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Kaseje N, Ranganathan M, Magadi M, Oria K, Haines A. The effectiveness of rural community health workers in improving health outcomes during the COVID-19 pandemic: a systematic review. Glob Health Action 2024; 17:2292385. [PMID: 38180049 PMCID: PMC10773683 DOI: 10.1080/16549716.2023.2292385] [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: 10/06/2023] [Accepted: 12/03/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Rural community health workers [CHWs] play a critical role in improving health outcomes during non-pandemic times, but evidence on their effectiveness during the COVID-19 pandemic is limited. There is a need to focus on rural CHWs and rural health systems as they have limited material and human resources rendering them more vulnerable than urban health systems to severe disruptions during pandemics. OBJECTIVES This systematic review aims to describe and appraise the current evidence on the effectiveness of rural CHWs in improving access to health services and health outcomes during the COVID-19 pandemic in low-and middle-income countries [LMICs]. METHODS We searched electronic databases for articles published from 2020 to 2023 describing rural CHW interventions during the COVID-19 pandemic in LMICs. We extracted data on study characteristics, interventions, outcome measures, and main results. We conducted a narrative synthesis of key results. RESULTS Fifteen studies from 10 countries met our inclusion criteria. Most of the studies were from Asia [10 of 15 studies]. Study designs varied and included descriptive and analytical studies. The evidence suggested that rural CHW interventions led to increased household access to health services and may be effective in improving COVID-19 and non-COVID-19 health outcomes. Overall, however, the quality of evidence was poor due to methodological limitations; 14 of 15 studies had a high risk of bias. CONCLUSION Rural CHWs may have improved access to health services and health outcomes during the COVID-19 pandemic in LMICs but more rigorous studies are needed during future pandemics to evaluate their effectiveness in improving health outcomes in different settings and to assess appropriate support required to ensure their impact at scale.
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Affiliation(s)
- Neema Kaseje
- London School of Hygiene & Tropical Medicine, London, UK
- Department of Research, Surgical Systems Research Group, Kisumu, Kenya
| | | | - Monica Magadi
- Keele School of Medicine, Keele University Staffordshire, Newcastle-under-Lyme, UK
| | - Kevin Oria
- Department of Research, Tropical Institute of Community Health, Kisumu, Kenya
| | - Andy Haines
- London School of Hygiene & Tropical Medicine, London, UK
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Amone A, Gabagaya G, Wavamunno P, Rukundo G, Namale-Matovu J, Malamba SS, Lubega I, Homsy J, King R, Nakabiito C, Namukwaya Z, Fowler MG, Musoke P. Enhanced peer-group strategies to support the prevention of mother-to-child HIV transmission leads to increased retention in care in Uganda: A randomized controlled trial. PLoS One 2024; 19:e0297652. [PMID: 38640123 PMCID: PMC11029615 DOI: 10.1371/journal.pone.0297652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/09/2024] [Indexed: 04/21/2024] Open
Abstract
INTRODUCTION Despite the scale-up of Option B+, long-term retention of women in HIV care during pregnancy and the postpartum period remains an important challenge. We compared adherence to clinic appointments and antiretroviral therapy (ART) at 6 weeks, 6, and and 24 months postpartum among pregnant women living with HIV and initiating Option B+. Women were randomized to a peer group support, community-based drug distribution and income-generating intervention called "Friends for Life Circles" (FLCs) versus the standard of care (SOC). Our secondary outcome was infant HIV status and HIV-free survival at 6 weeks and 18 months postpartum. METHODS Between 16 May 2016 and 12 September 2017, 540 ART-naïve pregnant women living with HIV at urban and rural health facilities in Uganda were enrolled in the study at any gestational age. Participants were randomized 1:1 to the unblinded FLC intervention or SOC at enrolment and assessed for adherence to the prevention of mother-to-child HIV transmission (PMTCT) clinic appointments at 6 weeks, 12, and 24 months postpartum, self-reported adherence to ART at 6 weeks, 6 and 24 months postpartum and supported by plasma HIV-1 RNA viral load (VL) measured at the same time