1
|
Suraratdecha C, MacKellar D, Steiner C, Rwabiyago OE, Cham HJ, Msumi O, Maruyama H, Kundi G, Byrd J, Weber R, Mkemwa G, Kazaura K, Justman J, Rwebembera A. Cost-outcome analysis of HIV testing and counseling, linkage, and defaulter tracing services in Bukoba, Tanzania. AIDS Care 2024; 36:744-751. [PMID: 37607238 PMCID: PMC10881889 DOI: 10.1080/09540121.2023.2247959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Effective services along the HIV continuum of care from HIV testing and counseling to linkage, and from linkage to antiretroviral therapy (ART) initiation and retention, are key to improved health outcomes of persons living with HIV. A comprehensive analysis of the costs and outcomes of cascade services is needed to help allocate and prioritize resources to achieve UNAIDS targets. We evaluated the costs and population-level impact of a community-wide, integrated scale-up of testing, linkage, and defaulter-tracing programs implemented in Bukoba Municipal Council, Tanzania. Costs per identified HIV-positive client for provider-initiated, and home- and venue-based testing and counseling were $92.64 United States dollars (USD), $256.33 USD, and $281.57 USD, respectively. Costs per patient linked to HIV care and ART were $47.69 USD and $74.12 USD, respectively, during all ART-eligibility periods combined. Costs per defaulter traced and returned to HIV care were $47.56 USD and $206.77 USD, respectively. The provider-initiated testing and counseling was the most cost-effective modality. Testing approaches targeted to populations groups and geographic location with high testing positivity rates may improve the overall efficiency of testing services. The expansion of ART eligibility criteria and high linkage rate also result in efficiency gains and economies of scale of linkage services.
Collapse
Affiliation(s)
- Chutima Suraratdecha
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Duncan MacKellar
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Haddi Jatou Cham
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Omari Msumi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | | | - Gerald Kundi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | | | - Rachel Weber
- Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Grace Mkemwa
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | | | | | - Anath Rwebembera
- National AIDS Control Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| |
Collapse
|
2
|
Youngui BT, Atwine D, Otai D, Vasiliu A, Ssekyanzi B, Sih C, Kana R, Arinaitwe R, Cuer B, Simo L, Okello R, Tchendjou P, Casenghi M, Kuate AK, Turyahabwe S, Cohn J, Bonnet M, Tchounga BK. Integration of HIV Testing in a Community Intervention for Tuberculosis Screening Among Household Contacts of Patients with Tuberculosis in Cameroon and Uganda. J Acquir Immune Defic Syndr 2024; 95:431-438. [PMID: 38489492 PMCID: PMC10927301 DOI: 10.1097/qai.0000000000003379] [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: 09/09/2023] [Accepted: 12/18/2023] [Indexed: 03/17/2024]
Abstract
INTRODUCTION People living with HIV are considered at higher risk of developing severe forms of tuberculosis (TB) disease. Providing HIV testing to TB-exposed people is therefore critical. We present the results of integrating HIV testing into a community-based intervention for household TB contact management in Cameroon and Uganda. METHODS Trained community health workers visited the households of index patients with TB identified in 3 urban/semiurban and 6 rural districts or subdistricts as part of a cluster-randomized trial and provided TB screening to all household contacts. Voluntary HIV counseling and testing were offered to contacts aged 5 years or older with unknown HIV status. We describe the cascade of care for HIV testing and the factors associated with the acceptance of HIV testing. RESULTS Overall, 1983 household contacts aged 5 years or older were screened for TB. Of these contacts, 1652 (83.3%) did not know their HIV status, 1457 (88.2%) accepted HIV testing, and 1439 (98.8%) received testing. HIV testing acceptance was lower among adults than children [adjusted odds ratio (aOR) = 0.35, 95% confidence interval (CI): 0.22 to 0.55], those living in household of an HIV-positive vs HIV-negative index case (aOR = 0.56, 95% CI: 0.38 to 0.83), and contacts requiring a reassessment visit after the initial TB screening visit vs asymptomatic contacts (aOR = 0.20, 95% CI: 0.06 to 0.67) and was higher if living in Uganda vs Cameroon (aOR = 4.54, 95% CI: 1.17 to 17.62) or if another contact of the same index case was tested for HIV (aOR = 9.22, 95% CI: 5.25 to 16.18). CONCLUSION HIV testing can be integrated into community-based household TB contact screening and is well-accepted.
Collapse
Affiliation(s)
- Boris Tchakounte Youngui
- TransVIHMI, University of Montpellier, Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche Médicale (INSERM), Montpellier, France
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroun
| | - Daniel Atwine
- Department of Clinical Research, Epicentre Research Center, Mbarara, Uganda;
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda;
| | - David Otai
- Department of Clinical Research, Epicentre Research Center, Mbarara, Uganda;
| | - Anca Vasiliu
- TransVIHMI, University of Montpellier, Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche Médicale (INSERM), Montpellier, France
| | - Bob Ssekyanzi
- Department of Clinical Research, Epicentre Research Center, Mbarara, Uganda;
| | - Colette Sih
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroun
| | - Rogacien Kana
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroun
| | - Rinah Arinaitwe
- Department of Clinical Research, Epicentre Research Center, Mbarara, Uganda;
| | - Benjamin Cuer
- TransVIHMI, University of Montpellier, Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche Médicale (INSERM), Montpellier, France
| | - Leonie Simo
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroun
| | - Richard Okello
- Elizabeth Glaser Pediatric AIDS Foundation, Kampala, Uganda;
| | | | - Martina Casenghi
- Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland;
| | | | - Stavia Turyahabwe
- Tuberculosis Leprosy Control, Ministry of Health, Kampala, Uganda; and
| | - Jennifer Cohn
- Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Maryline Bonnet
- TransVIHMI, University of Montpellier, Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche Médicale (INSERM), Montpellier, France
| | | |
Collapse
|
3
|
Chebrolu P, Chalem A, Ponticiello M, Broderick K, Vaidyanathan A, Lorenc R, Kulkarni V, Onawale A, Mathad JS, Sundararajan R. A community health worker-led program to improve access to gestational diabetes screening in urban slums of Pune, India: Results from a mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001622. [PMID: 37889879 PMCID: PMC10610081 DOI: 10.1371/journal.pgph.0001622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/14/2023] [Indexed: 10/29/2023]
Abstract
The World Health Organization recommends all pregnant women receive screening for gestational diabetes (GDM) with a fasting oral glucose tolerance test (OGTT). However, very few women receive recommended screening in resource-limited countries like India. We implemented a community health worker (CHW)-delivered program to evaluate if home-based, CHW-delivered OGTT would increase GDM screening in a low-resource setting. We conducted a mixed methods study in two urban slum communities in Pune, India. CHWs were trained to deliver home-based, point-of-care fasting OGTT to women in their third trimester of pregnancy. The primary outcome was uptake of CHW-delivered OGTT. Secondary outcomes included GDM prevalence and linkage to GDM care. Individual interviews were conducted with purposively sampled pregnant women, CHWs, and local clinicians to assess barriers and facilitators of this approach. From October 2021-June 2022, 248 eligible pregnant women were identified. Of these, 223 (90%) accepted CHW-delivered OGTT and 31 (14%) were diagnosed with GDM. Thirty (97%) women diagnosed with GDM subsequently sought GDM care; only 10 (33%) received lifestyle counseling or pharmacologic therapy. Qualitative interviews indicated that CHW-delivered testing was considered highly acceptable as home-based testing saved time and was more convenient than clinic-based testing. Inconsistent clinical management of GDM was attributed to providers' lack of time to deliver counseling, and perceptions that low-income populations are not at risk for GDM. Convenience and trust in a CHW-delivered GDM screening program resulted in high access to gold-standard OGTT screening and identification of a high GDM prevalence among pregnant women in two urban slum communities. Appropriate linkage to care was limited by clinician time constraints and misperceptions of GDM risk. CHW-delivered GDM screening and counseling may improve health education and access to preventive healthcare, offloading busy public clinics in high-need, low-resource settings.
Collapse
Affiliation(s)
- Puja Chebrolu
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Andrea Chalem
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Matthew Ponticiello
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Kathryn Broderick
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Arthi Vaidyanathan
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Rachel Lorenc
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | | | | | - Jyoti S. Mathad
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| |
Collapse
|
4
|
Ossomba JPBE, Ngangue P, Ekani ASO, Kamgain ET. De-medicalized and decentralized HIV testing: a strategy to test hard-to-reach men who have sex with men in Cameroon. Front Public Health 2023; 11:1180813. [PMID: 37564422 PMCID: PMC10410143 DOI: 10.3389/fpubh.2023.1180813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Conventional HIV testing performed by a health professional has shown its limitations in targeting marginalized and vulnerable populations. Indeed, men who have sex with men (MSM) due to social discrimination are often uncomfortable using this service at the health facilities level. In this perspective, new differentiated approaches have been thought through de-medicalized and decentralized HIV testing (DDHT). This HIV testing strategy enables overcoming the structural, legal, and social barriers that prevent these populations from quickly accessing HIV services. This article discusses the prerequisites and added value of implementing this strategy for MSM living in a criminalized context and its implication in decentralizing health services toward the community level.
Collapse
|
5
|
Lukyamuzi Z, Ssuna B, Mirembe RN, Mawanda D, Kinkumu P, Nalugo C, Adikin E, Namisango F, Nakalega R, Atuhaire P, Musoke P, Butler LM. Experiences and challenges of using community health worker-led mechanism in supporting HIV disclosure among adults living with HIV in heterosexual relationships in the rural Uganda. AIDS Res Ther 2023; 20:14. [PMID: 36906557 PMCID: PMC10008611 DOI: 10.1186/s12981-023-00508-0] [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: 11/07/2022] [Accepted: 02/23/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND HIV status disclosure among sexual partners is vital in HIV management. Community health workers (CHW) support HIV disclosure among adults living with HIV (ALHIV) in sexual relationships with disclosure difficulties. However, experiences and challenges of using CHW-led disclosure support mechanism were not documented. This study explored experiences and challenges involved in using CHW-led disclosure support mechanism among ALHIV in heterosexual relationships in the rural Uganda. METHODS This was a phenomenological qualitative study involving in-depth interviews among CHWs and ALHIV with HIV disclosure difficulties to sexual partners in greater Luwero region, Uganda. We conducted 27 interviews among purposively selected CHWs and participants who had participated in the CHW-led disclosure support mechanism. Interviews were conducted until saturation was reached; and analysis was done using inductive and deductive content analysis in Atlas. RESULTS All respondents viewed HIV disclosure as an important strategy in HIV management. Provision of adequate counseling and support to those intending to disclose was instrumental for successful disclosure. However, fear of the negative disclosure outcomes was viewed as a barrier to disclosure. The CHWs were viewed as having an added advantage in supporting disclosure as opposed to the routine disclosure counseling. However, HIV disclosure using CHW-led support mechanism would be limited by possible bleach of client's confidentiality. Therefore, respondents thought that appropriate selection of CHWs would improve their trust in the community. Additionally, providing CHWs with adequate training and facilitation during the disclosure support mechanism was viewed to improve their work. CONCLUSION Community health workers were viewed as being more supportive in HIV disclosure among ALHIV with disclosure difficulties to sexual partners compared to routine facility based disclosure counseling. Therefore, near location CHW-led disclosure mechanism was acceptable and useful in supporting HIV disclosure among HIV-affected sexual partners in rural settings.
