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Vilakati BP, Yeatman S. Men's perceptions of HIV self-testing in Eswatini: a qualitative study. AIDS Care 2024; 36:1492-1498. [PMID: 38766763 DOI: 10.1080/09540121.2024.2354222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
Men in Eswatini test for HIV at lower rates compared to women despite the widespread availability of HIV testing services in the country. HIV self-test kits have been proposed as an HIV testing model to reach more men by bypassing the health facility, which is known to be a barrier for men using HIV testing services. In this study, we sought to understand men's perspectives on HIV self-testing in Eswatini. We conducted semi-structured interviews with 22 men, recruited from a rural community and from an urban men's clinic, to assess their awareness of HIV self-testing and their perceptions of it as an alternative HIV testing option. Findings show that men were aware of HIV self-testing but had concerns that left most feeling hesitant about adopting it. Many men expressed doubts about the accuracy of self-testing and their own technical competence to use the kit without supervision. They also expressed fears about testing, and possibly learning they were HIV positive, without adequate pre - and post-HIV test counseling. To allay men's fears and improve uptake of HIV self-testing, practitioners might consider innovative methods such as virtual counseling services and linking HIV self-testing to other community-based HIV care services.
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Affiliation(s)
| | - Sara Yeatman
- Department of Health and Behavioral Sciences, University of Colorado, Denver, CO, USA
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2
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Oluokun EO, Adedoyin FF, Dogan H, Jiang N. Co-Designing Digital Health Intervention for Monitoring Medication and Consultation Among Transgender People in Underserved Communities: Collaborative Approach. JMIR Hum Factors 2024; 11:e45826. [PMID: 39264700 DOI: 10.2196/45826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/30/2023] [Accepted: 07/11/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND In many parts of the world, men who have sex with men and transgender individuals face criminalization and discrimination. As a result, they are less likely to seek medical help, despite experiencing higher rates of HIV/AIDS, mental health issues, and other health problems. Reaching key populations (KPs) with essential testing, care, and treatment services can be challenging, as they often have a higher likelihood of contracting and spreading the virus. They have limited access to antiretroviral (ARV) therapy (ART) services, which means that KPs may continue to serve as reservoirs for new HIV infections if they do not receive effective HIV programming. This ongoing issue complicates efforts to control the epidemic. Therefore, modeling a digital health system to track ARV medication access and use is crucial. This paper advocates for the use of digital interventions to manage the health of KPs in underserved regions, using Nigeria as a case study. OBJECTIVE This study aims to assess digital health interventions for monitoring medication and consultations among transgender people in underserved communities. It also sought to determine whether a system exists that could support ART adherence in Nigeria. Additionally, the study evaluated design strategies to address privacy and confidentiality concerns, aiming to reduce nonadherence to ARV medications among KPs in Nigeria. METHODS A qualitative approach was adopted for this research, involving a thematic analysis of information collected from interviews with clinicians and other health practitioners who work directly with these communities, as well as from an interactive (virtual) workshop. RESULTS The findings from the thematic analysis indicate a need to increase attendance at ART therapy sessions through the implementation of an intensive care web app. Unlike previous solutions, this study highlights the importance of incorporating a reminder feature that integrates with an in-app telemedicine consultancy platform. This platform would facilitate discussions about client challenges, such as adverse drug effects, counseling sessions with clinical psychologists, and the impact of identity discrimination on mental health. Other data-driven health needs identified in the study are unique drug request nodes, client-led viral load calculators, remote requests, and drug delivery features within the web app. Participants also emphasized the importance of monitoring medication compliance and incorporating user feedback mechanisms, such as ratings and encouragement symbols (eg, stars, checkmarks), to motivate adherence. CONCLUSIONS The study concludes that technology-driven solutions could enhance ART adherence and reduce HIV transmission among transgender people. It also recommends that local governments and international organizations collaborate and invest in health management services that prioritize health needs over identity.
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Affiliation(s)
- Emmanuel Oluwatosin Oluokun
- Department of Computing and Informatics, Faculty of Science and Technology, Bournemouth University, Poole, Dorset, United Kingdom
| | - Festus Fatai Adedoyin
- Department of Computing and Informatics, Faculty of Science and Technology, Bournemouth University, Poole, Dorset, United Kingdom
| | - Huseyin Dogan
- Department of Computing and Informatics, Faculty of Science and Technology, Bournemouth University, Poole, Dorset, United Kingdom
| | - Nan Jiang
- Department of Computing and Informatics, Faculty of Science and Technology, Bournemouth University, Poole, Dorset, United Kingdom
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3
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Li D, Ma S, Dang B, Shi H, Wei Y, Wang X. Effectiveness of telemedicine for the prevention of mother-to-child transmission of HIV in low-income and middle-income countries: a systematic review and meta-analysis. Int J Infect Dis 2024; 143:106981. [PMID: 38458425 DOI: 10.1016/j.ijid.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES We aimed to estimate the effectiveness of telemedicine for the prevention of mother-to-child transmission (PMTCT) program of HIV in low- and middle-income countries (LMICs). METHODS We did a systematic literature search of 15 databases for articles published from database inception to October 26, 2022, and performed meta-analyses to estimate the pooled risk ratio of intervention effect (RR) and its 95% confidence interval (CI). We used subgroup analyses and meta-regressions to explore variation in the RRs. Funnel plots and Egger regression tests were also performed to assess publication bias. RESULTS Seventeen studies were included in the systematic review, with a total sample size of 9118 participants. We found that telemedicine was beneficial for early infant diagnosis (EID) in the sixth week (RR 1.04 [95% CI 1.00-1.09]), exclusive breastfeeding (RR 1.12 [95% CI 1.01-1.24]) and PMTCT retention (RR 1.34 [95% CI 1.16-1.55]). However, we did not find a significant effect of telemedicine on infant prophylaxis, HIV transmission, and ART adherence. Besides, the heterogeneity of ART adherence was associated with enrollment time, while retention was related to ART initiation. CONCLUSIONS Our meta-analysis demonstrated the benefits of telemedicine in improving PMTCT, especially for EID, exclusive breastfeeding, and PMTCT retention.
