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Kennedy CE, Yeh PT, Verster A, Luhmann N, Nguyen VTT, de Mello MB, Baggaley R, Macdonald V. Do Peer Navigators Improve Initiation and Retention in HIV/VH/STI Treatment Programs for People From Key Populations? A Systematic Review of Effectiveness, Values and Preferences, and Cost. J Acquir Immune Defic Syndr 2024; 95:305-312. [PMID: 38416032 PMCID: PMC10896188 DOI: 10.1097/qai.0000000000003364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 11/15/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Key populations are disproportionately affected by HIV, viral hepatitis (VH), and sexually transmitted infections (STIs) and face barriers to care. Peer navigation programs are widely used, but evidence supporting their use has not been synthesized. SETTING Peer navigation programs for sex workers, men who have sex with men, people who inject drugs, prisoners, and trans and gender diverse people globally. METHODS To inform World Health Organization guidelines, we conducted a systematic review of effectiveness, values and preferences, and cost studies published between January 2010 and May 2021. We searched CINAHL, PsycINFO, PubMed, and EMBASE; screened abstracts; and extracted data in duplicate. The effectiveness review included randomized controlled trials and comparative observational studies evaluating time to diagnosis or linkage to care, treatment initiation, treatment retention/completion, viral load, cure, or mortality. We assessed risk of bias and summarized findings in GRADE evidence profiles. Values and preferences and cost data were summarized descriptively. RESULTS Four studies evaluated the effectiveness of peer navigators for key populations. All were focused on HIV; none were designed for VH or STIs. These studies showed mixed effects on linkage to care, treatment retention/completion, and viral load; no studies measured treatment initiation, cure, or mortality. Two values and preferences studies with community-based organization staff and health workers suggested peer navigators for key populations were acceptable and valued, although continued challenges remained. No cost studies were identified. CONCLUSIONS Although limited, available studies provide moderate certainty evidence for benefits of HIV/VH/STI peer navigation programs for key populations. Further evaluations are needed.
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Affiliation(s)
- Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | - Ping T. Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | - Annette Verster
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Niklas Luhmann
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Van T. T. Nguyen
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Maeve B. de Mello
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel Baggaley
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Virginia Macdonald
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
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Wamuti B, Jamil MS, Siegfried N, Ford N, Baggaley R, Johnson CC, Cherutich P. Understanding effective post-test linkage strategies for HIV prevention and care: a scoping review. J Int AIDS Soc 2024; 27:e26229. [PMID: 38604993 PMCID: PMC11009370 DOI: 10.1002/jia2.26229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 02/20/2024] [Indexed: 04/13/2024] Open
Abstract
INTRODUCTION Following HIV testing services (HTS), the World Health Organization recommends prompt linkage to prevention and treatment. Scale-up of effective linkage strategies is essential to achieving the global 95-95-95 goals for maintaining low HIV incidence by 2030 and reducing HIV-related morbidity and mortality. Whereas linkage to care including same-day antiretroviral therapy (ART) initiation for all people with HIV is now routinely implemented in testing programmes, linkage to HIV prevention interventions including behavioural or biomedical strategies, for HIV-negative individuals remains sub-optimal. This review aims to evaluate effective post-HTS linkage strategies for HIV overall, and highlight gaps specifically in linkage to prevention. METHODS Using the five-step Arksey and O'Malley framework, we conducted a scoping review searching existing published and grey literature. We searched PubMed, Cochrane Library, CINAHL, Web of Science and EMBASE databases for English-language studies published between 1 January 2010 and 30 November 2023. Linkage interventions included as streamlined interventions-involving same-day HIV testing, ART initiation and point-of-care CD4 cell count/viral load, case management-involving linkage coordinators developing personalized HIV care and risk reduction plans, incentives-financial and non-financial, partner services-including contact tracing, virtual-like social media, quality improvement-like use of score cards, and peer-based interventions. Outcomes of interest were linkage to any form of HIV prevention and/or care including ART initiation. RESULTS Of 2358 articles screened, 66 research studies met the inclusion criteria. Only nine linkage to prevention studies were identified (n = 9/66, 14%)-involving pre-exposure prophylaxis, voluntary medical male circumcision, sexually transmitted infection and cervical cancer screening. Linkage to care studies (n = 57/66, 86%) focused on streamlined interventions in the general population and on case management among key populations. DISCUSSION Despite a wide range of HIV prevention interventions available, there was a dearth of literature on HIV prevention programmes and on the use of messaging on treatment as prevention strategy. Linkage to care studies were comparatively numerous except those evaluating virtual interventions, incentives and quality improvement. CONCLUSIONS The findings give insights into linkage strategies but more understanding of how to provide these effectively for maximum prevention impact is needed.