Collapse
Affiliation(s)
- Zubair Lukyamuzi
- Johns Hopkins University Collaboration (MU-JHU), Makerere University, Upper Mulago Hill Road, Kampala, Uganda. .,School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Bashir Ssuna
- Uganda Tuberculosis Implementation Research Consortium (U-TIRC), Kampala, Uganda
| | - Ruth Nabisere Mirembe
- Infectious Diseases Institute (IDI), College of Health Sciences, Makerere University, Kampala, Uganda
| | - Denis Mawanda
- Johns Hopkins University Collaboration (MU-JHU), Makerere University, Upper Mulago Hill Road, Kampala, Uganda
| | - Paul Kinkumu
- Mildmay Hospital and Institute of Health Sciences, Mildmay Uganda, Box 24985, Kampala, Uganda
| | - Christine Nalugo
- Mildmay Hospital and Institute of Health Sciences, Mildmay Uganda, Box 24985, Kampala, Uganda
| | - Esther Adikin
- Mildmay Hospital and Institute of Health Sciences, Mildmay Uganda, Box 24985, Kampala, Uganda
| | | | - Rita Nakalega
- Johns Hopkins University Collaboration (MU-JHU), Makerere University, Upper Mulago Hill Road, Kampala, Uganda
| | - Patience Atuhaire
- Johns Hopkins University Collaboration (MU-JHU), Makerere University, Upper Mulago Hill Road, Kampala, Uganda
| | - Philippa Musoke
- Johns Hopkins University Collaboration (MU-JHU), Makerere University, Upper Mulago Hill Road, Kampala, Uganda
| | - Lisa M Butler
- Institute for Collaboration On Health, Intervention, and Policy, University of Connecticut, Storrs, CT, 06269, USA
| |
Collapse
|
6
|
Ware NC, Wyatt MA, Pisarski EE, Kamusiime B, Kasiita V, Nalukwago G, Nalumansi A, Twesigye C, Boyer J, Nakyanzi A, Naddunga F, Mujugira A, Celum CL. How pregnant women living with HIV and their male partners manage men's HIV self-testing: qualitative analysis of an HIVST secondary distribution process in Kampala, Uganda. J Int AIDS Soc 2023; 26:e26050. [PMID: 36659835 PMCID: PMC9852794 DOI: 10.1002/jia2.26050] [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: 06/17/2022] [Accepted: 11/30/2022] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Increased HIV testing by men in sub-Saharan Africa is key to meeting UNAIDS 2025 testing targets. Secondary distribution of HIV self-testing (HIVST) kits by pregnant women attending antenatal care to male partners has been shown to increase testing among African men. A detailed understanding of how women and male partners manage the distribution and use of HIVST and subsequent linkage to clinic-based follow-up can inform implementation and scale-up efforts. METHODS We use qualitative data from the Obumu Study, a randomized trial of secondary distribution of HIVST by pregnant women living with HIV to male partners in Kampala, Uganda, to unpack the HIVST delivery process. The protocol included a clinic visit by male partners to confirm HIVST results. Individual interviews eliciting data on experiences of delivering and using HIVST and of subsequent linkage to clinic-based testing were conducted with a purposefully selected sample of 45 women and 45 male partner Obumu Study participants from November 2018 to March 2021. Interview data from 59 participants (29 women and 30 men) in the HIVST arm were analysed through coding and category construction. RESULTS Women living with HIV were apprehensive about delivering HIVST to their partners, especially if they had not disclosed their HIV status. They invested effort in developing strategies for introducing HIVST. Male partners described a range of responses to receiving the self-testing kit, especially fear of a positive test result. Women reported leading the self-testing process, often conducting the test themselves. Most women confidently interpreted HIVST results. However, they tended to defer to healthcare workers rather than report positive results directly to partners. Women told their partners the testing process required a clinic follow-up visit, often without explaining the visit's purpose. Many partners delayed the visit as a result. Women again responded by strategizing to persuade their partners to link to follow-up care. CONCLUSIONS Secondary distribution of HIVST by pregnant women living with HIV to male partners can be challenging, especially when women have not disclosed their HIV status. Additional support may alleviate the burden; outreach to male partners may facilitate linkage to confirmatory testing and HIV care or prevention.
Collapse
Affiliation(s)
- Norma C. Ware
- Department of MedicineBrigham and Women's HospitalBostonMassachusettsUSA,Department of Global Health and Social MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Monique A. Wyatt
- Department of Global Health and Social MedicineHarvard Medical SchoolBostonMassachusettsUSA,Harvard GlobalCambridgeMassachusettsUSA
| | - Emily E. Pisarski
- Department of Global Health and Social MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | | | - Vicent Kasiita
- Infectious Diseases InstituteMakerere UniversityKampalaUganda
| | - Grace Nalukwago
- Infectious Diseases InstituteMakerere UniversityKampalaUganda
| | | | | | - Jade Boyer
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Agnes Nakyanzi
- Infectious Diseases InstituteMakerere UniversityKampalaUganda
| | - Faith Naddunga
- Infectious Diseases InstituteMakerere UniversityKampalaUganda
| | - Andrew Mujugira
- Infectious Diseases InstituteMakerere UniversityKampalaUganda,Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Connie L. Celum
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| |
Collapse
|
7
|
Suraratdecha C, MacKellar D, Hlophe T, Dlamini M, Ujamaa D, Pals S, Dube L, Williams D, Byrd J, Mndzebele P, Behel S, Pathmanathan I, Mazibuko S, Tilahun E, Ryan C. Evaluation of Community-Based, Mobile HIV-Care, Peer-Delivered Linkage Case Management in Manzini Region, Eswatini. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:38. [PMID: 36612360 PMCID: PMC9820019 DOI: 10.3390/ijerph20010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
The success of antiretroviral therapy (ART) requires continuous engagement in care and optimal levels of adherence to achieve sustained HIV viral suppression. We evaluated HIV-care cascade costs and outcomes of a community-based, mobile HIV-care, peer-delivered linkage case-management program (CommLink) implemented in Manzini region, Eswatini. Abstraction teams visited referral facilities during July 2019-April 2020 to locate, match, and abstract the clinical data of CommLink clients diagnosed between March 2016 and March 2018. An ingredients-based costing approach was used to assess economic costs associated with CommLink. The estimated total CommLink costs were $2 million. Personnel costs were the dominant component, followed by travel, commodities and supplies, and training. Costs per client tested positive were $499. Costs per client initiated on ART within 7, 30, and 90 days of diagnosis were $2114, $1634, and $1480, respectively. Costs per client initiated and retained on ART 6, 12, and 18 months after diagnosis were $2343, $2378, and $2462, respectively. CommLink outcomes and costs can help inform community-based HIV testing, linkage, and retention programs in other settings to strengthen effectiveness and improve efficiency.
Collapse
Affiliation(s)
- Chutima Suraratdecha
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Duncan MacKellar
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Thabo Hlophe
- Eswatini Ministry of Health, Mbabane P.O. Box 5, Eswatini
| | | | | | - Sherri Pals
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Lenhle Dube
- Eswatini Ministry of Health, Mbabane P.O. Box 5, Eswatini
| | - Daniel Williams
- U.S. Centers for Disease Control and Prevention, Pretoria P.O. Box 9536, South Africa
| | | | - Phumzile Mndzebele
- U.S. Centers for Disease Control and Prevention, Mbabane P.O. Box D202, Eswatini
| | - Stephanie Behel
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Ishani Pathmanathan
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Sikhathele Mazibuko
- U.S. Centers for Disease Control and Prevention, Mbabane P.O. Box D202, Eswatini
| | - Endale Tilahun
- Population Services International, Mbabane P.O. Box 170, Eswatini
| | - Caroline Ryan
- U.S. Centers for Disease Control and Prevention, Mbabane P.O. Box D202, Eswatini
| |
Collapse
|
8
|
Groves AK, Stankard P, Bowler SL, Jamil MS, Gebrekristos LT, Smith PD, Quinn C, Ba NS, Chidarikire T, Nguyen VTT, Baggaley R, Johnson C. A systematic review and meta-analysis of the evidence for community-based HIV testing on men's engagement in the HIV care cascade. Int J STD AIDS 2022; 33:1090-1105. [PMID: 35786140 PMCID: PMC9660288 DOI: 10.1177/09564624221111277] [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] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/29/2022] [Accepted: 06/13/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE Men with HIV are less likely than women to know their status, be on antiretroviral therapy, and be virally suppressed. This review examined men's community-based HIV testing services (CB-HTS) outcomes. DESIGN Systematic review and meta-analysis. METHODS We searched seven databases and conference abstracts through July 2018. We estimated pooled proportions and/or risk ratios (for meta-analyses) for each outcome using random effects models. RESULTS 188 studies met inclusion criteria. Common testing models included targeted outreach (e.g. mobile testing), home-based testing, and testing at stand-alone community sites. Across 25 studies reporting uptake, 81% (CI: 75-86%) of men offered testing accepted it. Uptake was higher among men reached through CB-HTS than facility-based HTS (RR = 1.39; CI: 1.13-1.71). Over 69% (CI: 64-71%) of those tested through CB-HTS were men, across 184 studies. Across studies reporting new HIV-positivity among men (n = 18), 96% were newly diagnosed (CI: 77-100%). Across studies reporting linkage to HIV care (n = 8), 70% (CI: 36-103%) of men were linked to care. Across 57 studies reporting sex-disaggregated data for CB-HTS conducted among key populations, men's uptake was high (80%; CI: 70-88%) and nearly all were newly diagnosed and linked to care (95%; CI: 94-100%; and 94%; CI: 88-100%, respectively). CONCLUSION CB-HTS is an important strategy for reaching undiagnosed men with HIV from the general population and key population groups, particularly using targeted outreach models. When compared to facility-based HIV testing services, men tested through CB-HTS are more likely to uptake testing, and nearly all men who tested positive through CB-HTS were newly diagnosed. Linkage to care may be a challenge following CB-HTS, and greater efforts and research are needed to effectively implement testing strategies that facilitate rapid ART initiation and linkage to prevention services.