points, retention in care through the end of study, and HIV status and HIV-free survival of infants at 18 months postpartum. The FLC groups were formed during pregnancy within 4 months of enrollment and held monthly meetings in their communites, and were followed up until the last group participant reached 24 months post delivery. We used Log-rank and Chi-Square p-values to test the equality of Kaplan-Meier survival probabilities and hazard rates (HR) for failure to retain in care for any reason by study arm. RESULTS There was no significant difference in adherence to PMTCT clinic visits or to ART or in median viral loads between FLC and SOC arms at any follow-up time points. Retention in care through the end of study was high in both arms but significantly higher among participants randomized to FLC (86.7%) compared to SOC (79.3%), p = 0.022. The adjusted HR of visit dropout was 2.4 times greater among participants randomized to SOC compared to FLC (aHR = 2.363, 95% CI: 1.199-4.656, p = 0.013). Median VL remained < 400 copies/ml in both arms at 6 weeks, 6, and 24 months postpartum. Eight of the 431 infants tested at 18 months were HIV positive (1.9%), however, this was not statistically different among mothers enrolled in the FLC arm compared to those in the SOC arm. At 18 months, HIV-free survival of children born to mothers in the FLC arm was significantly higher than that of children born to mothers in the SOC arm. CONCLUSIONS Our findings suggest that programmatic interventions that provide group support, community-based ART distribution, and income-generation activities may contribute to retention in PMTCT care, HIV-free survival of children born to women living with HIV, and ultimately, to the elimination of mother-to-child HIV transmission (EMTCT). TRIAL REGISTRATION NCT02515370 (04/08/2015) on ClinicalTrials.gov.
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Affiliation(s)
- Alexander Amone
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Grace Gabagaya
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Priscilla Wavamunno
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Gordon Rukundo
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Joyce Namale-Matovu
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Irene Lubega
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Jaco Homsy
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Rachel King
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Clemensia Nakabiito
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Zikulah Namukwaya
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Mary Glenn Fowler
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
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Mukomafhedzi N, Tshitangano TG, Tshivhase SE, Olaniyi FC. Protocol to develop a framework addressing barriers to utilization of elimination of mother- to -child transmission of HIV services among pregnant women and lactating mothers in Gauteng province. MethodsX 2023; 11:102351. [PMID: 37830000 PMCID: PMC10565866 DOI: 10.1016/j.mex.2023.102351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/26/2023] [Indexed: 10/14/2023] Open
Abstract
Mother-to-child transmission of HIV remains the primary contributor to HIV infections in children, globally. Despite the progress made to reduce new HIV infections in children, barriers to utilization of the Elimination of Mother-to-Child Transmission service remain the bottleneck that affects the program's effectiveness. This study aims to develop a framework to address barriers to the utilization of the Elimination of Mother-to-Child Transmission of HIV services among pregnant women and lactating mothers in Gauteng province. A convergent parallel mixed methods design will be employed in phases. Phase 1(a) quantitative will be collected from pregnant women and lactating mothers to describe barriers associated with poor utilization of elimination of mother-to-child transmission services and a potential strategy to facilitate EMTCT utilization; phase 1(b) qualitative data will be collected to explore reasons for poor utilization of EMTCT services and perceived strategy to enhance women's utilization of elimination of mother-to-child transmission services. Quantitative data will be analyzed using Stata software version 14.0 and qualitative data will be analyzed thematically and then results will be integrated. Phase 2: will focus on the development of a framework; Phase 3: will validate the developed framework. The conclusion and recommendations will be based on the findings of the study.
