiretroviral therapy (ART) with protease inhibitor (PI) mutations (VF-M) is on the rise. However, there is a paucity of information on the factors associated with this observation in low-income countries. Knowledge of underlying factors is critical if we are to minimize the number of PLHIV switched to costly third-line ART. Our study investigated the factors associated with VF-M. Methods We conducted a matched case–control analysis of patients' records kept at the Joint Clinical Research Center, starting from January 2008 to May 2018. We matched records of patients who failed the second-line ART with major PI mutations (cases) with records of patients who were virologically suppressed (controls) by a ratio of 1:3. Data analysis was conducted using STATA Version 14. Categorical variables were compared with the outcomes failure on second-line ART with PI mutations using the Chi-square and Fisher's exact tests where appropriate. Conditional logistic regression for paired data was used to assess the association between the outcome and exposure variables, employing the backward model building procedure. Results Of the 340 reviewed patients' records, 53% were women, and 6.2% had previous tuberculosis treatment. Males (aOR = 2.58, [CI 1.42–4.69]), and patients concurrently on tuberculosis treatment while on second-line ART (aOR = 5.65, [CI 1.76–18.09]) had higher odds of VF-M. ART initiation between 2001 and 2015 had lower odds of VF-M relative to initiation before the year 2001. Conclusion Males and patients concomitantly on tuberculosis treatment while on second-line ART are at a higher risk of VF-M. HIV/AIDS response programs should give special attention to this group of people if we are to minimize the need for expensive third-line ART. We recommend more extensive, explorative studies to ascertain underlying factors.
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Paredes R, Véliz F, Lucchetti A. Comparison of the Virological Response According to the Antiretroviral Regimens in Peruvian HIV Patients Who Presented the M184V Mutation in Two National Hospitals During the Years 2008 to 2019. AIDS Res Hum Retroviruses 2021; 37:196-203. [PMID: 33076683 DOI: 10.1089/aid.2020.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: In patients with HIV in antiretroviral treatment (ART) and virological failure to the first-line regimen, establishing a therapeutic regimen after having identified the M184V mutation, which confers ART resistance, represents a dilemma. Objective: To compare the virological response of the therapeutic regimens prescribed to patients with HIV who presented the M184V mutation in two national hospitals in Lima, Peru, during the years 2008 to 2019, and to determine the risk factors associated with poor virological response. Methods: A retrospective cohort study was developed based on the information of the HIV program participants with the M184V mutation. Results: A total of 175 participants were eligible for the study. The male sex predominated (75.4%), the current median age was 41 years [interquartile range (IQR) 35.84-47.47], and the time on ART was 89 months (IQR 57.7-124.53). The median initial viral load (VL) was 4.5 log10 copies/mL (IQR 3.97-5.09) and the time between genotyping and the change of therapy was 2 months (IQR 0-3.56). The most used antiretroviral regimen was protease inhibitor plus two nucleoside reverse transcriptase inhibitors (55.4%). With the protease inhibitor plus integrase inhibitor (PI + INI) ART, 69% less risk of poor virological response was obtained [p = .019 (confidence interval 95% 0.117-0.825)]. Conclusions: In patients with HIV and the M184V mutation, the PI + INI ART has shown a greater decrease in control VL and, thus, a good virological response. The risk factors associated with a poor virological response were the delay between genotyping and change of therapy, high levels of initial VL, and poor adherence among the participants.