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Affiliation(s)
- Dantong Li
- Department of Maternal and Child Health, Peking University School of Public Health, Beijing, China
| | - Shang Ma
- Department of Maternal and Child Health, Peking University School of Public Health, Beijing, China
| | - Binfei Dang
- Peking University Health Science Center, Beijing, China
| | - Huifeng Shi
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China; National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China; National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Yuan Wei
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China; National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China; National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Xiaoli Wang
- Department of Maternal and Child Health, Peking University School of Public Health, Beijing, China.
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Fonner V, Agostini T, Desai R, Hartzell P, Martin L, Meissner EG. Implementation of free-draft text messaging to enhance care retention and satisfaction for persons living with HIV infection. AIDS Care 2024; 36:452-462. [PMID: 37139535 PMCID: PMC10622326 DOI: 10.1080/09540121.2023.2208320] [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: 01/24/2022] [Accepted: 04/24/2023] [Indexed: 05/05/2023]
Abstract
Eligible persons with HIV infection can receive client-centered case management to coordinate medical and social services. Novel mobile health interventions could improve effective case management and retention in care, an important goal to help end the HIV epidemic. Using a hybrid type I effectiveness-implementation design, we assessed whether access to bidirectional, free-draft secure text messaging with a case manager and clinic pharmacist could improve client satisfaction and care retention in a Southern academic HIV clinic. Sixty-four clients enrolled between November 2019 and March 2020, had a median age of 39 years, and were mostly male, single, and African-American. Heavy app users texted over 100 times (n = 6) over the course of the 12-month intervention while others never texted (n = 12). App usage peaked during months of clinic closure due to COVID-19. Most participants reported high satisfaction with the app and planned continued usage after study completion. Changes in clinic retention and virologic suppression rates were not observed, a result confounded by practice changes due to COVID-19. High usage and satisfaction of free-draft text messaging in case-managed HIV clients supports inclusion of this communication option in routine HIV clinical care.
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Affiliation(s)
- Virginia Fonner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Thomas Agostini
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC
| | - Rohan Desai
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC
| | - Peyton Hartzell
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC
| | - Lisa Martin
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC
| | - Eric G. Meissner
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
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5
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Cuadros DF, Huang Q, Mathenjwa T, Gareta D, Devi C, Musuka G. Unlocking the potential of telehealth in Africa for HIV: opportunities, challenges, and pathways to equitable healthcare delivery. Front Digit Health 2024; 6:1278223. [PMID: 38500968 PMCID: PMC10944905 DOI: 10.3389/fdgth.2024.1278223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/16/2024] [Indexed: 03/20/2024] Open
Affiliation(s)
- Diego F. Cuadros
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, United States
| | - Qian Huang
- Center for Rural Health Research, College of Public Health, East Tennessee State University, Johnson City, TN, United States
| | - Thulile Mathenjwa
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Chayanika Devi
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, United States
| | - Godfrey Musuka
- International Initiative for Impact Evaluation, Harare, Zimbabwe
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Choi Y, Ibrahim S, Park LP, Bukusi EA, Huchko MJ. The impact of text message reminders on cryotherapy uptake among women testing positive for HPV in western Kenya: a prospective cohort study. BMC Womens Health 2024; 24:32. [PMID: 38218782 PMCID: PMC10787999 DOI: 10.1186/s12905-023-02842-x] [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: 04/17/2023] [Accepted: 12/13/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Mobile health (mHealth) has become an increasingly popular strategy to improve healthcare delivery and health outcomes. Communicating results and health education via text may facilitate program planning and promote better engagement in care for women undergoing human papillomavirus (HPV) screening. We sought to develop and evaluate an mHealth strategy with enhanced text messaging to improve follow-up throughout the cervical cancer screening cascade. METHODS Women aged 25-65 participated in HPV testing in six community health campaigns (CHCs) in western Kenya as part of a single arm of a cluster-randomized trial. Women received their HPV results via text message, phone call, or home visit. Those who opted for text in the first four communities received "standard" texts. After completing the fourth CHC, we conducted two semi-structured focus group discussions with women to develop an "enhanced" text strategy, including modifying the content, number, and timing of texts, for the subsequent two communities. We compared the overall receipt of results and follow-up for treatment evaluation among women in standard and enhanced text groups. RESULTS Among 2368 women who were screened in the first four communities, 566 (23.9%) received results via text, 1170 (49.4%) via phone call, and 632 (26.7%) via home visit. In the communities where enhanced text notification was offered, 264 of the 935 screened women (28.2%) opted for text, 474 (51.2%) opted for phone call, and 192 (20.5%) for home visit. Among 555 women (16.8%) who tested HPV-positive, 257 (46.3%) accessed treatment, with no difference in treatment uptake between the standard text group (48/90, 53.3%) and the enhanced text group (22/41, 53.7%). More women in the enhanced text group had prior cervical cancer screening (25.8% vs. 18.4%; p < 0.05) and reported living with HIV (32.6% vs. 20.2%; p < 0.001) than those in the standard text group. CONCLUSIONS Modifying the content and number of texts as an enhanced text messaging strategy was not sufficient to increase follow-up in an HPV-based cervical cancer screening program in western Kenya. A one-size approach to mHealth delivery does not meet the needs of all women in this region. More comprehensive programs are needed to improve linkage to care to further reduce structural and logistical barriers to cervical cancer treatment.