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Affiliation(s)
- Ndivhuwo Mukomafhedzi
- Department of Public Health, School of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Takalani G. Tshitangano
- Department of Public Health, School of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Shonisani E. Tshivhase
- Department of Public Health, School of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Foluke C. Olaniyi
- Department of Public Health, School of Health Sciences, University of Venda, Thohoyandou, South Africa
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Miskeen E, Al-Shahrani AM. The Primary Healthcare Physician's Awareness and Engagement in Community-Based Medical Education: A Mixed Qualitative and Quantitative Study. Healthcare (Basel) 2023; 11:2676. [PMID: 37830713 PMCID: PMC10572629 DOI: 10.3390/healthcare11192676] [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: 04/21/2023] [Revised: 07/20/2023] [Accepted: 08/22/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Community-based medical education (CBME) is an essential component of medical education, where primary healthcare physicians (PCPs) play a crucial role. This study explores PCPs' awareness and engagement in CBME and investigates the factors influencing their participation. METHODS This mixed study was conducted in two phases. In the first phase, a qualitative study was conducted using semi-structured interviews with PCPs as well as thematic analysis related to their awareness and engagement in CBME. In the second phase, a quantitative survey was conducted on 72 PCPs' pre- and post-training programs. RESULTS Primary healthcare physicians had a positive attitude toward community-based medical education. The participants had an acceptable level of awareness and engagement, which increased substantially by (p-value = 0.03) and (p-value = 0.003), respectively. Logistical analysis indicated that non-Saudi physicians were more likely to participate in the CBME (p-value = 0.001). Professions and academic experiences influenced their willingness to engage and participate in CBME (OR = 7.5, p-value = 0.001) and (OR = 0.21, p-value = 0.001), respectively. CONCLUSION The study findings highlighted the importance of increased awareness and the factors that enhance PCPs' engagement in CBME. This positive perspective of the PCPs will help build effective partnerships and facilitate the extension of the curriculum to apply CBME.
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Affiliation(s)
- Elhadi Miskeen
- Department of Obstetrics and Gynecology, College of Medicine, University of Bisha, Bisha 67714, Saudi Arabia
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Gezira, Wad Medani 21111, Sudan
| | - Abdullah M. Al-Shahrani
- Department of Family Medicine, College of Medicine, University of Bisha, Bisha 67714, Saudi Arabia;
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Amone A, Gabagaya G, Wavamunno P, Rukundo G, Namale-Matovu J, Malamba SS, Lubega I, Homsy J, King R, Nakabiito C, Namukwaya Z, Fowler MG, Musoke P. Enhanced Peer-Group strategies to support prevention of Mother-to-Child HIV transmission leads to increased retention in care in Uganda: A Randomized controlled trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.15.23288495. [PMID: 37131665 PMCID: PMC10153351 DOI: 10.1101/2023.04.15.23288495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Introduction Despite scale up of Option B+, long-term retention of women in HIV care during pregnancy and the postpartum period remains an important challenge. We compared adherence to clinic appointments and antiretroviral therapy (ART) at different follow-up time points between enrolment and 24 months postpartum among pregnant women living with HIV and initiating Option B+ randomized to a peer group support, community-based drug distribution and income-generating intervention called "Friends for Life Circles" (FLCs) versus the standard of care (SOC). Methods Between 16 May 2016 and 12 September 2017, 540 ART-naïve pregnant women living with HIV at urban and rural health facilities in Uganda were enrolled in the study. Participants were randomized 1:1 to the FLC intervention or SOC and assessed for adherence to prevention of mother to child HIV transmission (PMTCT) clinic appointments at 6 weeks, 12 and 24 months postpartum, self-reported adherence to ART at 6 weeks, 6 and 24 months postpartum validated by plasma HIV-1 RNA viral load (VL) measured at the same time points, and HIV status and HIV-free survival of infants at 18 months postpartum. We used Log-rank and Chi-Square p-values to test the equality of Kaplan-Meier survival probabilities and hazard rates (HR) for failure to retain in care for any reason by study arm. Results There was no significant difference in adherence to PMTCT clinic visits or to ART or in median viral loads between FLC and SOC arms at any follow-up time points. Retention in care through the end of study was high in both arms but significantly higher among participants randomized to FLC (86.7%) compared to SOC (79.3%), p=0.022. The adjusted HR of visit dropout was 2.5 times greater among participants randomized to SOC compared to FLC (aHR=2.498, 95% CI: 1.417 - 4.406, p=0.002). Median VL remained < 400 copies/ml in both arms at 6 weeks, 6 and 24 months postpartum. Conclusions Our findings suggest that programmatic interventions that provide group support, community based ART distribution and income-generation activities may contribute to retention in PMTCT care, HIV-free survival of children born to women living with HIV, and to the elimination of mother to child HIV transmission (MTCT).