Collapse
Affiliation(s)
- Allison K Groves
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | - Sarah L Bowler
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Muhammad S Jamil
- Department of HIV/AIDS, World Health
Organization, Geneva, Switzerland
| | | | - Patrick D Smith
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Caitlin Quinn
- Department of HIV/AIDS, World Health
Organization, Geneva, Switzerland
| | - Ndoungou Salla Ba
- Department of HIV/AIDS, World Health
Organization, Geneva, Switzerland
| | - Thato Chidarikire
- HIV Prevention Programmes, National Department of
Health, Johannesburg, South Africa
| | | | - Rachel Baggaley
- Department of HIV/AIDS, World Health
Organization, Geneva, Switzerland
| | - Cheryl Johnson
- Department of HIV/AIDS, World Health
Organization, Geneva, Switzerland
| |
Collapse
|
9
|
Costs and cost-effectiveness of HIV counselling and testing modalities in Southern Mozambique. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:49. [PMID: 36068574 PMCID: PMC9447341 DOI: 10.1186/s12962-022-00378-9] [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: 08/18/2020] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Despite the high HIV associated burden, Mozambique lacks data on HIV counselling and testing (HCT) costs. To help guide national HIV/AIDS programs, we estimated the cost per test for voluntary counselling and testing (VCT) from the patient’s perspective and the costs per person tested and per HIV-positive individual linked to care to the healthcare provider for VCT, provider-initiated counselling and testing (PICT) and home-based testing (HBT). We also assessed the cost-effectiveness of these strategies for linking patients to care. Methods Data from a cohort study conducted in the Manhiça District were used to derive costs and linkage-to-care outcomes of the three HCT strategies. A decision tree was used to model HCT costs according to the likelihood of HCT linking individuals to care and to obtain the incremental cost-effectiveness ratios (ICERs) of PICT and HBT with VCT as the comparator. Sensitivity analyses were performed to assess robustness of base-case findings. Findings Based on costs and valuations in 2015, average and median VCT costs to the patient per individual tested were US$1.34 and US$1.08, respectively. Costs per individual tested were greatest for HBT (US$11.07), followed by VCT (US$7.79), and PICT (US$7.14). The costs per HIV-positive individual linked to care followed a similar trend. PICT was not cost-effective in comparison with VCT at a willingness-to-accept threshold of US$4.53, but only marginally given a corresponding base-case ICER of US$4.15, while HBT was dominated, with higher costs and lower impact than VCT. Base-case results for the comparison between PICT and VCT presented great uncertainty, whereas findings for HBT were robust. Conclusion PICT and VCT are likely equally cost-effective in Manhiça. We recommend that VCT be offered as the predominant HCT strategy in Mozambique, but expansion of PICT could be considered in limited-resource areas. HBT without facilitated linkage or reduced costs is unlikely to be cost-effective.
Collapse
|
10
|
Fuge TG, Tsourtos G, Miller ER. Risk factors for late linkage to care and delayed antiretroviral therapy initiation amongst HIV infected adults in sub-Saharan Africa: a systematic review and meta-analyses. Int J Infect Dis 2022; 122:885-904. [PMID: 35843499 DOI: 10.1016/j.ijid.2022.07.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Late treatment initiation threatens the clinical and public health benefits of antiretroviral therapy (ART). Quantitative synthesises of the existing evidence related to this is lacking in sub-Saharan Africa (SSA), which would help ascertain the best evidence-based interventions. This review aimed to systematically synthesise the available literature on factors affecting linkage to care and ART initiation amongst HIV-infected adults in SSA. METHODS Systematic searches were undertaken on four databases to identify observational studies investigating factors affecting both HIV care outcomes amongst adults (age ≥19 years) in SSA, and were published between January 1, 2015 and June 1, 2021. RevMan-5 software was used to conduct meta-analyses and Mantel-Haenszel statistics to pool outcomes with 95% confidence interval and <0.05 level of significance. RESULTS Forty-six studies were included in the systematic review, of which 18 fulfilled requirements for meta-analysis. In both narrative review and meta-analyses, factors related to health care delivery, individual perception and sociodemographic circumstances were associated with late linkage to care and delays in ART initiation. CONCLUSION This review identified a range of risk factors for late linkage to care and delayed ART initiation amongst HIV-infected adults in SSA. We recommend implementation of patient-centred intervention approaches to alleviate these barriers.
Collapse
Affiliation(s)
- Terefe Gone Fuge
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - George Tsourtos
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Emma R Miller
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| |
Collapse
|
11
|
A Systematic Review of Linkage-to-Care and Antiretroviral Initiation Implementation Strategies in Low- and Middle-Income Countries Across Sub-Saharan Africa. AIDS Behav 2022; 26:2123-2134. [PMID: 35088176 PMCID: PMC9422958 DOI: 10.1007/s10461-021-03558-5] [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: 12/02/2021] [Indexed: 01/29/2023]
Abstract
Linkage to care (LTC) and initiation of antiretroviral therapy (ART) are key components in the longitudinal care cascade for people living with HIV. Many strategies to optimize these stages of HIV care have been implemented, though there is a paucity of analyses comparing the outcomes of these efforts in low- and middle-income countries. We conducted a systematic review of studies assessing interventions along all stages of the HIV care continuum published between 2008 and 2020. A comprehensive search strategy reviewed five electronic databases to capture studies assessing HIV testing, LTC, ART initiation, ART adherence, and viral suppression. Of the 388 articles that met the inclusion criteria, 78 described interventions for improving LTC/ART initiation. Efforts focused on empowering patients through integrative approaches generally yielded more substantive results compared to provider-initiated non-adaptive LTC interventions or cash incentives. Specifically, tailoring care and incorporating ART initiation into existing infrastructures, such as maternal clinics, had a high impact across settings. Moreover, strategies such as home-based HIV counseling and testing (HBHCT) appear to be most effective when implemented in tandem with other approaches including motivational counseling and point-of-care CD4 testing.
Collapse
|
12
|
PONTICIELLO M, MWANGA-AMUMPAIRE J, TUSHEMEREIRWE P, NUWAGABA G, NANSERA D, KING R, MUYINDIKE W, SUNDARARAJAN R. How informal healthcare providers improve uptake of HIV testing: qualitative results from a randomized controlled trial. AIDS 2022; 36:1161-1169. [PMID: 35442219 PMCID: PMC9262827 DOI: 10.1097/qad.0000000000003227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Uganda is HIV-endemic with a prevalence of 5.7%. Lack of epidemic control has been attributed to low engagement with HIV testing. Collaborating with informal healthcare providers, such as traditional healers, has been proposed as a strategy to increase testing uptake. We explored acceptability and implementation of an HIV testing program where traditional healers delivered point-of-care testing and counseling to adults of unknown serostatus (clinicaltrials.gov NCT#03718871). METHODS This study was conducted in rural, southwestern Uganda. We interviewed participating traditional healers ( N = 17) and a purposive sample of trial participants ( N = 107). Healers were practicing within 10 km of Mbarara township, and 18+ years old. Participants were 18+ years old; sexually active; had received care from participating healers; self-reported not receiving an HIV test in prior 12 months; and not previously diagnosed with HIV infection. Interviews explored perceptions of a healer-delivered HIV testing model and were analyzed following a content-analysis approach. RESULTS Most participants were female individuals ( N = 68, 55%). Healer-delivered HIV testing overcame structural barriers, such as underlying poverty and rural locations that limited use, as transportation was costly and often prohibitive. Additionally, healers were located in villages and communities, which made services more accessible compared with facility-based testing. Participants also considered healers trustworthy and 'confidential'. These qualities explain some preference for healer-delivered HIV testing, in contrast to 'stigmatizing' biomedical settings. CONCLUSION Traditional healer-delivered HIV testing was considered more confidential and easily accessible compared with clinic-based testing. Offering services through traditional healers may improve uptake of HIV testing services in rural, medically pluralistic communities.
Collapse
Affiliation(s)
- Matthew PONTICIELLO
- Department of Emergency Medicine, Weill Cornell Medicine, New York, USA
- Weill Cornell Center for Global Health, Weill Cornell Medicine, New York, USA
| | | | | | | | | | - Rachel KING
- University of California, San Francisco, San Francisco CA USA
| | | | - Radhika SUNDARARAJAN
- Department of Emergency Medicine, Weill Cornell Medicine, New York, USA
- Weill Cornell Center for Global Health, Weill Cornell Medicine, New York, USA
| |
Collapse
|
13
|
Okere NE, Sambu V, Ndungile Y, van Praag E, Hermans S, Naniche D, de Wit TFR, Maokola W, Gomez GB. The Shinyanga Patient: A Patient's Journey through HIV Treatment Cascade in Rural Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8418. [PMID: 34444166 PMCID: PMC8393654 DOI: 10.3390/ijerph18168418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/23/2021] [Accepted: 08/04/2021] [Indexed: 12/30/2022]
Abstract
The 2016-2017 Tanzania HIV Impact Survey (THIS) reported the accomplishments towards the 90-90-90 global HIV targets at 61-94-87, affirming the need to focus on the first 90 (i.e., getting 90% of people living with HIV (PLHIV) tested). We conducted a patient-pathway analysis to understand the gap observed, by assessing the alignment between where PLHIV seek healthcare and where HIV services are available in the Shinyanga region, Tanzania. We used existing and publicly available data from the National AIDS Control program, national surveys, registries, and relevant national reports. Region-wide, the majority (n = 458/722, 64%) of THIS respondents accessed their last HIV test at public sector facilities. There were 65.9%, 45.1%, and 74.1% who could also access antiretroviral therapy (ART), CD4 testing, and HIV viral load testing at the location of their last HIV test, respectively. In 2019, the viral suppression rate estimated among PLHIV on ART in the Shinyanga region was 91.5%. PLHIV access HIV testing mostly in public health facilities; our research shows that synergies can be achieved to improve access to services further down the cascade in this sector. Furthermore, effective engagement with the private sector (not-for-profit and for-profit) will help to achieve the last mile toward ending the HIV epidemic.
Collapse
Affiliation(s)
- Nwanneka E Okere
- Department of Global Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.H.); (T.F.R.d.W.)
- Amsterdam Institute for Global Health and Development, 1105 BP Amsterdam, The Netherlands;
| | - Veryeh Sambu
- National AIDS Control Programme, Dodoma 41110, Tanzania; (V.S.); (W.M.)
| | - Yudas Ndungile
- Regional Health Management Team, Shinyanga 37103, Tanzania;
| | - Eric van Praag
- Amsterdam Institute for Global Health and Development, 1105 BP Amsterdam, The Netherlands;
| | - Sabine Hermans
- Department of Global Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.H.); (T.F.R.d.W.)