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Affiliation(s)
- Beatrice Wamuti
- Department of Global Health and PopulationHarvard UniversityCambridgeMassachusettsUSA
| | - Muhammad S. Jamil
- Global HIV, Hepatitis and STIs Programs, World Health OrganizationGenevaSwitzerland
- Regional Office to the Eastern Mediterranean, World Health OrganizationCairoEgypt
| | | | - Nathan Ford
- Global HIV, Hepatitis and STIs Programs, World Health OrganizationGenevaSwitzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programs, World Health OrganizationGenevaSwitzerland
| | - Cheryl Case Johnson
- Global HIV, Hepatitis and STIs Programs, World Health OrganizationGenevaSwitzerland
| | - Peter Cherutich
- Global HIV, Hepatitis and STIs Programs, World Health OrganizationGenevaSwitzerland
- Department of Preventive and Promotive HealthMinistry of HealthNairobiKenya
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Sakala M, Johnson C, Chirombo J, Sacks JA, Baggaley R, Divala T. COVID-19 self-testing: Countries accelerating policies ahead of WHO guidelines during pandemics, a global consultation. PLOS Glob Public Health 2024; 4:e0002369. [PMID: 38498477 PMCID: PMC10947679 DOI: 10.1371/journal.pgph.0002369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/30/2024] [Indexed: 03/20/2024]
Abstract
The widespread use of antigen-detection rapid diagnostic tests (Ag-RDTs) has revolutionized SARS-CoV-2 (COVID-19) testing, particularly through the option of self-testing. The full extent of Ag-RDT utilization for self-testing, however, remains largely unexplored. To inform the development of WHO guidance on COVID-19 self-testing, we conducted a global consultation to gather the views and experiences of policy makers, researchers, and implementers worldwide. The consultation was conducted by disseminating a WHO questionnaire through professional networks via email and social media, encouraging onward sharing. We used a cross-sectional design with both closed and open-ended questions related to policy and program information concerning the regulation, availability, target population, indications, implementation, benefits, and challenges of COVID-19 self-testing (C19ST). We defined self-testing as tests performed and interpreted by an untrained individual, often at home. Descriptive summaries, cross-tabulations, and proportions were used to calculate outcomes at the global level and by WHO region and World Bank income classifications. All information was collated and reported according to WHO guideline development standards and practice for global consultations. Between 01 and 11 February 2022, 844 individuals from 139 countries responded to the survey, with 45% reporting affiliation with governments and 47% operating at the national level. 504 respondents from 101 countries reported policies supporting C19ST for a range of use cases, including symptomatic and asymptomatic populations. More respondents from low-and-middle-income countries (LMICs) than high-income countries (HICs) reported a lack of an C19ST policy (61 vs 11 countries) and low population-level reach of C19ST. Respondents with C19ST experience perceived that the tests were mostly acceptable to target populations, provided significant benefits, and highlighted several key challenges to be addressed for increased success. Reported costs varied widely, ranging from specific programmes enabling free access to certain users and others with high costs via the private sector. Based on this consultation, systems for the regulatory review, policy development and implementation of C19ST appeared to be much more common in HIC when compared to LIC in early 2022, though most respondents indicated self-testing was available to some extent (101 out of 139 countries) in their country. Addressing such global inequities is critical for ensuring access to innovative and impactful interventions in the context of a public health emergency of international concern. The challenges and opportunities highlighted by key stakeholders could be valuable to consider as future testing strategies are being set for outbreak-prone diseases.