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Affiliation(s)
- Alexander Amone
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Grace Gabagaya
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Priscilla Wavamunno
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Gordon Rukundo
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Joyce Namale-Matovu
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Irene Lubega
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Jaco Homsy
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Rachel King
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Clemensia Nakabiito
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Zikulah Namukwaya
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Mary Glenn Fowler
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
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Ally A, Exavery A, Charles J, Kikoyo L, Mseya R, Barankena A, Fovo R, Temu A. Determinants of viral load suppression among orphaned and vulnerable children living with HIV on ART in Tanzania. Front Public Health 2023; 11:1076614. [PMID: 37006553 PMCID: PMC10065403 DOI: 10.3389/fpubh.2023.1076614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/08/2023] [Indexed: 03/19/2023] Open
Abstract
IntroductionIn Tanzania, only 66% children 0–14 years living with HIV know their HIV status, 66% are on treatment while 47% of children on ART are virally suppressed. Although retention on ART and poor adherence remain a challenge for children living with HIV, orphans and vulnerable children (OVC) face a greater limitation of access to and utilization of comprehensive HIV care and treatment. In response to this, the current study assessed the determinants of viral load suppression (VLS) among OVC aged 0–14 years living with HIV enrolled in HIV interventions.MethodsThis was a cross-sectional study that used secondary data collected by the USAID Kizazi Kipya project in 81 district councils of Tanzania. Included in this study are 1,980 orphans and vulnerable children living with HIV (OVCLHIV) (0–14 years) enrolled and served by the project for 24 months. Data analysis involved multivariable logistic regression, with viral load suppression as the outcome of interest and HIV interventions as the main independent variables.ResultsThe overall VLS rate among the OVCLHIV was 85.3%. This rate increased from 85.3, 89.9, 97.6 to 98.8% after 6, 12, 18, and 24 months of retention on ART, respectively. Similar rates were observed as the duration of adherence to ART increased. In the multivariable analysis, OVCLHIV attending people living with HIV (PLHIV) support groups were 411 times more likely to be virally suppressed than those not attending (aOR = 411.25, 95% CI 168.2–1,005.4). OVCLHIV with health insurance were 6 times more likely to achieve viral suppression than those without (aOR = 6.05, 95% CI 3.28–11.15). OVCLHIV with >95% adherence to ART were 149 times more likely to be virally suppressed than those not adherent to ART (aOR = 148.96, 95% CI 42.6–520.6, p < 0.001). Other significant factors included food security and family size. OVCLHIV reached by the different HIV community-based interventions were more likely to be virally suppressed than those who were not.DiscussionTo advance viral suppression, efforts should be made to ensure that all OVCLHIV are reached by community-based interventions as well as integrating food support in HIV treatment interventions.
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Abraham JM, Melendez-Torres GJ. A realist review of interventions targeting maternal health in low- and middle-income countries. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231205687. [PMID: 37899651 PMCID: PMC10617292 DOI: 10.1177/17455057231205687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 09/04/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023]
Abstract
Maternal mortality is disproportionately higher in low- and middle-income countries compared to other parts of the world. International research efforts are reflective of the urgency to improve global maternal outcomes. The existing literature of maternal health interventions in low- and middle-income countries targets a variety of populations and intervention types. However, there is a notable lack of systemic reviews that examine the wider contextual and mechanistic factors that have contributed to the outcomes produced by interventions. This article aims to use realist synthesis design to identify and examine the relationships between the contexts, mechanisms and outcomes of maternal health interventions conducted in low- and middle-income countries. This will inform evidence-based practice for future maternal health interventions. In May 2022, we searched four electronic databases for systematic reviews of maternal health interventions in low- and middle-income countries published in the last 5 years. We used open and axial coding of contexts, mechanisms and outcomes to develop an explanatory framework for intervention effectiveness. After eligibility screening and full-text analysis, 44 papers were included. The majority of effective interventions reported good healthcare system contexts, especially the importance of infrastructural capacity to implement and sustain the intervention. Most intervention designs used increasing knowledge and awareness at an individual and healthcare-provider level to produce intended outcomes. The majority of outcomes reported related to uptake of healthcare services by women. All mechanism themes had a relationship with this outcome. Health system infrastructure must be considered in interventions to ensure effective implementation and sustainability. Healthcare-seeking behaviours are embedded within social and cultural norms, environmental conditions, family influences and provider attitudes. Therefore, effective engagement with communities and families is important to create new norms surrounding pregnancy and delivery. Future research should explore community mobilization and involvement to enable tailored interventions with optimal contextual fit.
