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Lefrancois LH, Nguyen BT, Pham TTP, Le NTH, Dao HTT, Tran TH, Ngo KP, Tong HT, Phan HTT, Ait-Ahmed M, Pham TH, Nguyen TA, Taieb F, Madec Y. Assessment of HIV viral load monitoring in remote settings in Vietnam - comparing people who inject drugs to the other patients. PLoS One 2023; 18:e0281857. [PMID: 36802388 PMCID: PMC9942987 DOI: 10.1371/journal.pone.0281857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/02/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Increasing access to viral load (VL) monitoring is essential to fight HIV epidemics. In remote settings in Vietnam, using dried blood spot (DBS) sampling for specimen collection could improve the situation. Here, people who inject drugs (PWID) represent many newly antiretroviral therapy (ART)-initiated patients. The goals of this evaluation were to evaluate if access to VL monitoring and the rate of virological failure differed between PWID and non-PWID. METHODS Prospective cohort study of patients newly initiated on ART in remote settings in Vietnam. DBS coverage at 6, 12 and 24 months of ART was investigated. Factors associated with DBS coverage were identified through logistic regression, as were factors associated with virological failure (VL ≥1,000 copies/mL) at 6, 12 and 24 months of ART. RESULTS Overall 578 patients were enrolled in the cohort, of whom 261 (45%) were PWID. DBS coverage improved from 74.7% to 82.9% between 6 and 24 months of ART (p = 0.001). PWID status was not associated with DBS coverage (p = 0.74), but DBS coverage was lower in patients who were late to clinical visits and in those in WHO stage 4 (p = 0.023 and p = 0.001, respectively). The virological failure rate decreased from 15.8% to 6.6% between 6 and 24 months of ART (p<0.001). In multivariate analysis, PWID were more at risk of failure (p = 0.001), as were patients who were late to clinical visits (p<0.001) and not fully adherent (p<0.001). CONCLUSIONS Despite training and simple procedures, DBS coverage was not perfect. DBS coverage was not associated with PWID status. Close management is required for effective routine HIV VL monitoring. PWID were more at risk of failure, as were patients who were not fully adherent and patients who were late to clinical visits. Specific interventions targeting these patients are needed to improve their outcomes. Overall, efforts in coordination and communication are essential to improve global HIV care. TRIAL REGISTRATION Clinical Trial Number: NCT03249493.
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Affiliation(s)
- Louise H. Lefrancois
- Epidemiology of Emerging Diseases, Institut Pasteur, Université de Paris, Paris, France
| | - Binh Thanh Nguyen
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tram Thi Phuong Pham
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Nhung Thi Hong Le
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Huyen Thi Thanh Dao
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tram Hong Tran
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Khanh Phuong Ngo
- Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Ha Thi Tong
- Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Huong Thi Thu Phan
- Vietnam Administration of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Mohand Ait-Ahmed
- Center for Translational Research, Institut Pasteur, Université de Paris, Paris, France
| | - Thang Hong Pham
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
- HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Fabien Taieb
- Center for Translational Research, Institut Pasteur, Université de Paris, Paris, France
- Department of International Affairs, Institut Pasteur, Université de Paris, Paris, France
| | - Yoann Madec
- Epidemiology of Emerging Diseases, Institut Pasteur, Université de Paris, Paris, France
- * E-mail:
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Khumalo GE, Lutge E, Mashamba-Thompson TP. Exploring how outreach team leaders perceive community health workers' experiences of providing HIV services in KwaZulu-Natal, South Africa. Afr J AIDS Res 2022; 21:239-250. [PMID: 36102053 DOI: 10.2989/16085906.2022.2060841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/22/2022] [Accepted: 03/29/2022] [Indexed: 06/15/2023]
Abstract
Objectives: In 2018, the KwaZulu-Natal Department of Health launched the ward-based primary health care outreach teams policy framework which sought to expand the community health worker (CHW) programme's provision of longitudinal patient support, including human immunodeficiency virus (HIV) services in communities. This study sought to explore the perceptions of outreach team leaders who supervise CHWs on their experiences of providing HIV services in the province.Study design: This was a qualitative, phenomenology study.Methods: Convenience sampling was done to select one outreach team leader from each of the 11 KwaZulu-Natal health districts to be interviewed using an interview guide. Thematic analysis, guided by the Ritchie and Spencer framework analysis, was used to analyse the data.Results: The challenges faced by CHWs in delivering HIV services were: the absence of individuals when CHWs visited their homes, self-HIV stigma, rejection of CHWs' HIV services due to traditional beliefs, CHW shortages, lack of other resources, low levels of CWH education and a lack of training. On the other hand, the provision of HIV services was fascilitated by: supportive supervision, training, having cell phones and having a positive attitude towards providing HIV services by CHWs that were HIV-positive.Conclusion: The CHWs in KwaZulu-Natal face more challenges than enablers in the provision of HIV services. The delegation of HIV services to CHWs should be aligned with their holistic empowerment by eliminating barriers to the provision of HIV services.