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Affiliation(s)
- Melody Sakala
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - James Chirombo
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | - Titus Divala
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
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Kadye T, Jamil MS, Johnson C, Baggaley R, Barr-DiChiara M, Cambiano V. Country uptake of WHO recommendations on differentiated HIV testing services approaches: a global policy review. BMJ Open 2024; 14:e058098. [PMID: 38485173 PMCID: PMC10941124 DOI: 10.1136/bmjopen-2021-058098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/03/2023] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES In 2015 and 2016, WHO issued guidelines on HIV testing services (HTS) highlighting recommendations for a strategic mix of differentiated HTS approaches. The policy review examines the uptake of differentiated HTS approaches recommendations in national policies. METHODS Data were extracted from national policies published between January 2015 and June 2019. The WHO-recommended HTS approaches included facility-based testing, community-based testing, HIV self-testing and provider-assisted referral (or assisted partner notification). Other supportive recommendations include pre-test information, post-test counselling, lay provider testing and rapid testing. Descriptive analyses were conducted to examine inclusion of recommendations in national policies. RESULTS Of 194 countries worldwide, 65 published policies were identified; 24 WHO Africa region (AFR) countries (51%, 24/47), 21 WHO European region (EUR) (40%, 21/53), 6 WHO Eastern Mediterranean region (EMR) (29%, 6/21), 5 Pan-American region (AMR) (14%, 5/35), 5 Western Pacific Region (WPR) (19%, 5/27) and 4 WHO South East Asia Region (SEAR) (36%, 4/11). Only five countries included all recommendations. 63 included a minimum of one. 85% (n=55) included facility-based testing for pregnant women, 75% (n=49) facility-based testing for key populations, 74% (n=48) community-based testing for key populations, 69% (n=45) rapid testing, 57% (n=37) post-test counselling, 45% (n=29) lay provider testing, 38% (n=25) HIV self-testing, 29% (n=19) pre-test information and 25% (n=16) provider-assisted referral. The proportion in each region that included at least one recommendation were: 100% AFR (24/47), 100% EMR (6/6), 100% AMR (5/5), 100% WPR (5/5), 100% SEAR (4/4) and 95% EUR (20/21). AFR followed by EMR included the highest number of reccomendations. CONCLUSION There was substantial variability in the uptake of the WHO-differentiated HTS recommendations. Those in EMR included the most WHO-differentiated HTS recommendation followed by AFR. Countries within AMR included the least number of recommendations. Ongoing advocacy and efforts are needed to support the uptake of the WHO-differentiated HTS recommendations in country policies as well as their implementation.
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Affiliation(s)
| | | | - Cheryl Johnson
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | | | - Magdalena Barr-DiChiara
- Department of Global Programmes of HIV, Hepatitis and HIV, World Health Organization, Geneva, Switzerland
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Cox SN, Wu L, Wittenauer R, Clark S, Roberts DA, Nwogu IB, Vitruk O, Kuo AP, Johnson C, Jamil MS, Sands A, Schaefer R, Kisia C, Baggaley R, Stekler JD, Akullian A, Sharma M. Impact of HIV self-testing for oral pre-exposure prophylaxis scale-up on drug resistance and HIV outcomes in western Kenya: a modelling study. Lancet HIV 2024; 11:e167-e175. [PMID: 38301668 PMCID: PMC10896737 DOI: 10.1016/s2352-3018(23)00268-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/08/2023] [Accepted: 10/13/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Community-based oral pre-exposure prophylaxis (PrEP) provision has the potential to expand PrEP coverage. HIV self-testing can facilitate PrEP community-based delivery but might have lower sensitivity than facility-based HIV testing, potentially leading to inappropriate PrEP use among people with HIV and subsequent development of drug resistance. We aimed to evaluate the impact of HIV self-testing use for PrEP scale-up. METHODS We parameterised an agent-based network model, EMOD-HIV, to simulate generic tenofovir disoproxil fumarate and emtricitabine PrEP scale-up in western Kenya using four testing scenarios: provider-administered nucleic acid testing, provider-administered rapid diagnostic tests detecting antibodies, blood-based HIV self-testing, or oral fluid HIV self-testing. Scenarios were compared with a no PrEP counterfactual. Individuals aged 18-49 years with one or more heterosexual partners who screened HIV-negative were eligible for PrEP. We assessed the cost and health impact of rapid PrEP scale-up with high coverage over 20 years, and the budget