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Affiliation(s)
- Raisa Paredes
- Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Fritner Véliz
- Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Aldo Lucchetti
- Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Servicio de Infectología, Hospital Nacional Arzobispo Loayza, Lima, Peru
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Prevalence and Determinants of Medication Adherence among Patients with HIV/AIDS in Southern Vietnam. Infect Dis Rep 2021; 13:126-135. [PMID: 33562451 PMCID: PMC7931092 DOI: 10.3390/idr13010014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 01/25/2023] Open
Abstract
This study was conducted to determine the prevalence and determinants of medication adherence among patients with HIV/AIDS in southern Vietnam. METHODS A cross-sectional study was conducted in a hospital in southern Vietnam from June to December 2019 on patients who began antiretroviral therapy (ART) for at least 6 months. Using a designed questionnaire, patients were considered adherent if they took correct medicines with right doses, on time and properly with food and beverage and had follow-up visits as scheduled. Multivariable logistic regression was used to identify determinants of adherence. KEY FINDINGS A total of 350 patients (from 861 medical records) were eligible for the study. The majority of patients were male (62.9%), and the dominant age group (≥35 years old) accounted for 53.7% of patients. Sexual intercourse was the primary route of transmission of HIV (95.1%). The proportions of participants who took the correct medicine and at a proper dose were 98.3% and 86.3%, respectively. In total, 94.9% of participants took medicine appropriately in combination with food and beverage, and 75.7% of participants were strictly adherent to ART. The factors marital status (odds ratio (OR) = 2.54; 95%CI = 1.51-4.28), being away from home (OR = 1.7; 95%CI = 1.03-2.78), substance abuse (OR = 2.7; 95%CI = 1.44-5.05), general knowledge about ART (OR = 2.75; 95%CI = 1.67-4.53), stopping medication after improvement (OR = 4.16; 95%CI = 2.29-7.56) and self-assessment of therapy adherence (OR = 9.83; 95%CI = 5.44-17.77) were significantly associated with patients' adherence. CONCLUSIONS Three-quarters of patients were adherent to ART. Researchers should consider these determinants of adherence in developing interventions in further studies.
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Mercy SK, Sebean M, Margaret M. Predictors of Non-Adherence to Combined Anti-Retroviral Therapy among Expectant and Breastfeeding Women Receiving Care through Test and Treat Model in Lusaka. Health (London) 2021. [DOI: 10.4236/health.2021.138067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Barriers and enablers of adherence to infant nevirapine prophylaxis against HIV 1 transmission among 6-week-old HIV exposed infants: A prospective cohort study in Northern Uganda. PLoS One 2020; 15:e0240529. [PMID: 33057393 PMCID: PMC7561159 DOI: 10.1371/journal.pone.0240529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022] Open
Abstract
Background Sub-optimal adherence to infant prophylaxis has been associated with mother-to-child-transmission of HIV. However, the factors associated have not been well characterised in different settings. This study describes barriers and enablers of adherence to infant prophylaxis among 6-week-old HIV exposed infants in Lira district, Northern Uganda. Methods This prospective cohort study was conducted from 2018–2020 at the PMTCT clinic at Lira Regional Referral Hospital and included 472 mother-infant pairs. HIV-infected pregnant women were recruited, followed up at delivery and 6 weeks postpartum. We used a structured questionnaire to obtain data on socio-demographic, reproductive-related, HIV-related characteristics and adherence. Data were analysed using Stata to estimate adjusted risk ratios using Poisson regression models to ascertain barriers and enablers of adherence to infant nevirapine prophylaxis. Results Barriers to infant adherence are maternal characteristics including: younger age (≤20 years adjusted risk ratio (ARR) = 1.55; 95% CI: 1.1–2.2), missing a viral load test during pregnancy (ARR: 1.4; 95% CI: 1.1–1.7) and not receiving nevirapine syrup for the baby after childbirth (ARR = 6.2; 95% CI: 5.1–7.6). Enablers were: having attained ≥14 years of schooling (ARR = 0.7; 95% CI: 0.5–0.9), taking a nevirapine-based regimen (ARR = 0.6; 95% CI: 0.4–0.9), long-term ART (≥ 60 months ARR = 0.75; 95% CI: 0.6–0.9), accompanied by a husband to hospital during labour and childbirth (ARR = 0.5; 95% CI: 0.4–0.7) and labour starting at night (ARR = 0.7; 95% CI: 0.6–0.8). Conclusion and recommendations Despite mothers receiving nevirapine syrup from the health workers for the infant, non-adherence rates still prevail at 14.8%. The health system needs to consider giving HIV infected pregnant women the nevirapine syrup before birth to avoid delays and non-adherence. There is need to pay particular attention to younger women and those who recently started ART.