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Affiliation(s)
- Yujung Choi
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | | | - Lawrence P Park
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | | | - Megan J Huchko
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
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Prabhune A, Bhat S, Mallavaram A, Mehar Shagufta A, Srinivasan S. A Situational Analysis of the Impact of the COVID-19 Pandemic on Digital Health Research Initiatives in South Asia. Cureus 2023; 15:e48977. [PMID: 38111408 PMCID: PMC10726017 DOI: 10.7759/cureus.48977] [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] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
The objective of this paper was to evaluate and compare the quantity and sustainability of digital health initiatives in the South Asia region before and during the COVID-19 pandemic. The study used a two-step methodology of (a) descriptive analysis of digital health research articles published from 2016 to 2021 from South Asia in terms of stratification of research articles based on diseases and conditions they were developed, geography, and tasks wherein the initiative was applied and (b) a simple and replicable tool developed by authors to assess the sustainability of digital health initiatives using experimental or observational study designs. The results of the descriptive analysis highlight the following: (a) there was a 40% increase in the number of studies reported in 2020 when compared to 2019; (b) the three most common areas wherein substantive digital health research has been focused are health systems strengthening, ophthalmic disorders, and COVID-19; and (c) remote consultation, health information delivery, and clinical decision support systems are the top three commonly developed tools. We developed and estimated the inter-rater operability of the sustainability assessment tool ascertained with a Kappa value of 0.806 (±0.088). We conclude that the COVID-19 pandemic has had a positive impact on digital health research with an improvement in the number of digital health initiatives and an improvement in the sustainability score of studies published during the COVID-19 pandemic.
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Affiliation(s)
- Akash Prabhune
- Health and Information Technology, Institute of Health Management Research, Bangalore, IND
| | - Sachin Bhat
- Health and Information Technology, Institute of Health Management Research, Bangalore, IND
| | | | | | - Surya Srinivasan
- Health and Information Technology, Institute of Health Management Research, Bangalore, IND
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8
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Kruse CS, Pacheco GJ, Rosenthal N, Kopp CJ, Omorotionmwan O, Cruz JE. Leveraging mHealth for the Treatment and Management of PLHIV. Risk Manag Healthc Policy 2023; 16:677-697. [PMID: 37077534 PMCID: PMC10106311 DOI: 10.2147/rmhp.s403946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/25/2023] [Indexed: 04/21/2023] Open
Abstract
Objective The objective of this systematic review was to analyze published literature from the last five years to assess facilitators and barriers to the adoption of mHealth as interventions to treat and manage HIV for PLHIV (people living with HIV). The primary outcomes were physical and mental conditions. The secondary outcomes were behavior based (substance use, care engagement, and healthy habits). Methods Four databases (PubMed, CINAHL, Web of Science, and ScienceDirect) were queried on 9/2/2022 for peer-reviewed studies on the treatment and management of PLHIV with mHealth as the intervention. The review was conducted in accordance with the Kruse Protocol and reported in accordance with PRISMA 2020. Results Five mHealth interventions were identified across 32 studies that resulted in improvements in physical health, mental health, care engagement, and behavior change. mHealth interventions offer both convenience and privacy, meet a digital preference, increase health knowledge, decrease healthcare utilization, and increase quality of life. Barriers are cost of technology and incentives, training of staff, security concerns, digital literacy gap, distribution of technology, technical issues, usability, and visual cues are not available over the phone. Conclusion mHealth offers interventions to improve physical health, mental health, care engagement, and behavior for PLHIV. There are many advantages to this intervention and very few barriers to its adoption. The barriers are strong, however, and should be addressed through policy. Further research should focus on specific apps for younger versus older PLHIV, based on preferences and the digital literacy gap.