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Affiliation(s)
- Gugulethu E Khumalo
- Public Health Medicine, School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
- Health Research & Knowledge Management Unit, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa
| | - Elizabeth Lutge
- Public Health Medicine, School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
- Health Research & Knowledge Management Unit, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa
| | - Tivani P Mashamba-Thompson
- Public Health Medicine, School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
- Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria, South Africa
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Mabizela S, Van Wyk B. Viral suppression among adolescents on HIV treatment in the Sedibeng District, Gauteng province. Curationis 2022; 45:e1-e8. [PMID: 36226955 PMCID: PMC9575385 DOI: 10.4102/curationis.v45i1.2312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 11/06/2022] Open
Abstract
Background Progress has been made to increase access to antiretroviral therapy (ART) for adolescents living with HIV (ALHIV) to improve their survival, but ALHIV still have worse treatment adherence and viral suppression compared to adults and children. Objective To determine the prevalence of viral suppression and the associated factors among adolescents aged 10–19 years on ART at an urban public primary healthcare facility in the Sedibeng district, Gauteng. Method A cross-sectional survey was conducted among 192 adolescents who were on ART for at least six months between 2015 and 2018. A self-developed data extraction tool was used to collect data from the Tier.Net electronic database and clinical folders. Data were captured on Microsoft Excel, and descriptive and inferential analyses were performed using SPSS 27 statistical software. Results The median age at ART initiation of adolescents was 9.0 years (interquartile range [IQR]: 5.0–12.0), and the median duration on ART was 70.5 (IQR: 30.25–105.5) months. The prevalence of viral suppression (< 1000 copies/mL) among adolescents on ART was 74%, with 41% achieving full suppression (< 50 copies/mL). Those adolescents who reported optimal ART adherence were more likely to be virally suppressed compared to those who reported poor adherence (98.1% vs 25.0%; p ≤ 0.001). Conclusion Adolescent viral suppression of 74% is higher than in comparable sites, but still way too short of the UNAIDS target of 90%. We recommend adherence support for adolescents to achieve viral suppression. Contribution The study highlights the urgent need for targeted adherence support interventions for adolescents living with HIV on antiretroviral therapy to improve rates of viral suppression to meet UNAIDS target of 95%.
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Affiliation(s)
- Sibongile Mabizela
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville.