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Prevalence and predictors for unintended pregnancy among HIV-infected pregnant women in Lira, Northern Uganda: a cross-sectional study. Sci Rep 2020; 10:16319. [PMID: 33004969 PMCID: PMC7529765 DOI: 10.1038/s41598-020-73490-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/17/2020] [Indexed: 11/24/2022] Open
Abstract
Prevention of unintended pregnancies is a global strategy to eliminate mother-to-child transmission of HIV. Factors surrounding unintended pregnancy among women living with HIV are not well understood. We aimed to determine the prevalence and predictors for unintended pregnancy among these women in Northern Uganda. We conducted a cross-sectional survey among 518 women using a structured questionnaire. We asked questions on socio-demographic, reproductive-related and HIV-related characteristics. We conducted multivariable logistic regression and reported adjusted odds ratios. The prevalence of unintended pregnancy was 41.1%. The predictors for unintended pregnancy were: being single (not living with a partner or being in a marital union), having five or more children and taking antiretroviral drugs for long periods of time. HIV counselling services should target women living with HIV who are not in a marital union, those having a higher parity and those who have taken ART for longer periods.
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de los Rios P, Okoli C, Young B, Allan B, Castellanos E, Brough G, Eremin A, Corbelli G, Hardy WD, Van de Velde N. Treatment aspirations and attitudes towards innovative
medications among people living with HIV in 25 countries. POPULATION MEDICINE 2020. [DOI: 10.18332/popmed/124781] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Jennings Mayo-Wilson L, Devoto B, Coleman J, Mukasa B, Shelton A, MacCarthy S, Saya U, Chemusto H, Linnemayr S. Habit formation in support of antiretroviral medication adherence in clinic-enrolled HIV-infected adults: a qualitative assessment using free-listing and unstructured interviewing in Kampala, Uganda. AIDS Res Ther 2020; 17:30. [PMID: 32513192 PMCID: PMC7278190 DOI: 10.1186/s12981-020-00283-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/15/2020] [Indexed: 12/03/2022] Open
Abstract
Background Despite initial high motivation, individuals receiving antiretroviral therapy (ART) for several years may experience incomplete adherence over time, increasing their risk of HIV-related morbidity and mortality. Habits, defined as automatic and regular practices, do not rely on conscious effort, and may therefore support high long-term ART adherence. Methods This qualitative study contributes to the evidence on how clients with adherence problems remember and form habits to take ART medications. Free-listing and unstructured interviewing were used among 42 clinic-enrolled adults in Kampala, Uganda who were receiving ART and participating in a randomized clinical trial for treatment adherence (clinicaltrials.gov: NCT03494777). Data were coded and analyzed using inductive content analysis. Results Findings indicated that clients’ most routine habits (eating, bathing, sleeping) did not always occur at the same time or place, making it difficult to reliably link to pill-taking times. Efforts to improve ART habits included having a relative to ask about pill-taking, re-packaging medications, leaving medications in view, using alarms, carrying water, or linking pill-taking to radio/prayer schedules. Reported challenges were adhering to ART schedules during changing employment hours, social activities, and travel. Conclusion While habit-forming interventions have the potential to improve ART adherence, targeting treatment-mature clients’ existing routines may be crucial in this population.