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Affiliation(s)
- Clemens Scott Kruse
- Texas State University, School of Health Administration, 601 University Drive, San Marcos, TX, 78666, USA
- Correspondence: Clemens Scott Kruse, Email
| | - Gerardo J Pacheco
- Texas State University, School of Health Administration, 601 University Drive, San Marcos, TX, 78666, USA
| | - Noah Rosenthal
- Texas State University, School of Health Administration, 601 University Drive, San Marcos, TX, 78666, USA
| | - Caris J Kopp
- Texas State University, School of Health Administration, 601 University Drive, San Marcos, TX, 78666, USA
| | - Omosigho Omorotionmwan
- Texas State University, School of Health Administration, 601 University Drive, San Marcos, TX, 78666, USA
| | - John E Cruz
- Texas State University, School of Health Administration, 601 University Drive, San Marcos, TX, 78666, USA
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Musiimenta A, Tumuhimbise W, Atukunda EC, Mugaba AT, Asasira J, Katusiime J, Zender R, Pinkwart N, Mugyenyi GR, Haberer JE. A mobile health app may improve maternal and child health knowledge and practices among rural women with limited education in Uganda: a pilot randomized controlled trial. JAMIA Open 2022; 5:ooac081. [PMID: 36225894 PMCID: PMC9542753 DOI: 10.1093/jamiaopen/ooac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 08/24/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
Objective This article describes the impact of a mobile health app (MatHealth App) on maternal and child health knowledge and practices among women with limited education. Materials and methods Pregnant women initiating antenatal care (ANC) were randomized (1:1) to the MatHealth App versus routine care. Participants were followed until 6 weeks after delivery. Questionnaires for assessing knowledge and practices were administered to participants from both arms at baseline and endline. Using logistic regression, we estimated the difference in odds of having maternal health knowledge. We reviewed clinic records to capture maternal health practices. Results Of the 80 enrolled participants, 69 (86%) completed the study with a median follow-up of 6 months. Women in the MatHealth arm had 8.2 (P = .19), 3.6 (P = .14), and 6.4 (P = .25), respectively higher odds of knowing (1) the recommended gestation period for starting ANC, (2) the recommended number of ANC visits, and (3) the timing and frequency of recommended human immunodeficiency virus (HIV) testing, respectively, compared to those in the routine care arm. All women in the MatHealth App arm exclusively breastfed their babies, and brought them at 6 weeks for HIV testing, compared to the routine care arm. Just over half of the women attended at least 4 prenatal visits across the 2 arms. The main reason for noncompliance to ANC appointments was a lack of transport to the clinic. Discussion and conclusion The app increased knowledge and practices although not reaching statistical significance. Future efforts can focus on addressing social and economic issues and assessing clinical outcomes.
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Affiliation(s)
- Angella Musiimenta
- Corresponding Author: Angella Musiimenta, PhD, Department of Information Technology, Mbarara University of Science and Technology, P.O. Box 653, Mbarara, Uganda;
| | - Wilson Tumuhimbise
- Department of Information Technology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Esther C Atukunda
- Department of Information Technology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Aaron T Mugaba
- Department of Information Technology, Mbarara University of Science and Technology, Mbarara, Uganda,Angels Compassion Research and Development Initiative, Mbarara, Uganda
| | - Justus Asasira
- Department of Information Technology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jane Katusiime
- Department of Information Technology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Raphael Zender
- Department of Computer Science, Humboldt Universitat zu Berlin, Berlin, Germany
| | - Niels Pinkwart
- Department of Computer Science, Humboldt Universitat zu Berlin, Berlin, Germany
| | | | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA,Medicine Department, Harvard Medical School, Boston, Massachusetts, USA
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Pugh LE, Roberts JS, Viswasam N, Hahn E, Ryan S, Turpin G, Lyons CE, Baral S, Hansoti B. Systematic review of interventions aimed at improving HIV adherence to care in low- and middle-income countries in Sub-Saharan Africa. J Infect Public Health 2022; 15:1053-1060. [PMID: 36063721 PMCID: PMC10117278 DOI: 10.1016/j.jiph.2022.08.012] [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: 10/22/2021] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/15/2022] Open
Abstract
Long-term adherence to antiretroviral medication continues to present as a challenge along the continuum of the HIV care cascade. HIV interventions and support programs are significantly threatened in resource-limited settings by challenges in maintaining long-term follow-up for ART adherence. We sought to complete a systematic review to comprehensively examine ART adherence and retention in care interventions in Sub-Saharan Africa and to report on the implementation of interventions in real-world settings to inform future health investments in HIV care. Interventions were grouped according to their impact on individual, community, and health-systems levels. While a vast majority of studies evaluated a combination of interventions, those studies that incorporated the community as a resource were most successful. In addition, providing education and behavior reminders proved effective and should be accompanied by community and peer efforts for best results. Multi-level interventions, such as combining individual and community-level interventions showed promising results for long term ART adherence.
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Affiliation(s)
- Laura E Pugh
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jacob S Roberts
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nikita Viswasam
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Hahn
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sophia Ryan
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ghilane Turpin
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carrie E Lyons
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of International Health, Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Okal JO, Sarna A, Lango D, Matheka J, Owuor D, Kinywa EA, Kalibala S. Client Experiences in a Mobile-Phone Counseling Intervention for Enhancing Access to Prevention of Mother To-Child Transmission (PMTCT) Services in Kenya. Front Glob Womens Health 2022; 3:785194. [PMID: 35720809 PMCID: PMC9204057 DOI: 10.3389/fgwh.2022.785194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 04/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background The prevention of mother-to-child transmission (PMTCT) is considered one of the most successful HIV prevention strategies in detecting and reducing HIV acquisition in utero or at birth. It is anticipated that with the increasing growth of digital technologies mobile phones can be utilized to enhance PMTCT services by improving provider-client interactions, expanding access to counseling services, and assisting in counteracting social and structural barriers to uptake of PMTCT services. Understanding the subjective experiences of women accessing PMTCT services in different settings has the potential to inform the development and promotion of such methods. This paper explores the perspectives of HIV-positive pregnant women attending maternal and neonatal clinic services in Kisumu, Kenya. Methods Data are reported from in-depth interviews with women, following a longitudinal study investigating the impact of a structured, counselor-delivered, mobile phone counseling intervention to promote retention in care and adherence to ARV prophylaxis/treatment, for HIV-positive pregnant women. Thematic content analysis was conducted. Results Discussions indicated that mobile-phone counseling provided useful health-related information, enhanced agency, and assisted mothers access critical PMTCT services across the cascade of care. Similarly, mobile-phone counseling offered personalized one-to-one contact with trained health providers including facilitating discussion of personal issues that likely affect access to services. Findings also identified barriers to the uptake of services, including a lack of partner support, poor health, poverty, facility-related factors, and provider attitudes. Discussion Overall, findings show that mobile-phone counseling is feasible, acceptable, and can enhance access to PMTCT services by overcoming some of the individual and facility-level barriers. Although mobile-phone counseling has not been routinized in most health facilities, future work is needed to assess whether mobile-phone counseling can be scaled-up to aid in the effective use of HIV and PMTCT services, as well as improving other related outcomes for mother and child dyad.