- Amsterdam Institute for Global Health and Development, 1105 BP Amsterdam, The Netherlands;
| | - Denise Naniche
- ISGlobal-Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain;
| | - Tobias F Rinke de Wit
- Department of Global Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.H.); (T.F.R.d.W.)
- Amsterdam Institute for Global Health and Development, 1105 BP Amsterdam, The Netherlands;
| | - Werner Maokola
- National AIDS Control Programme, Dodoma 41110, Tanzania; (V.S.); (W.M.)
| | - Gabriela B Gomez
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| |
Collapse
|
14
|
Adawiyah RA, Saweri OPM, Boettiger DC, Applegate TL, Probandari A, Guy R, Guinness L, Wiseman V. The costs of scaling up HIV and syphilis testing in low- and middle-income countries: a systematic review. Health Policy Plan 2021; 36:939-954. [PMID: 33693731 PMCID: PMC8227996 DOI: 10.1093/heapol/czab030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 12/18/2022] Open
Abstract
Around two-thirds of all new HIV infections and 90% of syphilis cases occur in low- and middle-income countries (LMICs). Testing is a key strategy for the prevention and treatment of HIV and syphilis. Decision-makers in LMICs face considerable uncertainties about the costs of scaling up HIV and syphilis testing. This paper synthesizes economic evidence on the costs of scaling up HIV and syphilis testing interventions in LMICs and evidence on how costs change with the scale of delivery. We systematically searched multiple databases (Medline, Econlit, Embase, EMCARE, CINAHL, Global Health and the NHS Economic Evaluation Database) for peer-reviewed studies examining the costs of scaling up HIV and syphilis testing in LMICs. Thirty-five eligible studies were identified from 4869 unique citations. Most studies were conducted in Sub-Saharan Africa (N = 17) and most explored the costs of rapid HIV in facilities targeted the general population (N = 19). Only two studies focused on syphilis testing. Seventeen studies were cost analyses, 17 were cost-effectiveness analyses and 1 was cost-benefit analysis of HIV or syphilis testing. Most studies took a modelling approach (N = 25) and assumed costs increased linearly with scale. Ten studies examined cost efficiencies associated with scale, most reporting short-run economies of scale. Important drivers of the costs of scaling up included testing uptake and the price of test kits. The 'true' cost of scaling up testing is likely to be masked by the use of short-term decision frameworks, linear unit-cost projections (i.e. multiplying an average cost by a factor reflecting activity at a larger scale) and availability of health system capacity and infrastructure to supervise and support scale up. Cost data need to be routinely collected alongside other monitoring indicators as HIV and syphilis testing continues to be scaled up in LMICs.
Collapse
Affiliation(s)
- Rabiah Al Adawiyah
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Olga P M Saweri
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia.,Population Health and Demography, Papua New Guinea Institute of Medical Research, PO Box 60 Homate Street, Goroka, Papua New Guinea
| | - David C Boettiger
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Tanya L Applegate
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Ari Probandari
- Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir. Sutami 36A. Surakarta, 57126, Indonesia
| | - Rebecca Guy
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Lorna Guinness
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.,Centre for Global DevelopmentEurope, Great Peter House, Great College St, London SW1P 3SE, UK
| | - Virginia Wiseman
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia.,London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| |
Collapse
|
15
|
Amstutz A, Matsela L, Lejone TI, Kopo M, Glass TR, Labhardt ND. Reaching Absent and Refusing Individuals During Home-Based HIV Testing Through Self-Testing-at What Cost? Front Med (Lausanne) 2021; 8:653677. [PMID: 34268321 PMCID: PMC8276095 DOI: 10.3389/fmed.2021.653677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/18/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: In the HOSENG trial (NCT03598686), the secondary distribution of oral self-tests for persons absent or refusing to test during a home-based HIV testing campaign in rural Lesotho resulted in an increase in testing coverage of 21% compared to a testing campaign without secondary distribution. This study aims to determine the per patient costs of both HOSENG trial arms. Method: We conducted a micro-costing study to estimate the cost of home-based HIV testing with (HOSENG intervention arm) and without (HOSENG control arm) secondary self-test distribution from a provider's perspective. A mixture of top-down and bottom-up costing was used. We estimated both the financial and economic per patient costs of each possible testing cascade scenario. The costs were adjusted to 2018 US$. Results: The overall provider cost for delivering the home-based HIV testing with secondary distribution was US$36,481 among the 4,174 persons enumerated and 3,094 eligible for testing in the intervention villages compared to US$28,620 for 3,642 persons enumerated and 2,727 eligible for testing in the control. The cost per person eligible for testing was US$11.79 in the intervention vs. US$10.50 in the control. This difference was mainly driven by the cost of distributed oral self-tests. The cost per person tested was, however, lower in intervention villages (US$15.70 vs. US$22.15) due to the higher testing coverage achieved through self-test distribution. The cost per person confirmed new HIV+ was US$889.79 in the intervention and US$753.17 in the control. Conclusion: During home-based HIV testing in Lesotho, the secondary distribution of self-tests for persons absent or refusing to test during the visit reduced the costs per person tested and thus presents a promising add-on for such campaigns. Trial Registration:https://ClinicalTrials.gov/, identifier: NCT03598686
Collapse
Affiliation(s)
- Alain Amstutz
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Lineo Matsela
- Health Economics Unit, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Mathebe Kopo
- SolidarMed, Partnerships for Health, Butha-Buthe, Lesotho
| | - Tracy Renée Glass
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Niklaus Daniel Labhardt
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
16
|
Factors Influencing Utilization of HIV Testing Services among Boda-Boda Riders in Kabarole District, Southwestern Uganda: A Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8877402. [PMID: 33869636 PMCID: PMC8035009 DOI: 10.1155/2021/8877402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 03/16/2021] [Accepted: 03/27/2021] [Indexed: 11/17/2022]
Abstract
Background HIV testing is an important step for entry and linkage into HIV care. Utilization of HIV testing services among transport workers may be challenging, because of the mobile nature of their jobs. We assessed utilization of HIV testing services and identified factors influencing the utilization of HIV testing services among motorcycle taxi (boda-boda) riders in Fort Portal Municipality, Kabarole District, Southwestern Uganda. Methods We conducted a cross-sectional study among boda-boda riders, aged 18 years and above, from July 15 to July 29, 2020. We recruited participants through simple random sampling. Data were captured using a self-administered questionnaire. Binary logistic regression was used to identify factors associated with utilization of HIV testing services. Results Of the 315 participants who received questionnaires, 305 (97%) responded. The mean age of the participants was 32 (±7.1) years and ranged from 18 to 55 years. Of the 305 participants, 238 reported having taken an HIV test and received results in the past 12 months, for an HIV testing utilization rate of 78.0% (95% CI: 73.0–82.6%). In multivariable analysis, participants who were less likely to utilize HIV testing services were those aged ≥30 years (aOR = 0.33; 95% CI: 0.16–0.70, P = 0.004) and those who had HIV-related stigma (aOR = 0.27; 95% CI: 0.08–0.88, P = 0.030). Participants who were more likely to utilize HIV testing services were those who knew HIV status of their primary partners (aOR = 4.23; 95% CI: 1.24–14.49, P = 0.022) and those who had good knowledge on HIV/AIDS (aOR = 3.94; 95% CI: 1.65–9.41, P = 0.002). Conclusions Utilization of HIV testing services among the boda-boda riders in Fort Portal Municipality, Southwestern Uganda, was high. More efforts should focus on targeting older boda-boda riders for HIV testing, reduction of HIV-related stigma, improving knowledge on HIV/AIDS, and encouraging communication and disclosure between partners, in order to consolidate the gains made in HIV testing services in this bridge population.
Collapse
|
17
|
Broderick K, Ponticiello M, Nabukalu D, Tushemereirwe P, Nuwagaba G, King R, Mwanga-Amumpaire J, Sundararajan R. Shortening "the Road" to Improve Engagement with HIV Testing Resources: A Qualitative Study Among Stakeholders in Rural Uganda. AIDS Patient Care STDS 2021; 35:56-62. [PMID: 33471578 PMCID: PMC7885900 DOI: 10.1089/apc.2020.0235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In HIV-endemic areas, traditional healers are frequently used with, or instead of, biomedical resources for health care needs. Studies show healers are interested in and capable of supporting patients in the HIV care cascade. However, adults who receive care from healers have low engagement with HIV services. To achieve epidemic control, we must understand gaps between the needs of HIV-endemic communities and the potential for healers to improve HIV service uptake. This study's objective was to characterize stakeholder perspectives on barriers to HIV testing and approaches to mitigate barriers in a medically pluralistic, HIV-endemic region. This study was conducted in Mbarara District, a rural area of southwestern Uganda with high HIV prevalence. Participants included HIV clinical staff, traditional healers, and adults receiving care from healers. Fifty-six participants [N = 30 females (52%), median age 40 years (interquartile range, 32-51.5)] were recruited across three stakeholder groups for minimally structured interviews. Themes were identified using an inductive, grounded theory approach and linked together to create a framework explaining stakeholder perspectives on HIV testing. Stakeholders described the "road" to HIV testing as time-consuming, expensive, and stigmatizing. All agreed healers could mitigate barriers by delivering HIV testing at their practices. Collaborations between biomedical and traditional providers were considered essential to a successful healer-delivered HIV testing program. This work describes a novel approach to "shorten the road" to HIV testing, suggesting that traditional healer-delivered HIV testing holds promise to expand uptake of testing among communities with limited access to existing programs.
Collapse
Affiliation(s)
| | - Matthew Ponticiello
- Department of Global and Public Health Sciences, Cornell University, Ithaca, New York, USA
| | - Doreen Nabukalu
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Patricia Tushemereirwe
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Gabriel Nuwagaba
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rachel King
- Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Juliet Mwanga-Amumpaire
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
18
|
Macharia LW, Wexler C, Brown M, Maloba M, Pricilla RA, Mabachi NM, Muchoki E, Babu S, Ochieng M, Gautney B, Goggin K, Finocchario-Kessler S. Implementation planning for community-based point-of-care HIV testing for infants: Recommendations from community leaders in Kenya. PLoS One 2020; 15:e0240476. [PMID: 33057444 PMCID: PMC7561120 DOI: 10.1371/journal.pone.0240476] [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: 04/14/2020] [Accepted: 09/25/2020] [Indexed: 11/18/2022] Open
Abstract
Background Early infant diagnosis (EID) establishes the presence of HIV infection in HIV-exposed infants and children younger than 18 months of age. EID services are hospital-based, and thus fail to capture HIV-exposed infants who are not brought to the hospital for care. Point-of-care (POC) diagnostic systems deployed in the community could increase the proportion tested and linked to treatment, but little feasibility and acceptability data is available. Methods Semi-structured interviews (n = 74) were conducted by a Kenyan team with community members (Community Health Workers/Volunteers [CHW/CHV], Traditional Birth Attendants [TBAs], community leaders) and parents of HIV-exposed infants at four study sites in Kenya to elicit feedback on the acceptability and feasibility of community-based POC HIV testing. Results Participants described existing community health resources that could be leveraged to support integration of community-based POC HIV testing; however, the added demand placed on CHW/CHV could pose a challenge. Participants indicated that other potential barriers (concerns about confidentiality, disclosure, and HIV stigma) could be overcome with strong engagement from trusted community leaders and health providers, community sensitization, and strategic location and timing of testing. These steps were seen to improve acceptability and maximize the recognized benefits (rapid results, improved reach) of community-based testing. Conclusion Community members felt that with strategic planning and engagement, community-based POC HIV testing could be a feasible and acceptable strategy to overcome the existing barriers of hospital-based EID.