impact over 5 years, using various HIV testing modalities. FINDINGS PrEP coverage of 29% was projected to avert approximately 54% of HIV infections and 17% of HIV-related deaths among adults aged 18-49 years over 20 years; health impacts were similar across HIV testing modalities used to deliver PrEP. The percentage of HIV infections with PrEP-associated nucleoside reverse transcriptase inhibitor (NRTI) drug resistance was 0·6% (95% uncertainty intervals 0·4-0·9) in the blood HIV self-testing scenario and 0·8% (0·6-1·0) in the oral HIV self-testing scenario, compared with 0·3% (0·2-0·3) in the antibody rapid diagnostic testing scenario and 0·2% (0·1-0·2) in the nucleic acid testing scenario. Accounting for background NRTI resistance, we found similarly low proportions of drug resistance across scenarios. The budget impact of implementing PrEP using HIV self-testing and provider-administered rapid diagnostic tests were similar, while nucleic acid testing was approximately 50% more costly. INTERPRETATION Scaling up PrEP using HIV self-testing has similar health impacts, costs, and low risk of drug resistance as provider-administered rapid diagnostic tests. Policy makers should consider leveraging HIV self-testing to expand PrEP access among those at HIV risk. FUNDING The Bill and Melinda Gates Foundation.
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Affiliation(s)
- Sarah N Cox
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Linxuan Wu
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Rachel Wittenauer
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Samantha Clark
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - D Allen Roberts
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Ifechukwu Benedict Nwogu
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Olga Vitruk
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Alexandra P Kuo
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Cheryl Johnson
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S Jamil
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Anita Sands
- Regulation and Prequalification Department, World Health Organization, Geneva, Switzerland
| | - Robin Schaefer
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Christine Kisia
- World Health Organization - Kenya Country Office, Nairobi, Kenya
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Joanne D Stekler
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Adam Akullian
- Department of Global Health, University of Washington, Seattle, WA, USA; Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, WA, USA.
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Fajardo E, Lastrucci C, Bah N, Mingiedi CM, Ba NS, Mosha F, Lule FJ, Paul MAS, Hughes L, Barr-DiChiara M, Jamil MS, Sands A, Baggaley R, Johnson C. Country adoption of WHO 2019 guidance on HIV testing strategies and algorithms: a policy review across the WHO African region. BMJ Open 2023; 13:e071198. [PMID: 38154882 PMCID: PMC10759095 DOI: 10.1136/bmjopen-2022-071198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 11/08/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVES In 2019, the WHO released guidelines on HIV testing service (HTS). We aim to assess the adoption of six of these recommendations on HIV testing strategies among African countries. DESIGN Policy review. SETTING 47 countries within the WHO African region. PARTICIPANTS National HTS policies from the WHO African region as of December 2021. PRIMARY AND SECONDARY OUTCOME MEASURES Uptake of WHO recommendations across national HTS policies including the standard three-test strategy; discontinuation of a tiebreaker test to rule in HIV infection; discontinuation of western blotting (WB) for HIV diagnosis; retesting prior to antiretroviral treatment (ART) initiation and the use of dual HIV/syphilis rapid diagnostic tests (RDTs) in antenatal care. Country policy adoption was assessed on a continuum, based on varying levels of complete adoption. RESULTS National policies were reviewed for 96% (n=45/47) of countries in the WHO African region, 38% (n=18) were published before 2019 and 60% (n=28) adopted WHO guidance. Among countries that had not fully adopted WHO guidance, not yet adopting a three-test strategy was the most common reason for misalignment (45%, 21/47); of which 31% and 22% were in low-prevalence (<5%) and high-prevalence (≥5%) countries, respectively. Ten policies (21%) recommended the use of WB and 49% (n=23) recommended retesting before ART initiation. Dual HIV/syphilis RDTs were recommended in 45% (n=21/47) of policies. CONCLUSIONS Many countries in the African region have adopted WHO-recommended HIV testing strategies; however, efforts are still needed to fully adopt WHO guidance. Countries should accelerate their efforts to adopt and implement a three-test strategy, retesting prior to ART initiation and the use of dual HIV/syphilis RDTs.