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Affiliation(s)
- Jerry Okoth Okal
- Population Council, Nairobi, Kenya
- *Correspondence: Jerry Okoth Okal
| | | | | | | | | | | | - Sam Kalibala
- Population Council, Washington, DC, United States
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Duffy M, Madevu‐Matson C, Posner JE, Zwick H, Sharer M, Powell AM. Systematic review: Development of a person-centered care framework within the context of HIV treatment settings in sub-Saharan Africa. Trop Med Int Health 2022; 27:479-493. [PMID: 35316549 PMCID: PMC9324124 DOI: 10.1111/tmi.13746] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVES Person-centred care (PCC) meets the needs of individuals by increasing convenience, providing supportive and culturally appropriate services to diverse populations, and engaging families, communities, and stakeholders in planning and provision of care. While the evidence demonstrates that PCC approaches can lead to clinical improvements across the HIV care continuum, it is not yet well defined in the context of HIV service delivery. METHODS A systematic review was conducted to define PCC practices for HIV treatment services in health facilities in sub-Saharan Africa. Data synthesis led to the development of a PCC framework including domain and sub-domain development. The study team used the Effective Public Health Project Practice tool for quantitative studies to assess the quality of the included studies. RESULTS Thirty-one studies from 12 countries met the inclusion criteria, including 56,586 study participants (females 42%-100% and males 0%-58%), resulting in three major domains and 11 sub-domains. These include staffing (sub-domains of composition, availability, and competency); service delivery standards (sub-domains of client feedback mechanisms; service efficiency and integration; convenience and access; and digital health worker support tools); and direct client support services (sub-domains of psychosocial services, logistics support, client-agency, and digital client support tools). Twenty-five of the person-centred interventions within these domains resulted in improvements in linkage to care, treatment retention, and/or viral suppression. CONCLUSIONS The PCC framework can help to provide a more consistent classification of HIV treatment interventions and will support improved assessment of these interventions to ensure that people receive personalised care.
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Affiliation(s)
- Malia Duffy
- International DivisionJohn Snow, Inc.BostonMassachusettsUSA
- Public HealthSaint Ambrose UniversityDavenportIowaUSA
| | | | | | - Hana Zwick
- International DivisionJohn Snow, Inc.BostonMassachusettsUSA
- Global Health InstituteDuke UniversityDurhamNorth CarolinaUSA
| | - Melissa Sharer
- International DivisionJohn Snow, Inc.BostonMassachusettsUSA
- Public HealthSaint Ambrose UniversityDavenportIowaUSA
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Okusanya B, Kimaru LJ, Mantina N, Gerald LB, Pettygrove S, Taren D, Ehiri J. Interventions to increase early infant diagnosis of HIV infection: A systematic review and meta-analysis. PLoS One 2022; 17:e0258863. [PMID: 35213579 PMCID: PMC8880648 DOI: 10.1371/journal.pone.0258863] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/06/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives
Early infant diagnosis (EID) of HIV infection increases antiretroviral therapy initiation, which reduces pediatric HIV-related morbidity and mortality. This review aims to critically appraise the effects of interventions to increase uptake of early infant diagnosis.
Design
This is a systematic review and meta-analysis of interventions to increase the EID of HIV infection. We searched PubMed, EMBASE, CINAHL, and PsycINFO to identify eligible studies from inception of these databases to June 18, 2020. EID Uptake at 4–8 weeks of age was primary outcome assessed by the review. We conducted meta-analysis, using data from reports of included studies. The measure of the effect of dichotomous data was odds ratios (OR), with a 95% confidence interval. The grading of recommendations assessment, development, and evaluation (GRADE) approach was used to assess quality of evidence.
Settings
The review was not limited by time of publication or setting in which the studies conducted.
Participants
HIV-exposed infants were participants.
Results
Database search and review of reference lists yielded 923 unique titles, out of which 16 studies involving 13,822 HIV exposed infants (HEI) were eligible for inclusion in the review. Included studies were published between 2014 and 2019 from Kenya, Nigeria, Uganda, South Africa, Zambia, and India. Of the 16 included studies, nine (experimental) and seven (observational) studies included had low to moderate risk of bias. The studies evaluated eHealth services (n = 6), service improvement (n = 4), service integration (n = 2), behavioral interventions (n = 3), and male partner involvement (n = 1). Overall, there was no evidence that any of the evaluated interventions, including eHealth, health systems improvements, integration of EID, conditional cash transfer, mother-to-mother support, or partner (male) involvement, was effective in increasing uptake of EID at 4–8 weeks of age. There was also no evidence that any intervention was effective in increasing HIV-infected infants’ identification at 4–8 weeks of age.
Conclusions
There is limited evidence to support the hypothesis that interventions implemented to increase uptake of EID were effective at 4–8 weeks of life. Further research is required to identify effective interventions that increase early infant diagnosis of HIV at 4–8 weeks of age.