Collapse
Affiliation(s)
- Lynton W. Macharia
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Melinda Brown
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | | | - Natabhona M. Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | | | | | | | - Brad Gautney
- Global Health Innovations, Dallas, TX, United States of America
| | - Kathy Goggin
- Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO, United States of America
- Schools of Medicine and Pharmacy, University of Missouri-Kansas City, Kansas City, MO, United States of America
| | - Sarah Finocchario-Kessler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
- * E-mail:
| |
Collapse
|
19
|
Barnabas RV, Szpiro AA, van Rooyen H, Asiimwe S, Pillay D, Ware NC, Schaafsma TT, Krows ML, van Heerden A, Joseph P, Shahmanesh M, Wyatt MA, Sausi K, Turyamureeba B, Sithole N, Morrison S, Shapiro AE, Roberts DA, Thomas KK, Koole O, Bershteyn A, Ehrenkranz P, Baeten JM, Celum C. Community-based antiretroviral therapy versus standard clinic-based services for HIV in South Africa and Uganda (DO ART): a randomised trial. Lancet Glob Health 2020; 8:e1305-e1315. [PMID: 32971053 PMCID: PMC7527697 DOI: 10.1016/s2214-109x(20)30313-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Community-based delivery of antiretroviral therapy (ART) for HIV, including ART initiation, clinical and laboratory monitoring, and refills, could reduce barriers to treatment and improve viral suppression, reducing the gap in access to care for individuals who have detectable HIV viral load, including men who are less likely than women to be virally suppressed. We aimed to test the effect of community-based ART delivery on viral suppression among people living with HIV not on ART. METHODS We did a household-randomised, unblinded trial (DO ART) of delivery of ART in the community compared with the clinic in rural and peri-urban settings in KwaZulu-Natal, South Africa and the Sheema District, Uganda. After community-based HIV testing, people living with HIV were randomly assigned (1:1:1) with mobile phone software to community-based ART initiation with quarterly monitoring and ART refills through mobile vans; ART initiation at the clinic followed by mobile van monitoring and refills (hybrid approach); or standard clinic ART initiation and refills. The primary outcome was HIV viral suppression at 12 months. If the difference in viral suppression was not superior between study groups, an a-priori test for non-inferiority was done to test for a relative risk (RR) of more than 0·95. The cost per person virally suppressed was a co-primary outcome of the study. This study is registered with ClinicalTrials.gov, NCT02929992. FINDINGS Between May 26, 2016, and March 28, 2019, of 2479 assessed for eligibility, 1315 people living with HIV and not on ART with detectable viral load at baseline were randomly assigned; 666 (51%) were men. Retention at the month 12 visit was 95% (n=1253). At 12 months, community-based ART increased viral suppression compared with the clinic group (306 [74%] vs 269 [63%], RR 1·18, 95% CI 1·07-1·29; psuperiority=0·0005) and the hybrid approach was non-inferior (282 [68%] vs 269 [63%], RR 1·08, 0·98-1·19; pnon-inferiority=0·0049). Community-based ART increased viral suppression among men (73%, RR 1·34, 95% CI 1·16-1·55; psuperiority<0·0001) as did the hybrid approach (66%, RR 1·19, 1·02-1·40; psuperiority=0·026), compared with clinic-based ART (54%). Viral suppression was similar for men (n=156 [73%]) and women (n=150 [75%]) in the community-based ART group. With efficient scale-up, community-based ART could cost US$275-452 per person reaching viral suppression. Community-based ART was considered safe, with few adverse events. INTERPRETATION In high and medium HIV prevalence settings in South Africa and Uganda, community-based delivery of ART significantly increased viral suppression compared with clinic-based ART, particularly among men, eliminating disparities in viral suppression by gender. Community-based ART should be implemented and evaluated in different contexts for people with detectable viral load. FUNDING The Bill & Melinda Gates Foundation; the University of Washington and Fred Hutch Center for AIDS Research; the Wellcome Trust; the University of Washington Royalty Research Fund; and the University of Washington King K Holmes Endowed Professorship in STDs and AIDS.
Collapse
Affiliation(s)
- Ruanne V Barnabas
- Department of Global Health, University of Washington, Seattle, WA, USA; Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Adam A Szpiro
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Heidi van Rooyen
- Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa; MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Deenan Pillay
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Torin T Schaafsma
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Meighan L Krows
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Alastair van Heerden
- Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa; MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Philip Joseph
- Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa
| | | | | | - Kombi Sausi
- Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa
| | | | - Nsika Sithole
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Susan Morrison
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Adrienne E Shapiro
- Department of Global Health, University of Washington, Seattle, WA, USA; Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - D Allen Roberts
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | - Olivier Koole
- London School of Hygiene & Tropical Medicine, London, UK
| | - Anna Bershteyn
- New York University School of Medicine, New York, NY, USA
| | | | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA; Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, WA, USA; Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| |
Collapse
|
20
|
Zakumumpa H. Reimagining the role of the nursing workforce in Uganda after more than a decade of ART scale-up. HUMAN RESOURCES FOR HEALTH 2020; 18:39. [PMID: 32471426 PMCID: PMC7257122 DOI: 10.1186/s12960-020-00479-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/11/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND The expanding roles and increasing importance of the nursing workforce in health services delivery in resource-limited settings is not adequately documented and sufficiently recognized in the current literature. Drawing upon the theme of 2020 as the International Year of the Nurse and the Midwife, we set out to describe how the role of nurses expanded tremendously in health facilities in Uganda during the era of anti-retroviral therapy (ART) scale-up that commenced in June 2004. METHODS We employed a mixed-methods sequential explanatory research design. Phase I entailed a cross-sectional health facility survey (n = 195) to assess the extent to which human resource management strategies (such as task shifting) were common. Phase II entailed a qualitative multiple case study of 16 (of the 195) health facilities for an in-depth understanding of the strategies adopted (e.g. nurse-centred HIV care). Descriptive analyses were performed in STATA (v 13) while qualitative data were analysed by thematic approach. RESULTS We found that nurses were the most represented cadre of health workers involved in the overall leadership of HIV clinics across Uganda. Most nurse-led HIV clinics were based in rural settings; however, this trend was fairly even across setting (rural/urban/peri-urban). While 181 (93%) health facilities allowed non-physician cadre to prescribe ART, a number of health facilities (n = 36) or 18% deliberately adopted nurse-led HIV care models. Nurses were empowered to be multi-skilled with a wide range of competencies across the HIV care continuum right from HIV testing to mainstream clinical HIV disease management. In several facilities, nursing cadre were the backbone of ART service delivery. A select number of facilities devised differentiated models of task shifting from physicians to nurses in which the latter handled patients who were stable on ART. CONCLUSION Overall, our study reveals a wide expansion in the scope-of-practice of nurses during ART scale-up in Uganda. Nurses were thrust in roles of HIV disease management that were traditionally the preserve of physicians. Our study underscores the importance of reforming regulatory frameworks governing nursing workforce scope of practice such as the need for developing a policy on task shifting which is currently lacking in Uganda.
Collapse
Affiliation(s)
- Henry Zakumumpa
- Makerere University, School of Public Health, P O Box 7072, Kampala, Uganda.
| |
Collapse
|
21
|
Luwanda LB, Vyas S, Songo J, Chimukuche RS, McLean E, Hassan F, Schouten E, Todd J, Geubbels E, Wringe A, Renju J. Assessing the implementation of facility-based HIV testing policies in Malawi, South Africa and Tanzania from 2013–2018: Findings from SHAPE-UTT study. Glob Public Health 2020; 16:241-255. [DOI: 10.1080/17441692.2020.1763420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Seema Vyas
- Department of Population Studies, London School of Hygiene and Tropical Medicine, London, UK
| | - John Songo
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | | | - Estelle McLean
- Department of Population Studies, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Jim Todd
- Department of Population Studies, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Alison Wringe
- Department of Population Studies, London School of Hygiene and Tropical Medicine, London, UK
| | - Jenny Renju
- Department of Population Studies, London School of Hygiene and Tropical Medicine, London, UK
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| |
Collapse
|
22
|
Labhardt ND, Ringera I, Lejone TI, Amstutz A, Klimkait T, Muhairwe J, Glass TR. Effect and cost of two successive home visits to increase HIV testing coverage: a prospective study in Lesotho, Southern Africa. BMC Public Health 2019; 19:1441. [PMID: 31676001 PMCID: PMC6825349 DOI: 10.1186/s12889-019-7784-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background Home-based HIV testing and counselling (HB-HTC) is frequently used to increase awareness of HIV status in sub-Saharan Africa. Whereas acceptance of HB-HTC is usually high, testing coverage may remain low due to household members being absent during the home visits. This study assessed whether two consecutive visits, one during the week, one on the weekend, increase coverage. Methods The study was a predefined nested-study of the CASCADE-trial protocol and conducted in 62 randomly selected villages and 17 urban areas in Butha-Buthe district, Lesotho. HB-HTC teams visited each village/urban area twice: first during a weekday, followed by a weekend visit to catch-up for household members absent during the week. Primary outcome was HTC coverage after first and second visit. Coverage was defined as all individuals who knew their HIV status out of all household members (present and absent). Results HB-HTC teams visited 6665 households with 18,286 household members. At first visit, 69.2 and 75.4% of household members were encountered in rural and urban households respectively (p < 0.001) and acceptance for testing was 88.5% in rural and 79.5% in urban areas (p < 0.001), resulting in a coverage of 61.8 and 61.5%, respectively. After catch-up visit, the HTC coverage increased to 71.9% in rural and 69.4% in urban areas. The number of first time testers was higher at the second visit (47% versus 35%, p < 0.001). Direct cost per person tested and per person tested HIV positive were lower during weekdays (10.50 and 335 USD) than during weekends (20 and 1056 USD). Conclusions A catch-up visit on weekends increased the proportion of persons knowing their HIV status from 62 to 71% and reached more first-time testers. However, cost per person tested during catch-up visits was nearly twice the cost during first visit. Trial registration NCT02692027 (prospectively registered on February 21, 2016).