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Affiliation(s)
- Emmanuel Fajardo
- Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Céline Lastrucci
- Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Nayé Bah
- World Health Organization Regional Office for Africa, Bamako, Mali
| | - Casimir Manzengo Mingiedi
- Inter-country support team for Central Africa, World Health Organization Regional Office for Africa, Libreville, Gabon
| | - Ndoungou Salla Ba
- Inter-country support team for Western and Central Africa, World Health Organization Regional Office for Africa, Ouagadougou, Burkina Faso
| | - Fausta Mosha
- Inter-country support team for Eastern and Southern Africa, World Health Organization Regional Office for Africa, Harare, Zimbabwe
| | - Frank John Lule
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Lago Hughes
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Muhammad S Jamil
- Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Anita Sands
- Regulation and Prequalification, World Health Organization, Geneva, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl Johnson
- Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland
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Lyu Y, Choong A, Chow EPF, Seib KL, Marshall HS, Unemo M, de Voux A, Wang B, Miranda AE, Gottlieb SL, Mello MB, Wi T, Baggaley R, Marshall C, Abu-Raddad LJ, Abara WE, Chen XS, Ong JJ. Vaccine value profile for Neisseria gonorrhoeae. Vaccine 2023:S0264-410X(23)00086-5. [PMID: 38123397 DOI: 10.1016/j.vaccine.2023.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/23/2022] [Accepted: 01/23/2023] [Indexed: 12/23/2023]
Abstract
Neisseria gonorrhoeae infection (gonorrhoea) is a global public health challenge, causing substantial sexual and reproductive health consequences, such as infertility, pregnancy complications and increased acquisition or transmission of HIV. There is an urgency to controlling gonorrhoea because of increasing antimicrobial resistance to ceftriaxone, the last remaining treatment option, and the potential for gonorrhoea to become untreatable. No licensed gonococcal vaccine is available. Mounting observational evidence suggests that N. meningitidis serogroup B outer membrane vesicle-based vaccines may induce cross-protection against N. gonorrhoeae (estimated 30%-40% effectiveness using the 4CMenB vaccine). Clinical trials to determine the efficacy of the 4CMenB vaccine against N. gonorrhoeae are underway, as are Phase 1/2 studies of a new gonococcal-specific vaccine candidate. Ultimately, a gonococcal vaccine must be accessible, affordable and equitably dispensed, given that those most affected by gonorrhoea are also those who may be most disadvantaged in our societies, and most cases are in less-resourced settings. This vaccine value profile (VVP) provides a high level, holistic assessment of the current data to inform the potential public health, economic and societal value of pipeline vaccines. This was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships and multi-lateral organizations. All contributors have extensive expertise on various elements of the N. gonorrhoeae VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using published data obtained from peer-reviewed journals or reports.
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Affiliation(s)
- Yiming Lyu
- University of Melbourne, Parkville, Victoria 3010, Australia.
| | - Annabelle Choong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Eric P F Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Victoria 3053, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Victoria 3053, Australia.
| | - Kate L Seib
- Institute for Glycomics, Griffith University, Gold Coast, Queensland 4222, Australia.
| | - Helen S Marshall
- The University of Adelaide, Adelaide, South Australia 5005, Australia; Women's and Children's Health Network, North Adelaide, South Australia, Australia.
| | - Magnus Unemo
- WHO CC for Gonorrhoea and Other STIs, Örebro University, Örebro, Sweden; Institute for Global Health, University College London (UCL), London, UK.
| | - Alex de Voux
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, University of Cape Town, Rondebosch, Cape Town 7700, South Africa.
| | - Bing Wang
- The University of Adelaide, Adelaide, South Australia 5005, Australia; Women's and Children's Health Network, North Adelaide, South Australia, Australia.
| | - Angelica E Miranda
- Department of Social Medicine, Universidade Federal do Espirito Santo, Av. Fernando Ferrari, 514 - Goiabeiras, Vitória - ES 29075-910, Brazil.