Prospero number
(CRD42020191738).
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Affiliation(s)
- Babasola Okusanya
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
- * E-mail:
| | - Linda J. Kimaru
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Namoonga Mantina
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Lynn B. Gerald
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Sydney Pettygrove
- Department of Epidemiology, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Douglas Taren
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - John Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
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Brittain K, Teasdale CA, Ngeno B, Odondi J, Ochanda B, Brown K, Langat A, Modi S, Abrams EJ. Improving retention in antenatal and postnatal care: a systematic review of evidence to inform strategies for adolescents and young women living with HIV. J Int AIDS Soc 2021; 24:e25770. [PMID: 34449121 PMCID: PMC8395389 DOI: 10.1002/jia2.25770] [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: 01/11/2021] [Revised: 05/17/2021] [Accepted: 06/01/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Young pregnant and postpartum women living with HIV (WLHIV) are at high risk of poor outcomes in prevention of mother-to-child transmission services. The aim of this systematic review was to collate evidence on strategies to improve retention in antenatal and/or postpartum care in this population. We also conducted a secondary review of strategies to increase attendance at antenatal care (ANC) and/or facility delivery among pregnant adolescents, regardless of HIV status, to identify approaches that could be adapted for adolescents and young WLHIV. METHODS Selected databases were searched on 1 December 2020, for studies published between January 2006 and November 2020, with screening and data abstraction by two independent reviewers. We identified papers that reported age-disaggregated results for adolescents and young WLHIV aged <25 years at the full-text review stage. For the secondary search, we included studies among female adolescents aged 10 to 19 years. RESULTS AND DISCUSSION Of 37 papers examining approaches to increase retention among pregnant and postpartum WLHIV, only two reported age-disaggregated results: one showed that integrated care during the postpartum period increased retention in HIV care among women aged 18 to 24 years; and another showed that a lay counsellor-led combination intervention did not reduce attrition among women aged 16 to 24 years; one further study noted that age did not modify the effectiveness of a combination intervention. Mobile health technologies, enhanced support, active follow-up and tracing and integrated services were commonly examined as standalone interventions or as part of combination approaches, with mixed evidence for each strategy. Of 10 papers identified in the secondary search, adolescent-focused services and continuity of care with the same provider appeared to be effective in improving attendance at ANC and/or facility delivery, while home visits and group ANC had mixed results. CONCLUSIONS This review highlights the lack of evidence regarding effective strategies to improve retention in antenatal and/or postpartum care among adolescents and young WLHIV specifically, as well as a distinct lack of age-disaggregated results in studies examining retention interventions for pregnant WLHIV of all ages. Identifying and prioritizing approaches to improve retention of adolescents and young WLHIV are critical for improving maternal and child health.
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Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology & BiostatisticsSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
- Centre for Infectious Disease Epidemiology & ResearchSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Chloe A Teasdale
- Mailman School of Public HealthICAP‐Columbia UniversityNew YorkNYUSA
- Department of EpidemiologyMailman School of Public HealthNew YorkNYUSA
- Department of Epidemiology and BiostatisticsCUNY Graduate School of Public Health & Health PolicyNew YorkNYUSA
| | - Bernadette Ngeno
- Division of Global HIV and Tuberculosis (DGHT)US Centers for Disease Control and PreventionAtlantaGAUSA
| | - Judith Odondi
- Mailman School of Public HealthICAP‐Columbia UniversityNew YorkNYUSA
| | - Boniface Ochanda
- Division of Global HIV and Tuberculosis (DGHT)US Centers for Disease Control and PreventionNairobiKenya
| | - Karryn Brown
- Division of Epidemiology & BiostatisticsSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Agnes Langat
- Division of Global HIV and Tuberculosis (DGHT)US Centers for Disease Control and PreventionNairobiKenya
| | - Surbhi Modi
- Division of Global HIV and Tuberculosis (DGHT)US Centers for Disease Control and PreventionAtlantaGAUSA
| | - Elaine J Abrams
- Mailman School of Public HealthICAP‐Columbia UniversityNew YorkNYUSA
- Department of EpidemiologyMailman School of Public HealthNew YorkNYUSA
- Department of PediatricsVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
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15
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King EJ, Yakovleva A, Lisecki SR, Shastina E, Sukhova N, Titina E, Legchilova D, Evdokimova I, Godunova J. Social support and postpartum adherence to HIV treatment: a community-based participatory research study in Russia. Eur J Public Health 2021; 31:63-67. [PMID: 32951027 DOI: 10.1093/eurpub/ckaa133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are over 1 million people living with HIV in Russia, and less than half of them are on antiretroviral treatment (ART). Earlier in the epidemic, Russia was successful in implementing prevention of mother-to-child transmission programmes; however, there is a gap in knowledge about postpartum adherence to ART among women living with HIV (WLHIV). The objective of our research study was to identify which factors are associated with postpartum engagement in HIV care and treatment in Russia. METHODS We conducted a community-based participatory research study in five Russian cities. We surveyed 200 WLHIV who had given birth within the previous 24 months about their use of ART. We used multivariable logistic regression to determine which types of social support are associated with adherence to ART in the postpartum period. RESULTS Less than half (40%) of mothers reported being adherent to ART. Multivariable analysis showed that having a supportive family environment [aOR = 2.64, 95% CI (1.91-5.83)], and active engagement with other HIV-positive mothers [aOR = 2.20, 95% CI (1.04-4.66)] were positively associated with postpartum adherence to ART. WLHIV who had more than one child were less likely to be adherent then WLHIV with just one child [aOR = 0.44, 95% CI (0.22-0.91)]. CONCLUSION The support that new mothers have or do not have can play an important role in WLHIV adherence to ART. The findings from our study provide ideas for improving the likelihood that women will continue to engage in HIV treatment and care after pregnancy.