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Tong PD, Atuhairwe C, Taremwa IM. <p>Differential Self-Reported Determinants to Antiretroviral Therapy Adherence: Findings from Caregivers of Children Under Five Years Living with Human Immunodeficiency Virus Infection Attending Al-Sabah Hospital, South Sudan</p>. HIV AIDS (Auckl) 2020; 12:175-186. [PMID: 32547247 PMCID: PMC7244449 DOI: 10.2147/hiv.s248057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/24/2020] [Indexed: 11/23/2022] Open
Abstract
Aim/Objective This study explored the caregivers’ self-reported determinants of antiretroviral therapy (ART) adherence among children under five years living with human immunodeficiency virus (HIV) infection attending Al-Sabah Hospital, South Sudan. Methods A cross-sectional study of 126 caregivers of HIV-infected children under five years was conducted at Al-Sabah Hospital, South Sudan. Data were collected using an interviewer-administered questionnaire. The self-reported adherence was measured as a binary variable using binary logistic regression. Only variables that were significant at bivariate analysis were analyzed at multivariate level and interpreted using the odds ratios (p< 0.05). Results Out of 126 caregivers with HIV-infected children, 38 (30.2%) did not adhere to ART. Of the proportion that adhered to ART (88, 69.8%), 49 (55.7%) were male. Most of the children (52, 59.1%) were above two years, but under five years. Fifty (56.8%) of those who adhered had completed 3 months on ART, and the majority were at WHO stage-1 of HIV infection. Analysis of the determinants indicated that children’s duration on ART (p=0.001), type of ART regimen (single, double or triple therapy) (p=0.065), type of work done by the caregiver to earn a living (p-value 0.003), time a child was initiated on ART (p=0.002), caregiver–child relationship (p=0.002), caregiver-spousal support (p=0.019), type of support obtained whether monetary or not (p=0.000), when the child was started on ART (p=0.004), the person administering ART (p=0.010), the type of ARVs administered (p=0.001), the caregiver detecting ART side effects (p=0.000), types of adverse effects suffered by the child (p=0.043), time of receiving ART (p=0.047), use of western medicine (p=0.043), healthcare cadre (p=0.002), the kind of attention the healthcare provider offered (p=0.015), and improvements in quality of HIV services (p=0.001) were significantly associated with ART adherence. Conclusion The study findings indicated that ART adherence among HIV-infected children under five years was suboptimal. This will necessitate continuous engagement and education of caregivers on the prominence of adhering to ART.
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Affiliation(s)
| | | | - Ivan Mugisha Taremwa
- Clarke International University, Kampala, Uganda
- Correspondence: Ivan Mugisha Taremwa Tel +256 774346368 Email
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Tumwine C, Aggleton P, Bell S. Accessing HIV treatment and care services in fishing communities around Lake Victoria in Uganda: mobility and transport challenges. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 18:205-214. [PMID: 31575339 DOI: 10.2989/16085906.2019.1648306] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Qualitative research exploring the influence of community-level factors on access to and use of HIV treatment and care services among people living in fishing communities is limited, especially with respect to those already in receipt of HIV care and on treatment. To enhance understanding of these issues, semi-structured in-depth interviews were conducted with 42 HIV-positive fisherfolk and 15 health care providers from two HIV clinics located in two fishing communities in Uganda. Fisherfolk's mobility and poor transport systems were significant barriers to access to and use of HIV treatment and care. Mobility, which involved regular movement between communities, sometimes led to fisherfolk's inability to access HIV treatment and care. A poor transport system in fishing communities - characterised by irregular transport services and boats in a poor condition - was reported to force both fisherfolk and health care providers sometimes to cancel journeys to centres providing treatment and support. Community-level factors such as these, which relate to the organisation and provision of transport in local community settings, are significant influences on access to HIV treatment and care. Interventions that address these challenges are needed to improve access to and use of HIV treatment and care in fishing communities.
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Affiliation(s)
- Christopher Tumwine
- Centre for Social Research in Health , UNSW Sydney , Australia.,Department of Sociology and Social Administration, Kyambogo University , Kampala , Uganda
| | - Peter Aggleton
- Centre for Social Research in Health , UNSW Sydney , Australia.,School of Sociology, The Australian National University , Canberra , Australia.,Centre for Gender and Global Health, UCL , London , United Kingdom
| | - Stephen Bell
- Centre for Social Research in Health , UNSW Sydney , Australia.,Kirby Institute for Infection and Immunity in Society , UNSW Sydney , Australia
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