Collapse
Affiliation(s)
- Niklaus Daniel Labhardt
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Isaac Ringera
- SolidarMed, Swiss Organization for Health in Africa, Maseru, Lesotho
| | | | - Alain Amstutz
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland.,Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Thomas Klimkait
- University of Basel, Basel, Switzerland.,Molecular Virology, Department of Biomedicine, Basel, Switzerland
| | | | - Tracy Renee Glass
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| |
Collapse
|
23
|
Kelly N, Maokola W, Mudasiru O, McCoy SI. Interventions to Improve Linkage to HIV Care in the Era of "Treat All" in Sub-Saharan Africa: a Systematic Review. Curr HIV/AIDS Rep 2019; 16:292-303. [PMID: 31201613 PMCID: PMC10655251 DOI: 10.1007/s11904-019-00451-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF THE REVIEW In 2015, antiretroviral therapy (ART) was recommended for all people living with HIV (PLHIV) regardless of CD4 count ("Treat All"). To better understand how to improve linkage to care under these new guidelines, we conducted a systematic review of studies evaluating linkage interventions in Sub-Saharan Africa under Treat All. RECENT FINDINGS We identified 14 eligible articles and qualitatively analyzed the effectiveness of the interventions. Increases in linkage were reported by supply-side and counseling interventions. Mobile testing and economic incentives did not increase linkage. Given the lag time between adoption and implementation, only two of the studies were conducted in a Treat All setting. None of the interventions specifically focused on re-linking PLHIV who had disengaged from care. Future studies must design interventions that target not only newly diagnosed or treatment naïve PLHIV, but should explicitly focus on PLHIV who have disengaged from care.
Collapse
Affiliation(s)
- Nicole Kelly
- University of California, 2121 Berkeley Way, MC 7360, Berkeley, CA, 94720, USA.
| | - Werner Maokola
- University of California, 2121 Berkeley Way, MC 7360, Berkeley, CA, 94720, USA
- Community Development, Gender, Elderly, and Children, Ministry of Health, Dar es Salaam, Tanzania
| | - Omobola Mudasiru
- University of California, 2121 Berkeley Way, MC 7360, Berkeley, CA, 94720, USA
| | - Sandra I McCoy
- University of California, 2121 Berkeley Way, MC 7360, Berkeley, CA, 94720, USA
| |
Collapse
|
24
|
Yotebieng M, Brazier E, Addison D, Kimmel AD, Cornell M, Keiser O, Parcesepe AM, Onovo A, Lancaster KE, Castelnuovo B, Murnane PM, Cohen CR, Vreeman RC, Davies M, Duda SN, Yiannoutsos CT, Bono RS, Agler R, Bernard C, Syvertsen JL, Sinayobye JD, Wikramanayake R, Sohn AH, von Groote PM, Wandeler G, Leroy V, Williams CF, Wools‐Kaloustian K, Nash D. Research priorities to inform "Treat All" policy implementation for people living with HIV in sub-Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA). J Int AIDS Soc 2019; 22:e25218. [PMID: 30657644 PMCID: PMC6338103 DOI: 10.1002/jia2.25218] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/07/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION "Treat All" - the treatment of all people with HIV, irrespective of disease stage or CD4 cell count - represents a paradigm shift in HIV care that has the potential to end AIDS as a public health threat. With accelerating implementation of Treat All in sub-Saharan Africa (SSA), there is a need for a focused agenda and research to identify and inform strategies for promoting timely uptake of HIV treatment, retention in care, and sustained viral suppression and addressing bottlenecks impeding implementation. METHODS The Delphi approach was used to develop consensus around research priorities for Treat All implementation in SSA. Through an iterative process (June 2017 to March 2018), a set of research priorities was collectively formulated and refined by a technical working group and shared for review, deliberation and prioritization by more than 200 researchers, implementation experts, policy/decision-makers, and HIV community representatives in East, Central, Southern and West Africa. RESULTS AND DISCUSSION The process resulted in a list of nine research priorities for generating evidence to guide Treat All policies, implementation strategies and monitoring efforts. These priorities highlight the need for increased focus on adolescents, men, and those with mental health and substance use disorders - groups that remain underserved in SSA and for whom more effective testing, linkage and care strategies need to be identified. The priorities also reflect consensus on the need to: (1) generate accurate national and sub-national estimates of the size of key populations and describe those who remain underserved along the HIV-care continuum; (2) characterize the timeliness of HIV care and short- and long-term HIV care continuum outcomes, as well as factors influencing timely achievement of these outcomes; (3) estimate the incidence and prevalence of HIV-drug resistance and regimen switching; and (4) identify cost-effective and affordable service delivery models and strategies to optimize uptake and minimize gaps, disparities, and losses along the HIV-care continuum, particularly among underserved populations. CONCLUSIONS Reflecting consensus among a broad group of experts, researchers, policy- and decision-makers, PLWH, and other stakeholders, the resulting research priorities highlight important evidence gaps that are relevant for ministries of health, funders, normative bodies and research networks.
Collapse
Affiliation(s)
| | - Ellen Brazier
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNYUSA
- Department of Epidemiology and BiostatisticsGraduate School of Public Health and Health PolicyCity University of New YorkNew YorkNYUSA
| | - Diane Addison
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNYUSA
- Department of Epidemiology and BiostatisticsGraduate School of Public Health and Health PolicyCity University of New YorkNew YorkNYUSA
| | - April D Kimmel
- Department of Health Behavior and PolicyVirginia Commonwealth University School of MedicineRichmondVAUSA
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology& ResearchSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Olivia Keiser
- Institute of Global HealthUniversity of GenevaGenevaSwitzerland
| | | | - Amobi Onovo
- University of North Carolina at Chapel HillChapel HillNCUSA
| | | | | | - Pamela M Murnane
- Center for AIDS Prevention StudiesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive SciencesBixby Center for Global Reproductive HealthUniversity of California San FranciscoSan FranciscoCAUSA
| | - Rachel C Vreeman
- Department of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Mary‐Ann Davies
- School of Public Health and Family MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | | | | | - Rose S Bono
- Department of Health Behavior and PolicyVirginia Commonwealth University School of MedicineRichmondVAUSA
| | | | - Charlotte Bernard
- InsermCentre INSERM U1219‐Epidémiologie‐BiostatistiqueSchool of Public Health (ISPED)University of BordeauxBordeauxFrance
| | | | | | - Radhika Wikramanayake
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNYUSA
- Department of Epidemiology and BiostatisticsGraduate School of Public Health and Health PolicyCity University of New YorkNew YorkNYUSA
| | - Annette H Sohn
- TREAT AsiaamfAR – The Foundation for AIDS ResearchBangkokThailand
| | - Per M von Groote
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Gilles Wandeler
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Valeriane Leroy
- Inserm (French Institute of Health and Medical Research)UMR 1027 Université Toulouse 3ToulouseFrance
| | - Carolyn F Williams
- Epidemiology BranchDivision of AIDS at National Institute of Allergy and Infectious Diseases (NIAID)National Institute of Health (NIH)RockvilleMDUSA
| | | | - Denis Nash
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNYUSA
- Department of Epidemiology and BiostatisticsGraduate School of Public Health and Health PolicyCity University of New YorkNew YorkNYUSA
| |
Collapse
|
25
|
Ibiloye O, Decroo T, Eyona N, Eze P, Agada P. Characteristics and early clinical outcomes of key populations attending comprehensive community-based HIV care: Experiences from Nasarawa State, Nigeria. PLoS One 2018; 13:e0209477. [PMID: 30571744 PMCID: PMC6301656 DOI: 10.1371/journal.pone.0209477] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 12/06/2018] [Indexed: 11/19/2022] Open
Abstract
Background Despite a call for differentiated care, there are limited data from sub-Saharan Africa on comprehensive community-based HIV care for key populations (KP), including commercial sex workers (CSW), men who have sex with men (MSM), and people who inject drugs (PWID). In Nigeria, a programme was implemented that liaised with community-based organizations and offered HIV testing, same-day ART initiation, and ART follow-up to KP. Here we characterize KP and their partners enrolled on ART. Our objective is to assess the early treatment outcomes and to estimate predictors of attrition among KP. Method This is a retrospective cohort study of routinely collected data in a community-based HIV program for KP in Nasarawa state, Nigeria from August 2016 to November 2017. Variables of interest were socio-demographic, KP types, treatment outcomes, ART adherence, WHO stage, TB status and viral load. Summary statistics, logistic and Cox proportional hazard regression were used to describe the characteristics of KP and estimate predictors of attrition (patients either lost to follow-up (LTFU) or dead). Result Seven hundred and ten (710) KP and their partners were enrolled into this study, 77.3% (549) of study participants were female and the median age was 30 years (IQR: 24–35). Respectively, 74.2%, 4.5%, 1.1% and 20% were FSW, MSM, PWID and their partners. Of 710 KP who started ART, 13.9% (99/710) discontinued after the first visit. After a median follow-up time of 7 months on ART 73.2% of patients were retained, 23.4% were LTFU, and 3.4% were dead. Lack of formal education (aHR 1.8; 95% CI 1.3–2.6) and unemployment (aHR 1.8; 95% CI 1.2–2.6) were significantly associated with attrition. Conclusion Comprehensive community-based HIV care, including HIV testing and same-day ART is feasible. However, ART initiation on the same day of confirmatory HIV testing resulted in a high uptake of ART, but possibly inflated early attrition on ART. To mitigate early attrition among KP after same-day ART initiation, the psychosocial readiness of clients should be assessed better. We strongly recommend further studies to understand factors contributing to high attrition among the KP.