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Khumalo GE, Ntuli S, Lutge E, Mashamba-Thompson TP. Geo-analysis: the distribution of community health workers in relation to the HIV prevalence in KwaZulu-Natal province, South Africa. BMC Health Serv Res 2022; 22:326. [PMID: 35277152 PMCID: PMC8915516 DOI: 10.1186/s12913-022-07707-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/28/2022] [Indexed: 11/21/2022] Open
Abstract
Background The South African Ward Based Primary Health Care Outreach Team (WBPHCOT) policy framework states that the distribution of community health workers (CHWs) should be proportional to levels of poverty and disease within the population. We aimed to describe the spatial distribution of CHWs in relation to the prevalence of the Human Immunodeficiency Virus (HIV) which has itself been associated with poverty in previous studies. Methods This was a descriptive, cross-sectional study in which secondary data was used for geospatial analysis. Based on the extrapolation from the norm of one WBPHCOT per 6000 individuals, we utilized geographic information system (GIS) methods to visualize the distribution of CHWs in relation to the prevalence of HIV in KwaZulu-Natal (KZN). Dot density mapping was used to visualize the random distribution of CHWs in relation to HIV prevalence and population in the districts. The districts’ HIV prevalence, number of PLWH, ratio of CHW: people living with HIV (PLWH), ratio of CHW: population and poverty scores were mapped using choropleth mapping. MapInfo Pro 17.0 was used to map geospatial presentation of the data. Results Overall, KZN province showed under allocation of CHWs with a CHW: people ratio of 1: 1156 compared to the estimated norm of 1: 600–1000. At district level, only two of 11 districts met the suggested norm of CHW: PLWH (1: 109–181). This indicates shortages and misallocation of CHWs in the nine remaining districts. Furthermore, our findings showed extensive geospatial heterogeneity with no clear pattern in the distribution of CHWs. There was no relationship between CHW distribution and HIV prevalence or poverty scores in the districts. Conclusion This study shows inequality in the distribution of CHWs which may be associated with inequalities in the provision of HIV related services. It is critical to strengthen the response to the HIV epidemic through the appropriate distribution of CHWs especially in those districts with high levels of HIV prevalence and poverty.
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Woldesenbet SA, Kufa-Chakezha T, Lombard C, Manda S, Cheyip M, Ayalew K, Puren A. Coverage of maternal viral load monitoring during pregnancy in South Africa: Results from the 2019 national Antenatal HIV Sentinel Survey. HIV Med 2021; 22:805-815. [PMID: 34213065 PMCID: PMC9292699 DOI: 10.1111/hiv.13126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/08/2021] [Accepted: 05/06/2021] [Indexed: 11/28/2022]
Abstract
Objectives: South Africa has made remarkable progress in increasing the coverage of antiretroviral therapy (ART) among pregnant women; however, viral suppression among pregnant women receiving ART is reported to be low. Access to routine viral load testing is crucial to identify women with unsuppressed viral load early in pregnancy and to provide timely intervention to improve viral suppression. This study aimed to determine the coverage of maternal viral load monitoring nationally, focusing on viral load testing, documentation of viral load test results, and viral suppression (viral load < 50 copies/mL). At the time of this study, the first-line regimen for women initiating ART during pregnancy was non-nucleoside reverse transcriptase (NNRTI)-based regimen. Methods: Between 1 October and 15 November 2019, a cross-sectional survey was conducted among 15- to 49-year-old pregnant women attending antenatal care in 1589 nationally representative public health facilities. Data on ART status, viral load testing and viral load test results were extracted from medical records. Logistic regression was used to examine factors associated with coverage of viral load testing. Results: Of 8112 participants eligible for viral load testing, 81.7% received viral load testing, and 94.1% of the viral load test results were documented in the medical records. Of those who had viral load test results documented, 74.1% were virally suppressed. Women initiated on ART during pregnancy and who received ART for three months had lower coverage of viral load testing (73%) and viral suppression (56.8%) compared with women initiated on ART before pregnancy (82.8% and 76.1%, respectively). Initiating ART during pregnancy rather than before pregnancy was associated with a lower likelihood of receiving a viral load test during pregnancy (adjusted odds ratio = 1.6, 95% confidence interval: 1.4–1.8). Conclusions: Viral load result documentation was high; viral load testing could be improved especially among women initiating ART during pregnancy. The low viral suppression among women who initiated ART during pregnancy despite receiving ART for three months highlights the importance of enhanced adherence counselling during pregnancy. Our finding supports the WHO recommendation that a Dolutegravir-containing regimen be the preferred regimen for women who are newly initiating ART during pregnancy for more rapid viral suppression.