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Affiliation(s)
- Elizabeth J King
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Anna Yakovleva
- Sociological Institute of Russian Academy of Sciences, St. Petersburg, Russia
| | - Shelbi R Lisecki
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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16
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Pappalardo M, Fanelli U, Chiné V, Neglia C, Gramegna A, Argentiero A, Esposito S. Telemedicine in Pediatric Infectious Diseases. CHILDREN-BASEL 2021; 8:children8040260. [PMID: 33800549 PMCID: PMC8066295 DOI: 10.3390/children8040260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/18/2022]
Abstract
Telemedicine is the remote practice of medicine through the use of information and communication technologies for the prevention, diagnosis, treatment and management of diseases. In this narrative review, we illustrate how telemedicine technologies are increasingly integrated into pediatric infectious disease programs with the aim of facilitating access to specialist care and reducing costs. There is widespread use of telemedicine for the management of acute and chronic infectious diseases, particularly in countries in which the majority of the population lives in rural areas, far from third-level hospital centers located in large urban centers. Obviously, telemedicine is also used in developed countries, and its importance has been further increased recently given the COVID-19 pandemic. It has many advantages for patients, such as saving time, money and working hours, and reducing cancelled appointments and delays, while there are also many advantages for doctors, allowing collaborations with specialists and continuous updating. Among the disadvantages are the limitation in carrying out an objective examination, which is particularly important for children under 2 years of age, and the need for cutting-edge technology and reliable connectivity. Telemedicine increasingly represents the future and the beginning of a new healthcare system that also will redefine medical care for the treatment of infectious diseases, both acute and chronic. However, the majority of the experience has involved adults, and its validation in pediatric care, as well as its application in real-life practices, are urgently needed.
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Affiliation(s)
- Marco Pappalardo
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Umberto Fanelli
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Vincenzo Chiné
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Cosimo Neglia
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Andrea Gramegna
- Respiratory Unit and Cystic Fibrosis Adult Center, Internal Medicine Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Alberto Argentiero
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
- Correspondence: ; Tel.: +39-0521-704790
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17
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Fuente-Soro L, Fernández-Luis S, López-Varela E, Augusto O, Nhampossa T, Nhacolo A, Bernardo E, Burgueño B, Ngeno B, Couto A, Guambe H, Tibana K, Urso M, Naniche D. Community-based progress indicators for prevention of mother-to-child transmission and mortality rates in HIV-exposed children in rural Mozambique. BMC Public Health 2021; 21:520. [PMID: 33731061 PMCID: PMC7970736 DOI: 10.1186/s12889-021-10568-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/03/2021] [Indexed: 12/17/2022] Open
Abstract
Background Eliminating mother-to-child HIV-transmission (EMTCT) implies a case rate target of new pediatric HIV-infections< 50/100,000 live-births and a transmission rate < 5%. We assessed these indicators at community-level in Mozambique, where MTCT is the second highest globally.. Methods A cross-sectional household survey was conducted within the Manhiça Health Demographic Surveillance System in Mozambique (October 2017–April 2018). Live births in the previous 4 years were randomly selected, and mother/child HIV-status was ascertained through documentation or age-appropriate testing. Estimates on prevalence and transmission were adjusted by multiple imputation chained equation (MICE) for participants with missing HIV-status. Retrospective cumulative mortality rate and risk factors were estimate by Fine-Gray model. Results Among 5000 selected mother-child pairs, 3486 consented participate. Community HIV-prevalence estimate in mothers after MICE adjustment was 37.6% (95%CI:35.8–39.4%). Estimates doubled in adolescents aged < 19 years (from 8.0 to 19.1%) and increased 1.5-times in mothers aged < 25 years. Overall adjusted vertical HIV-transmission at the time of the study were 4.4% (95% CI:3.1–5.7%) in HIV-exposed children (HEC). Pediatric case rate-infection was estimated at 1654/100,000 live-births. Testing coverage in HEC was close to 96.0%; however, only 69.1% of them were tested early(< 2 months of age). Cumulative child mortality rate was 41.6/1000 live-births. HIV-positive status and later birth order were significantly associated with death. Neonatal complications, HIV and pneumonia were main pediatric causes of death. Conclusions In Mozambique, SPECTRUM modeling estimated 15% MTCT, higher than our district-level community-based estimates of MTCT among HIV-exposed children. Community-based subnational assessments of progress towards EMTCT are needed to complement clinic-based and modeling estimates. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10568-4.