Collapse
Affiliation(s)
- Olujuwon Ibiloye
- Lafia Integrated Sexual Health Centre, Society for Family Health, Lafia, Nigeria
- Clinical services, APIN Public Health Initiative, Abuja, Nigeria
- * E-mail:
| | - Tom Decroo
- Institute of Tropical Medicine, Antwerpen, Belgium
- Research Foundation Flanders, Brussels, Belgium
| | - Nathaniel Eyona
- Lafia Integrated Sexual Health Centre, Society for Family Health, Lafia, Nigeria
| | - Peter Eze
- Lafia Integrated Sexual Health Centre, Society for Family Health, Lafia, Nigeria
| | - Peter Agada
- Lafia Integrated Sexual Health Centre, Society for Family Health, Lafia, Nigeria
| |
Collapse
|
26
|
MacKellar D, Maruyama H, Rwabiyago OE, Steiner C, Cham H, Msumi O, Weber R, Kundi G, Suraratdecha C, Mengistu T, Byrd J, Pals S, Churi E, Madevu-Matson C, Kazaura K, Morales F, Rutachunzibwa T, Justman J, Rwebembera A. Implementing the package of CDC and WHO recommended linkage services: Methods, outcomes, and costs of the Bukoba Tanzania Combination Prevention Evaluation peer-delivered, linkage case management program, 2014-2017. PLoS One 2018; 13:e0208919. [PMID: 30543693 PMCID: PMC6292635 DOI: 10.1371/journal.pone.0208919] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/26/2018] [Indexed: 12/23/2022] Open
Abstract
Although several studies have evaluated one or more linkage services to improve early enrollment in HIV care in Tanzania, none have evaluated the package of linkage services recommended by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). We describe the uptake of each component of the CDC/WHO recommended package of linkage services, and early enrollment in HIV care and antiretroviral therapy (ART) initiation among persons with HIV who participated in a peer-delivered, linkage case management (LCM) program implemented in Bukoba, Tanzania, October 2014 –May 2017. Of 4206 participants (88% newly HIV diagnosed), most received recommended services including counseling on the importance of early enrollment in care and ART (100%); escort by foot or car to an HIV care and treatment clinic (CTC) (83%); treatment navigation at a CTC (94%); telephone support and appointment reminders (77% among clients with cellphones); and counseling on HIV-status disclosure and partner/family testing (77%), and on barriers to care (69%). During three periods with different ART-eligibility thresholds [CD4<350 (Oct 2014 –Dec 2015, n = 2233), CD4≤500 (Jan 2016 –Sept 2016, n = 1221), and Test & Start (Oct 2016 –May 2017, n = 752)], 90%, 96%, and 97% of clients enrolled in HIV care, and 47%, 67%, and 86% of clients initiated ART, respectively, within three months of diagnosis. Of 463 LCM clients who participated in the last three months of the rollout of Test & Start, 91% initiated ART. Estimated per-client cost was $44 United States dollars (USD) for delivering LCM services in communities and facilities overall, and $18 USD for a facility-only model with task shifting. Well accepted by persons with HIV, peer-delivered LCM services recommended by CDC and WHO can achieve near universal early ART initiation in the Test & Start era at modest cost and should be considered for implementation in facilities and communities experiencing <90% early enrollment in ART care.
Collapse
Affiliation(s)
- Duncan MacKellar
- Division of Global HIV and TB, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | | | | | | | - Haddi Cham
- Division of Global HIV and TB, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Omari Msumi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | - Rachel Weber
- CTS Global, Inc., assigned to Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Gerald Kundi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | - Chutima Suraratdecha
- Division of Global HIV and TB, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tewodaj Mengistu
- Division of Global HIV and TB, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Sherri Pals
- Division of Global HIV and TB, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eliufoo Churi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | | | | | | | | | - Jessica Justman
- ICAP at Columbia University, New York, New York, United States of America
| | - Anath Rwebembera
- National AIDS Control Program, MoHCDGEC, Dar es Salaam, Tanzania
| |
Collapse
|
27
|
van Olmen J, Delobelle P, Guwatudde D, Absetz P, Sanders D, Mölsted Alvesson H, Puoane T, Ostenson CG, Tomson G, Mayega RW, Sundberg CJ, Peterson S, Daivadanam M. Using a cross-contextual reciprocal learning approach in a multisite implementation research project to improve self-management for type 2 diabetes. BMJ Glob Health 2018; 3:e001068. [PMID: 30555727 PMCID: PMC6267315 DOI: 10.1136/bmjgh-2018-001068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/23/2018] [Accepted: 10/28/2018] [Indexed: 11/16/2022] Open
Abstract
This paper reports on the use of reciprocal learning for identifying, adopting and adapting a type 2 diabetes self-management support intervention in a multisite implementation trial conducted in a rural setting in a low-income country (Uganda), a periurban township in a middle-income country (South Africa) and socioeconomically disadvantaged suburbs in a high-income country (Sweden). The learning process was guided by a framework for knowledge translation and structured into three learning cycles, allowing for a balance between evidence, stakeholder interaction and contextual adaptation. Key factors included commitment, common goals, leadership and partnerships. Synergistic outcomes were the cocreation of knowledge, interventions and implementation methods, including reverse innovations such as adaption of community-linked models of care. Contextualisation was achieved by cross-site exchanges and local stakeholder interaction to balance intervention fidelity with local adaptation. Interdisciplinary and cross-site collaboration resulted in the establishment of learning networks. Limitations of reciprocal learning relate to the complexity of the process with unpredictable outcomes and the limited generalisability of results.
Collapse
Affiliation(s)
- Josefien van Olmen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Peter Delobelle
- Chronic Disease Initiative for Africa, Faculty of Health Sciences - University of Cape Town, Cape Town, South Africa
- School of Public Health, University of Western Cape, Bellville, South Africa
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Pilvikki Absetz
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Collaborative Care Systems Finland, Helsinki, Finland
| | - David Sanders
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | | | - Thandi Puoane
- School of Public Health, University of Western Cape, Bellville, South Africa
| | - Claes-Goran Ostenson
- Department of Molecular Medicine and Surgery, Diabetes and Endocrine Unit, Karolinska Institutet, Stockholm, Sweden
| | - Göran Tomson
- Department of Public Health Sciences, Karolinska Institutet and Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Roy William Mayega
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Carl Johan Sundberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Peterson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Uppsala University, Uppsala, Sweden
| | - Meena Daivadanam
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Dept of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| |
Collapse
|
28
|
Busza J, Dauya E, Makamba M, Ferrand RA. "I will not stop visiting!" a qualitative study of community health workers' reluctance to withdraw household support following the end of a community-based intervention in Zimbabwe. BMC Health Serv Res 2018; 18:718. [PMID: 30223831 PMCID: PMC6142685 DOI: 10.1186/s12913-018-3531-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community Health Worker (CHW) programmes are increasingly important in HIV service delivery. CHWs' familiarity with the local context can improve intervention acceptability and sustainability but concerns have been raised about potential exploitation and "burnout" of CHWs as they become emotionally involved in clients' lives. Little attention has been paid to what happens at the end of time-limited CHW interventions. This study aimed to examine the experience of CHWs' withdrawal from clients and their families. METHODS We conducted a qualitative study of CHWs' experiences of "exiting" from households during the ZENITH (Zimbabwe Study for Enhancing Testing and Improving Treatment of HIV in Children) intervention, which provided 12 structured home visits over 72 weeks to families with children recently diagnosed with HIV. We conducted semi-structured interviews at 12 and 18 months with all 19 CHWs delivering the intervention and 36 purposively selected caregivers who received home visits. Analysis focused on perceptions of the end of the trial, when CHWs completed the scheduled home-based visits and there was no guarantee of programme continuation beyond the study. RESULTS Termination of scheduled home visits caused significant distress to both CHWs and the households they visited. We identify 3 thematic "lessons learned" for CHW programmes. First, CHWs derived pride and self-worth from emotional labour as they became integral to families' improved ability to cope, motivating them to go beyond formal job requirements. Second, clients' growing dependence on CHWs led to "exit" being interpreted as abandonment by both CHWs and households, causing distress on both sides. Finally, in response to anxiety about "abandoning" families, CHWs maintained contact with families long after scheduled withdrawal of services. CONCLUSIONS CHWs can forge genuine bonds with households, creating expectations of long-term engagement. On the positive side, CHW derive pride from their work, attach social responsibility to their roles, and feel personal fulfilment in supporting families. If CHWs do not disengage from interventions as planned, or become demoralised by "exits", interventions will prove less sustainable. CHWs are often lauded for their ability to develop trust with peers, yet this willingness and ability to create enduring emotional bonds could threaten programme delivery.
Collapse
Affiliation(s)
- Joanna Busza
- Department of Public Health, Environment and Society and Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Ethel Dauya
- Biomedical Research & Training Institute, No. 10 Seagrave road, Avondale, Harare, Zimbabwe
| | - Memory Makamba
- Biomedical Research & Training Institute, No. 10 Seagrave road, Avondale, Harare, Zimbabwe
| | - Rashida A. Ferrand
- Biomedical Research & Training Institute, No. 10 Seagrave road, Avondale, Harare, Zimbabwe
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| |
Collapse
|
29
|
A Systematic Review of the Current Status of Safer Conception Strategies for HIV Affected Heterosexual Couples in Sub-Saharan Africa. AIDS Behav 2018; 22:2916-2946. [PMID: 29869184 DOI: 10.1007/s10461-018-2170-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
We conducted a systematic review of safer conception strategies (SCS) for HIV-affected couples in sub-Saharan Africa to inform evidence-based safer conception interventions. Following PRISMA guidelines, we searched fifteen electronic databases using the following inclusion criteria: SCS research in HIV-affected couples; published after 2007; in sub-Saharan Africa; primary research; peer-reviewed; and addressed a primary topic of interest (SCS availability, feasibility, and acceptability, and/or education and promotion). Researchers independently reviewed each study for eligibility using a standardized tool. We categorize studies by their topic area. We identified 41 studies (26 qualitative and 15 quantitative) that met inclusion criteria. Reviewed SCSs included: antiretroviral therapy (ART), pre-exposure prophylaxis, timed unprotected intercourse, manual/self-insemination, sperm washing, and voluntary male medical circumcision (VMMC). SCS were largely unavailable outside of research settings, except for general availability (i.e., not specifically for safer conception) of ART and VMMC. SCS acceptability was impacted by low client and provider knowledge about safer conception services, stigma around HIV-affected couples wanting children, and difficulty with HIV disclosure in HIV-affected couples. Couples expressed desire to learn more about SCS; however, provider training, patient education, SCS promotions, and integration of reproductive health and HIV services remain limited. Studies of provider training and couple-based education showed improvements in communication around fertility intentions and SCS knowledge. SCS are not yet widely available to HIV-affected African couples. Successful implementation of SCS requires that providers receive training on effective SCS and provide couple-based safer conception counseling to improve disclosure and communication around fertility intentions and reproductive health.