| | - Sami L Gottlieb
- Department of Sexual and Reproductive Health and Research, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Maeve B Mello
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Teodora Wi
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Rachel Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Caroline Marshall
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Laith J Abu-Raddad
- Weill Cornell Medicine-Qatar, Qatar Foundation - Education City, Box 24144, Doha, Qatar.
| | - Winston E Abara
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
| | - Xiang-Sheng Chen
- National Center for STD Control of China CDC, 12 Jiangwangmiao Street, Nanjing 210042, China.
| | - Jason J Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
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Schaefer R, Peralta H, Radebe M, Baggaley R. Young People Need More HIV Prevention Options, Delivered in an Acceptable Way. J Adolesc Health 2023; 73:S8-S10. [PMID: 37953013 DOI: 10.1016/j.jadohealth.2023.08.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Robin Schaefer
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland.
| | | | - Mopo Radebe
- World Health Organization, Pretoria, South Africa
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
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9
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Munari SC, Traeger MW, Menon V, Latham NH, Manoharan L, Luhmann N, Baggaley R, MacDonald V, Verster A, Siegfried N, Conway B, Klein M, Bruneau J, Stoové MA, Hellard ME, Doyle JS. Determining reinfection rates by hepatitis C testing interval among key populations: A systematic review and meta-analysis. Liver Int 2023; 43:2625-2644. [PMID: 37817387 DOI: 10.1111/liv.15705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND & AIMS Detecting hepatitis C virus (HCV) reinfection among key populations helps prevent ongoing transmission. This systematic review aims to determine the association between different testing intervals during post-SVR follow-up on the detection of HCV reinfection among highest risk populations. METHODS We searched electronic databases between January 2014 and February 2023 for studies that tested individuals at risk for HCV reinfection at discrete testing intervals and reported HCV reinfection incidence among key populations. Pooled estimates of reinfection incidence were calculated by population and testing frequency using random-effects meta-analysis. RESULTS Forty-one single-armed observational studies (9453 individuals) were included. Thirty-eight studies (8931 individuals) reported HCV reinfection incidence rate and were included in meta-analyses. The overall pooled estimate of HCV reinfection incidence rate was 4.13 per 100 per person-years (py) (95% confidence interval [CI]: 3.45-4.81). The pooled incidence estimate among people who inject drugs (PWID) was 2.84 per 100 py (95% CI: 2.19-3.50), among men who have sex with men (MSM) 7.37 per 100 py (95% CI: 5.09-9.65) and among people in custodial settings 7.23 per 100 py (95% CI: 2.13-16.59). The pooled incidence estimate for studies reporting a testing interval of ≤6 months (4.26 per 100 py; 95% CI: 2.86-5.65) was higher than studies reporting testing intervals >6 months (5.19 per 100 py; 95% CI: 3.92-6.46). CONCLUSIONS HCV reinfection incidence was highest in studies of MSM and did not appear to change with retesting interval. Shorter testing intervals are likely to identify more reinfections, help prevent onward transmission where treatment is available and enable progress towards global HCV elimination, but additional comparative studies are required.