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Affiliation(s)
- Laura Fuente-Soro
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique. .,Barcelona Institute for Global Health, Barcelona, Spain. .,ISGlobal, Barcelona Institute for Global Health, Rossello, 132, 08036, Barcelona, Spain.
| | - Sheila Fernández-Luis
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Barcelona Institute for Global Health, Barcelona, Spain
| | - Elisa López-Varela
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Barcelona Institute for Global Health, Barcelona, Spain
| | - Orvalho Augusto
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Instituto Nacional de Saúde, Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Edson Bernardo
- Manhiça District Health Services, Maputo, Mozambique.,Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
| | | | - Bernadette Ngeno
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Aleny Couto
- Ministério da Saúde de Moçambique, Maputo, Mozambique
| | - Helga Guambe
- Ministério da Saúde de Moçambique, Maputo, Mozambique
| | | | - Marilena Urso
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Denise Naniche
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Barcelona Institute for Global Health, Barcelona, Spain
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Ngowi K, Pima F, Mmbaga BT, Aarnoutse RE, Reiss P, Nieuwkerk PT, Sprangers M, Sumari-de Boer M. "I Wish to Continue Receiving the Reminder Short Messaging Service": A Mixed Methods Study on the Acceptability of Digital Adherence Tools Among Adults Living with HIV on Antiretroviral Treatment in Tanzania. Patient Prefer Adherence 2021; 15:559-568. [PMID: 33727801 PMCID: PMC7955743 DOI: 10.2147/ppa.s290079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/06/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Digital Adherence Tools (DAT) to promote adherence to antiretroviral treatment (ART) for HIV are being increasingly adopted globally, however their effectiveness and acceptability in limited resource settings has been challenging. In this study, we examine the acceptability of DATs to improve adherence to ART. METHODS This study was part of a three-arm randomized controlled trial (REMIND) which investigated the effect of two different DAT's: SMS text messages (SMS) or real-time medication monitoring (RTMM) on treatment adherence; compared to standard of care. Exit interviews and in-depth interviews were conducted at 48 weeks follow-up, to collect data on their experiences (successes, challenges, and barriers) and behaviours regarding the implementation of the interventions. Translated transcripts, memos and field notes were imported to NVivo software version 12. We used a thematic framework analysis which drew from Sekhon's theoretical framework of acceptability (TFA), which comprises of seven constructs (affective attitude, perceived burden, perceived effectiveness, ethicality, self-efficacy, intervention coherence and opportunity costs). RESULTS Of the 166 participants enrolled, 143 (86%) were interviewed (68 in the SMS arm and 75 in the RTMM arm). Participants were highly satisfied (98%) with the DAT system and the majority of them reported it motivated them to take their medication (99%). The majority of participants reported they were confident in their ability to comply with the intervention and understood how the intervention worked (97%). Very few reported negatively about the devices (carrying the device), with only 6% reporting that they did not feel comfortable and 8% had ethical concerns with the SMS-content A few participants reported challenges with their connectivity/network and that the visits were too time-consuming. A few participants reported that they incurred extra cost for the sake of the study. CONCLUSION Overall, the acceptability of these DATs was high. However, several factors may hamper their acceptability including the content and number of SMS, carrying the devices and the network availability.
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Affiliation(s)
- Kennedy Ngowi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Amsterdam UMC, Location AMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - Francis Pima
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Blandina Theophil Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rob E Aarnoutse
- Radboudumc, Radboud Institute for Health Sciences & Department of Pharmacy, Nijmegen, The Netherlands
| | - Peter Reiss
- Amsterdam UMC, Location AMC, University of Amsterdam, Department of Global Health, And Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Pythia T Nieuwkerk
- Amsterdam UMC, Location AMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - Mirjam Sprangers
- Amsterdam UMC, Location AMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
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Davis A, Allen Z, Nascimento ND, Chapman J, Donco R, Velthausz D. A Qualitative Comparative Analysis of the Drivers of HIV Status Knowledge in Orphans and Vulnerable Children in Mozambique. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:534-548. [PMID: 33008862 PMCID: PMC7541122 DOI: 10.9745/ghsp-d-20-00311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 07/22/2020] [Indexed: 12/04/2022]
Abstract
We identified combinations of modifiable factors that HIV programs supporting orphans, vulnerable children, and their families may be able to act on to increase the proportion of beneficiaries who know their HIV status. In Mozambique, more than a million children are living with HIV or are otherwise vulnerable due to HIV. In response to this crisis, the US President’s Emergency Plan for AIDS Relief funds programs that serve orphans and vulnerable children affected by HIV and their families. These programs retain case workers, known as activistas, who provide and refer beneficiaries to services to increase beneficiaries’ knowledge of their HIV status and to improve retention in care among those living with HIV. To improve program effectiveness, implementing organizations need to understand how different case management attributes affect beneficiary outcomes. We applied fuzzy-set qualitative comparative analysis (QCA), based on 119 interviews, to identify the combinations of case management attributes that led to (1) increased knowledge of HIV status, and (2) high percentages of beneficiaries with known HIV status. We identified 6 pathways for the first outcome and 5 pathways for the second outcome. Each pathway demonstrates an alternative combination of conditions that positively influences the outcome and is equally sufficient in achieving the outcome. To improve knowledge of HIV status, programs in a similar context as this study may select any of the identified pathways based on their existing resources and work on ensuring the presence of each of the conditions in the pathway. Overall, based on the presence of some of the factors in multiple pathways, we conclude that to improve knowledge of HIV status it is important that programs implement a formal process to assign cases considering case complexity and existing caseload to reduce overwork; provide activistas with external support such as weekly care team meetings, weekly supervisor meetings, and/or low supervision ratios; hire experienced activistas; provide all activistas with follow-up trainings so they have the tools to address challenging cases; expand the financial resources offered to activistas; and reimburse activistas for work-related expenses.
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Affiliation(s)
- Allie Davis
- American Institute of Physics State Department Science Fellow, US Department of State, Washington, DC, USA
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