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Gumede SB, Venter F, de Wit J, Wensing A, Lalla-Edward ST. Antiretroviral therapy uptake and predictors of virological failure in patients with HIV receiving first-line and second-line regimens in Johannesburg, South Africa: a retrospective cohort data analysis. BMJ Open 2022; 12:e054019. [PMID: 35428623 PMCID: PMC9013990 DOI: 10.1136/bmjopen-2021-054019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study described the demographics, treatment information and identified characteristics associated with virological failure and being lost to follow-up (LTFU) for patients with HIV on first-line and second-line antiretroviral therapy (ART) regimens in a large South African cohort. DESIGN A quantitative retrospective cohort study using secondary data analysis. SETTING Seven Johannesburg inner city facilities. PARTICIPANTS Unique records of 123 002 people with HIV receiving ART at any point in the period 1 April 2004 to 29 February 2020 were included. MEASURES Demographic characteristics, ART status, CD4 count information and retention status were collected and analysed as covariates of outcomes (viral load (VL) and LTFU). RESULTS Of the total study patients, 95% (n=1 17 260) were on a first-line regimen and 5% (n=5742) were on a second-line regimen. Almost two-thirds were female (64%, n=79 226). Most patients (60%, n=72 430) were initiated on an efavirenz-based, tenofovir disoproxil fumarate-based and emtricitabine-based regimen (fixed-dose combination). 91% (n=76 737) achieved viral suppression at least once since initiating on ART and 60% (n=57 981) remained in care as at the end of February 2020. Patients from the community health centre and primary healthcare clinics were not only more likely to be virally suppressed but also more likely to be LTFU. Patients on second-line regimens were less likely to reach viral suppression (adjusted OR (aOR)=0.26, CI=0.23 to 0.28) and more likely to be LTFU (aOR=1.21, CI=1.09 to 1.35). Being older (≥25 years) and having a recent CD4 cell count≥100 cells/µL were predictors of viral suppression and retention in patients on ART. CONCLUSION Patients on first-line regimens had higher VL suppression rates and were more likely to remain in care than those on a second-line regimen. Being younger and having low CD4 cell counts were associated with poor outcomes, suggesting priority groups for ART adherence support.
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Affiliation(s)
- Siphamandla Bonga Gumede
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - John de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Annemarie Wensing
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Ssetaala A, Ssempiira J, Wambuzi M, Nanyonjo G, Okech B, Chinyenze K, Bagaya B, Price MA, Kiwanuka N, Degomme O. Improving access to maternal health services among rural hard-to-reach fishing communities in Uganda, the role of community health workers. WOMEN'S HEALTH 2022; 18:17455057221103993. [PMID: 35748585 PMCID: PMC9234847 DOI: 10.1177/17455057221103993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives: To explore whether community health worker household-based maternal health
visits improve antenatal care and skilled birth attendance among
hard-to-reach fishing villages on Lake Victoria, Uganda. Methods: This quasi-experimental 18-month prospective study involved 486 consenting
women aged 15–49 years, who were pregnant or had a pregnancy outcome in the
past 6 months, from 6 island fishing communities. The community health
worker household-based intervention (community health workers’ household
visits to provide counseling, blood pressure measurement, anemia, and HIV
testing) involved 243 women from three fishing communities. Random effects
logistic regression was used to determine the association between the
community health worker intervention and antenatal care and skilled birth
attendance among women who had at least 5 months of pregnancy or childbirth
at follow-up. Results: Almost all women accepted the community health worker intervention (90.9%
(221/243)). Hypertension was at 12.5% (27/216) among those who accepted
blood pressure measurements, a third (33.3% (9/27)) were pregnant. HIV
prevalence was 23.5% (52/221). Over a third (34.2% (69/202)) of women tested
had anemia (hemoglobin levels less than 11 g/dL). The community health
worker intervention was associated with attendance of first antenatal care
visit within 20 weeks of pregnancy (adjusted odd ratio = 2.1 (95% confidence
interval 0.6–7.6)), attendance of at least four antenatal care visits
(adjusted odd ratio = 0.9 (95% confidence interval 0.4–2.0)), and skilled
birth attendance (adjusted odd ratio = 0.5 (95% confidence interval
0.1–1.5)), though not statistically significant. Conclusion: Community health workers have a crucial role in improving early antenatal
care attendance, early community-based diagnosis of anemia, hypertensive
disorders, and HIV among women in these hard-to-reach fishing
communities.