Collapse
|
30
|
Trafford Z, Gomba Y, Colvin CJ, Iyun VO, Phillips TK, Brittain K, Myer L, Abrams EJ, Zerbe A. Experiences of HIV-positive postpartum women and health workers involved with community-based antiretroviral therapy adherence clubs in Cape Town, South Africa. BMC Public Health 2018; 18:935. [PMID: 30064405 PMCID: PMC6069812 DOI: 10.1186/s12889-018-5836-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 07/11/2018] [Indexed: 11/10/2022] Open
Abstract
Background The rollout of universal, lifelong treatment for all HIV-positive pregnant and breastfeeding women (“Option B+”) has rapidly increased the number of women initiating antiretroviral treatment (ART) and requiring ART care postpartum. In a pilot project in South Africa, eligible postpartum women were offered the choice of referral to the standard of care, a local primary health care clinic, or a community-based model of differentiated ART services, the adherence club (AC). ACs have typically enrolled only non-pregnant and non-postpartum adults; postpartum women had not previously been referred directly from antenatal care. There is little evidence regarding postpartum women’s preferences for and experiences of differentiated models of care, or the capacity of this particular model to cater to their specific needs. This qualitative paper reports on feedback from both postpartum women and health workers who care for them on their respective experiences of the AC. Methods One-on-one in-depth qualitative interviews were conducted with 19 (23%) of the 84 postpartum women who selected the AC and were retained at approximately 12 months postpartum, and 9 health workers who staff the AC. Data were transcribed and thematically analysed using NVivo 11. Results Postpartum women’s inclusion in the AC was acceptable for both participants and health workers. Health workers were welcoming of postpartum women but expressed concerns about prospects for longer term adherence and retention, and raised logistical issues they felt might compromise trust with AC members in general. Conclusions Enrolling postpartum women in mixed groups with the general adult population is feasible and acceptable. Preliminary recommendations are offered and may assist in supporting the specific needs of postpartum women transitioning from antenatal ART care. Trial registration Number NCT02417675 clinicaltrials.gov/ct2/show/record/NCT02417675 (retrospective reg.)
Collapse
Affiliation(s)
- Zara Trafford
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Yolanda Gomba
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christopher J Colvin
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Victoria O Iyun
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Tamsin K Phillips
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kirsty Brittain
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Elaine J Abrams
- Mailman School of Public Health, ICAP, Columbia University, New York, USA.,College of Physicians and Surgeons, Columbia University, New York, USA
| | - Allison Zerbe
- Mailman School of Public Health, ICAP, Columbia University, New York, USA
| |
Collapse
|
31
|
Ochom E, Meyer AJ, Armstrong-Hough M, Kizito S, Ayakaka I, Turimumahoro P, Ggita JM, Katamba A, Davis JL. Integrating home HIV counselling and testing into household TB contact investigation: a mixed-methods study. Public Health Action 2018; 8:72-78. [PMID: 29946523 PMCID: PMC6012957 DOI: 10.5588/pha.18.0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/07/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: Community health workers (CHWs) increasingly deliver community-based human immunodeficiency virus (HIV) counselling and testing (HCT) services. Less is known about how this strategy performs when integrated with household tuberculosis (TB) contact investigations. Objective: We conducted a prospective mixed-methods study to evaluate the feasibility and quality of CHW-facilitated, home-based HCT among household TB contacts. Design: CHWs visited households of consenting TB patients to screen household contacts for TB and HIV. They performed HIV testing using a serial enzyme-linked immunosorbent assay rapid-antibody testing algorithm. Laboratory technicians at health facilities re-tested the samples and coordinated quarterly HIV panel testing for CHWs. We conducted focus group discussions (FGDs) with CHWs on their experiences in carrying out home-based HCT. Results: Of 114 household contacts who consented to and underwent HIV testing by CHWs, 5 (4%) tested positive, 108 (95%) tested negative, and 1 (1%) had indeterminate results; 110 (96%) samples had adequate volume for re-testing. Overall agreement between CHWs and laboratory technicians was 99.1% (κ = 0.90, 95%CI 0.71-1.00, P < 0.0001). In FGDs, CHWs described context-specific social challenges to performing HCT in a household setting, but said that their confidence grew with experience. Conclusion: Home-based HCT by CHWs was feasible among household TB contacts and produced high-quality results. Strategies to address social challenges are required to optimize yield.
Collapse
Affiliation(s)
- E Ochom
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - A J Meyer
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - M Armstrong-Hough
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - S Kizito
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - I Ayakaka
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - P Turimumahoro
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - J M Ggita
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - A Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - J L Davis
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
32
|
Sonderman KA, Nkurunziza T, Kateera F, Gruendl M, Koch R, Gaju E, Habiyakare C, Matousek A, Nahimana E, Ntakiyiruta G, Riviello R, Hedt-Gauthier BL. Using mobile health technology and community health workers to identify and refer caesarean-related surgical site infections in rural Rwanda: a randomised controlled trial protocol. BMJ Open 2018; 8:e022214. [PMID: 29739786 PMCID: PMC5942430 DOI: 10.1136/bmjopen-2018-022214] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Surgical site infections (SSIs) are a significant cause of morbidity and mortality in low-income and middle-income countries, where rates of SSIs can reach 30%. Due to limited access, there is minimal follow-up postoperatively. Community health workers (CHWs) have not yet been used for surgical patients in most settings. Advancements in telecommunication create an opportunity for mobile health (mHealth) tools to support CHWs. We aim to evaluate the use of mHealth technology to aid CHWs in identification of SSIs and promote referral of patients back to healthcare facilities. METHODS AND ANALYSIS Prospective randomised controlled trial conducted at Kirehe District Hospital, Rwanda, from November 2017 to November 2018. Patients ≥18 years who undergo caesarean section are eligible. Non-residents of Kirehe District or patients who remain in hospital >10 days postoperatively will be excluded. Patients will be randomised to one of three arms. For arm 1, a CHW will visit the patient's home on postoperative day 10 (±3 days) to administer an SSI screening protocol (fever, pain or purulent drainage) using an electronic tablet. For arm 2, the CHW will administer the screening protocol over the phone. For both arms 1 and 2, the CHW will refer patients who respond 'yes' to any of the questions to a health facility. For arm 3, patients will not receive follow-up care. Our primary outcome will be the impact of the mHealth-CHW intervention on the rate of return to care for patients with an SSI. ETHICS AND DISSEMINATION The study has received ethical approval from the Rwandan National Ethics Committee and Partners Healthcare. Results will be disseminated to Kirehe District Hospital, Rwanda Ministry of Health, Rwanda Surgical Society, Partners In Health, through conferences and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03311399.
Collapse
Affiliation(s)
- Kristin A Sonderman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Magdalena Gruendl
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel Koch
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Alexi Matousek
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Bethany L Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Kigali, Rwanda
| |
Collapse
|
33
|
Gilbert HN, Wyatt MA, Asiimwe S, Turyamureeba B, Tumwesigye E, Van Rooyen H, Barnabas RV, Celum CL, Ware NC. Messaging Circumstances and Economic Pressures as Influences on Linkage to Medical Male Circumcision following Community-Based HIV Testing for Men in Rural Southwest Uganda: A Qualitative Study. AIDS Res Treat 2018; 2018:8387436. [PMID: 29854445 PMCID: PMC5960566 DOI: 10.1155/2018/8387436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/26/2018] [Indexed: 12/03/2022] Open
Abstract
Voluntary medical male circumcision (MMC) reduces risk of HIV infection, but uptake remains suboptimal among certain age groups and locations in sub-Saharan Africa. We analysed qualitative data as part of the Linkages Study, a randomized controlled trial to evaluate community-based HIV testing and follow-up as interventions promoting linkage to HIV treatment and prevention in Uganda and South Africa. Fifty-two HIV-negative uncircumcised men participated in the qualitative study. They participated in semistructured individual interviews exploring (a) home HTC experience; (b) responses to test results; (c) efforts to access circumcision services; (d) outcomes of efforts; (e) experiences of follow-up support; and (f) local HIV education and support. Interviews were audio-recorded, translated, transcribed, and summarized into "linkage summaries." Summaries were analysed inductively to identify the following three thematic experiences shaping men's circumcision choices: (1) intense relief upon receipt of an unanticipated seronegative diagnosis, (2) the role of peer support in overcoming fear, and (3) anticipation of missed economic productivity. Increased attention to the timing of demand creation activities, to who delivers information about the HIV prevention benefits of MMC, and to the importance of missed income during recovery as a barrier to uptake promises to strengthen and sharpen future MMC demand creation strategies.
Collapse
Affiliation(s)
- Hannah N. Gilbert
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Monique A. Wyatt
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Harvard Global, Cambridge, MA, USA
| | | | | | | | - Heidi Van Rooyen
- Human Sciences Research Council, Durban, South Africa
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ruanne V. Barnabas
- Department of Global Health, School of Medicine and School of Public Health, University of Washington, Seattle, WA, USA
| | - Connie L. Celum
- Department of Global Health, School of Medicine and School of Public Health, University of Washington, Seattle, WA, USA
| | - Norma C. Ware
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
34
|
Venuti A, Pastori C, Lopalco L. The Role of Natural Antibodies to CC Chemokine Receptor 5 in HIV Infection. Front Immunol 2017; 8:1358. [PMID: 29163468 PMCID: PMC5670346 DOI: 10.3389/fimmu.2017.01358] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/03/2017] [Indexed: 12/22/2022] Open
Abstract
The CC chemokine receptor 5 (CCR5) is responsible for immune and inflammatory responses by mediation of chemotactic activity in leukocytes, although it is expressed on different cell types. It has been shown to act as co-receptor for the human and simian immunodeficiency viruses (HIV-1, HIV-2, and SIV). Natural reactive antibodies (Abs) recognizing first loop (ECL1) of CCR5 have been detected in several pools of immunoglobulins from healthy donors and from several cohorts of either HIV-exposed but uninfected subjects (ESN) or HIV-infected individuals who control disease progression (LTNP) as well. The reason of development of anti-CCR5 Abs in the absence of autoimmune disease is still unknown; however, the presence of these Abs specific for CCR5 or for other immune receptors and mediators probably is related to homeostasis maintenance. The majority of anti-CCR5 Abs is directed to HIV binding site (N-terminus and ECL2) of the receptor. Conversely, it is well known that ECL1 of CCR5 does not bind HIV; thus, the anti-CCR5 Abs directed to ECL1 elicit a long-lasting internalization of CCR5 but not interfere with HIV binding directly; these Abs block HIV infection in either epithelial cells or CD4+ T lymphocytes and the mechanism differs from those ones described for all other CCR5-specific ligands. The Ab-mediated CCR5 internalization allows the formation of a stable signalosome by interaction of CCR5, β-arrestin2 and ERK1 proteins. The signalosome degradation and the subsequent de novo proteins synthesis determine the CCR5 reappearance on the cell membrane with a very long-lasting kinetics (8 days). The use of monoclonal Abs to CCR5 with particular characteristics and mode of action may represent a novel mode to fight viral infection in either vaccinal or therapeutic strategies.
Collapse
Affiliation(s)
- Assunta Venuti
- Division of Immunology, Transplantation and Infectious Diseases, DIBIT - San Raffaele Scientific Institute, Milan, Italy
| | - Claudia Pastori
- Division of Immunology, Transplantation and Infectious Diseases, DIBIT - San Raffaele Scientific Institute, Milan, Italy
| | - Lucia Lopalco
- Division of Immunology, Transplantation and Infectious Diseases, DIBIT - San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
35
|
|