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Affiliation(s)
- Selamawit A Woldesenbet
- Centre for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Tendesayi Kufa-Chakezha
- Centre for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Samuel Manda
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa.,Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - Mireille Cheyip
- Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Kassahun Ayalew
- Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Adrian Puren
- Centre for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa.,Division of Virology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
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Ross J, Ribakare M, Remera E, Murenzi G, Munyaneza A, Hoover DR, Shi Q, Nsanzimana S, Yotebieng M, Nash D, Anastos K. High levels of viral load monitoring and viral suppression under Treat All in Rwanda - a cross-sectional study. J Int AIDS Soc 2020; 23:e25543. [PMID: 32536033 PMCID: PMC7293767 DOI: 10.1002/jia2.25543] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/14/2020] [Accepted: 05/13/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Aiming to reach UNAIDS 90-90-90 targets, nearly all sub-Saharan African countries have expanded antiretroviral therapy (ART) to all people living with HIV (PLWH) (Treat All). Few published data exist on viral load testing and viral suppression under Treat All in this region. We assessed proportions of patients with available viral load test results and who were virally suppressed, as well as factors associated with viral suppression, among PLWH in 10 Rwandan health centres after Treat All implementation. METHODS Cross-sectional study during 2018 of adults (≥15 years) engaged in HIV care at 10 Rwandan health centres. Outcomes were being on ART (available ART initiation date in the study database, with no ART discontinuation prior to 1 January 2018), retained on ART (≥2 post-ART health centre visits ≥90 days apart during 2018), available viral load test results (viral load measured in 2018 and available in study database) and virally suppressed (most recent 2018 viral load <200 copies/mL). We used modified Poisson regression models accounting for clustering by health centre to determine factors associated with being virally suppressed. RESULTS Of 12,238 patients, 7050 (58%) were female and 1028 (8%) were aged 15 to 24 years. Nearly all patients (11,933; 97%) were on ART, of whom 11,198 (94%) were retained on ART. Among patients retained on ART, 10,200 (91%) had available viral load results; of these 9331 (91%) were virally suppressed. Viral suppression was less likely among patients aged 15 to 24 compared to >49 years (adjusted prevalence ratio (aPR): 0.83, 95% CI 0.76 to 0.90 and those with pre-ART CD4 counts of <200 compared to ≥500 cells/mm3 (aPR: 0.92, 95% CI 0.90 to 0.93). There was no statistically significant difference in viral suppression among patients who entered after Treat All implementation compared to those who enrolled before 2010 (aPR 0.98, 95% CI 0.94 to 1.03). CONCLUSIONS In this large cohort of Rwandan PLWH receiving HIV care after Treat All implementation, patients in study health centres have surpassed the third UNAIDS 90-90-90 target. To ensure all PLWH fully benefit from ART, additional efforts should focus on improving ART adherence among younger persons.
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Affiliation(s)
- Jonathan Ross
- Division of General Internal MedicineMontefiore Medical Center/Albert Einstein College of MedicineBronxNYUSA
| | - Muhayimpundu Ribakare
- Institute of HIV/AIDS Disease Prevention and ControlRwanda Biomedical CenterKigaliRwanda
| | - Eric Remera
- Institute of HIV/AIDS Disease Prevention and ControlRwanda Biomedical CenterKigaliRwanda
| | - Gad Murenzi
- Research DivisionRwanda Military HospitalKigaliRwanda
| | | | - Donald R Hoover
- Department of Statistics and Biostatistics and Institute for HealthHealth Care Policy and Aging ResearchRutgers the State University of New JerseyNJUSA
| | - Qiuhu Shi
- Department of Epidemiology and Community HealthNew York Medical CollegeValhallaNYUSA
| | - Sabin Nsanzimana
- Institute of HIV/AIDS Disease Prevention and ControlRwanda Biomedical CenterKigaliRwanda
| | - Marcel Yotebieng
- Division of General Internal MedicineMontefiore Medical Center/Albert Einstein College of MedicineBronxNYUSA
| | - Denis Nash
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNYUSA
| | - Kathryn Anastos
- Division of General Internal MedicineMontefiore Medical Center/Albert Einstein College of MedicineBronxNYUSA
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