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Affiliation(s)
- Ali Ssetaala
- UVRI-IAVI HIV Vaccine Program, Entebbe, Uganda
- Ghent University International Centre for Reproductive Health, Ghent, Belgium
| | - Julius Ssempiira
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | | | | | - Bernard Bagaya
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Matt A Price
- IAVI, New York, NY, USA
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA
| | - Noah Kiwanuka
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Olivier Degomme
- Ghent University International Centre for Reproductive Health, Ghent, Belgium
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Abuogi LL, Onono M, Odeny TA, Owuor K, Helova A, Hampanda K, Odwar T, Onyango D, McClure LA, Bukusi EA, Turan JM. Effects of behavioural interventions on postpartum retention and adherence among women with HIV on lifelong ART: the results of a cluster randomized trial in Kenya (the MOTIVATE trial). J Int AIDS Soc 2022; 25:e25852. [PMID: 35041776 PMCID: PMC8765560 DOI: 10.1002/jia2.25852] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 11/18/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Retention in HIV care and adherence to antiretroviral therapy (ART) during pregnancy and postpartum for women living with HIV (WLWH) are necessary to optimize health outcomes for women and infants. The objective of this study was to evaluate the impact of two evidenced-based behavioural interventions on postpartum adherence and retention in WLWH in Kenya. METHODS The Mother-Infant Visit Adherence and Treatment Engagement (MOTIVATE) study was a cluster-randomized trial enrolling pregnant WLWH from December 2015 to August 2017. Twenty-four health facilities in southwestern Kenya were randomized to: (1) standard care (control), (2) text-messaging, (3) community-based mentor mothers (cMM) or (4) text-messaging and cMM. Primary outcomes included retention in care and ART adherence at 12 months postpartum. Analyses utilized generalized estimating equations and competing risks regression. Per-protocol analyses examined differences in postpartum retention for women with high versus low levels of exposure to the interventions. RESULTS We enrolled 1331 pregnant WLWH (mean age 28 years). At 12 months postpartum, 1140 (85.6%) women were retained in care, 96 women (7.2%) were lost-to-follow-up (LTFU) and 95 (7.1%) were discontinued from the study. In intention-to-treat analyses, the relative risk of being retained at 12-months postpartum was not significantly higher in the intervention arms versus the control arm. In time-to-event analysis, the cMM and text arm had significantly lower rates of LTFU (hazard ratio 0.44, p = 0.019). In per-protocol analysis, the relative risk of 12-month postpartum retention was 24-29% higher for women receiving at least 80% of the expected intervention compared to the control arm; text message only risk ratio (RR) 1.24 (95% confidence interval [CI] 1.16-1.32, p<0.001), cMM only RR 1.29 (95% CI 1.21-1.37, p<0.001) and cMM plus text RR 1.29 (1.21-1.37, p<0.001). Women LTFU were younger (p<0.001), less likely to be married (p<0.001) and more likely to be newly diagnosed with HIV during pregnancy (p<0.001). Self-reported ART adherence did not vary by study arm. CONCLUSIONS Behavioural interventions using peer support and text messages did not appear to improve 12-month postpartum retention and adherence in intention-to-treat analyses. Higher levels of exposure to the interventions may be necessary to achieve the desired effects.
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Affiliation(s)
- Lisa L. Abuogi
- Department of PediatricsUniversity of Colorado DenverAuroraColoradoUSA
- Center for Global HealthColorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Maricianah Onono
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | - Thomas A. Odeny
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
- National Cancer InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - Kevin Owuor
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
- Department of BiostatisticsSchool of Public HealthUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Anna Helova
- Department of Health Care Policy and OrganizationSchool of Public HealthUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Karen Hampanda
- Center for Global HealthColorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Department of Obstetrics and GynecologyUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Tobias Odwar
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | | | - Leslie A. McClure
- Department of Epidemiology and BiostatisticsDornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Elizabeth A. Bukusi
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | - Janet M. Turan
- Department of Health Care Policy and OrganizationSchool of Public HealthUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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