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Affiliation(s)
| | - Michael W Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Vinay Menon
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Ned H Latham
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | | | - Niklas Luhmann
- World Health Organization, Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, Geneva, Switzerland
| | - Rachel Baggaley
- World Health Organization, Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, Geneva, Switzerland
| | - Virginia MacDonald
- World Health Organization, Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, Geneva, Switzerland
| | - Annette Verster
- World Health Organization, Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, Geneva, Switzerland
| | - Nandi Siegfried
- Independent Clinical Epidemiologist, Cape Town, South Africa
| | - Brian Conway
- Vancouver Infectious Diseases Centre & Simon Fraser University Vancouver, Canada
| | - Marina Klein
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Julie Bruneau
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - Mark A Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia
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Henderson M, Schmidt HMA, Chitembo L, Peralta H, Alaama AS, Johnson C, Baggaley R, Schaefer R. The Future of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention: A Global Qualitative Consultation on Provider Perspectives on New Products and Differentiated Service Delivery. AIDS Behav 2023; 27:3755-3766. [PMID: 37351685 PMCID: PMC10589125 DOI: 10.1007/s10461-023-04093-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/24/2023]
Abstract
Differentiated service delivery and new products, such as long-acting injectable cabotegravir (CAB-LA) and the dapivirine vaginal ring (DVR), could increase uptake and use of pre-exposure prophylaxis (PrEP) for HIV prevention. We explored PrEP provider perspectives on differentiated PrEP service delivery and new PrEP products to inform World Health Organization (WHO) guidelines and programme implementation. 150 PrEP providers who participated in a WHO survey were randomly selected and 67 were invited for interviews based on geographic representation, provider cadre, gender, experience with community-based PrEP service delivery, and familiarity with new PrEP products. Semi-structured interviews were conducted virtually. Key themes were inductively extracted relating to differentiated service delivery and benefits and concerns regarding new PrEP products. 30 PrEP providers from 24 countries were interviewed. Across regions, providers were supportive of differentiated service delivery to respond to clients' needs and preferences, maintain services during COVID-19, and ensure access for priority populations that may face access challenges. Providers welcomed prospects of offering CAB-LA to their clients but had concerns about HIV testing, costs, and the need for clinic-based services, including staff who can administer injections. Providers felt the DVR was potentially important for some cisgender women, especially young clients and female sex workers, and raised fewer concerns compared to injectable PrEP. Providers' views are critical for the development of guidelines and implementing programmes that will best serve PrEP users. Understanding areas where provider capacities and biases may create barriers can define opportunities for training and support to ensure that providers can deliver effective programmes.
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Affiliation(s)
| | - Heather-Marie A Schmidt
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland
- UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand
| | | | | | - Ahmed S Alaama
- World Health Organization Office for the Eastern Mediterranean Region, Cairo, Egypt
| | - Cheryl Johnson
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland
| | - Robin Schaefer
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland.
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11
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Seale A, Baggaley R, Vojnov L, Doherty M. Role of viral suppression in HIV treatment and prevention and its potential in addressing harmful laws and discrimination. Sex Health 2023; 20:181-185. [PMID: 37407497 DOI: 10.1071/sh23048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/10/2023] [Indexed: 07/07/2023]
Abstract
The World Health Organization's (WHO) global public health mandate includes a focus on expanding access to HIV testing, antiretroviral therapy (ART) and treatment monitoring to improve the clinical management of HIV, achieve sustained viral suppression, and prevent HIV-related incidence, morbidity, and mortality. This article documents key moments in research and WHO policies that have informed how ART is applied within HIV programs, including as a prevention tool with the potential to support efforts to address HIV-related discrimination. For more than 20years, WHO has promoted the benefits of HIV treatment including as part of the approach to prevent the mother-to-child transmission (vertical transmission) of HIV. WHO guidance has followed, and continues to follow, the evolving evidence. In 2023, WHO continues to clarify that there is zero risk of sexual HIV transmission when a person living with HIV has an undetectable viral load and an almost zero or negligible risk of sexual transmission when a person living with HIV has a viral load of ≤1000copies/mL - helping to evolve the focus of community campaigns and health worker training to include a focus on 'virally suppressed' while also continuing to emphasise the ultimate goal of achieving an undetectable viral load. This evolution does two things: first, it strongly reasserts the evidence around there being no chance of transmission if a person has an undetectable viral load; and second, it provides an extremely strong degree of confidence that, similarly, individuals who are virally suppressed will not pass on the virus sexually. WHO is now encouraging positive and clear messaging to highlight that the consistent use of ART prevents onwards HIV transmission.
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Affiliation(s)
- Andy Seale
- Department of Global HIV, Viral Hepatitis and Sexually Transmitted Infections Programmes, WHO, Geneva, Switzerland
| | - Rachel Baggaley
- Department of Global HIV, Viral Hepatitis and Sexually Transmitted Infections Programmes, WHO, Geneva, Switzerland
| | - Lara Vojnov
- Department of Global HIV, Viral Hepatitis and Sexually Transmitted Infections Programmes, WHO, Geneva, Switzerland
| | - Meg Doherty
- Department of Global HIV, Viral Hepatitis and Sexually Transmitted Infections Programmes, WHO, Geneva, Switzerland
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12
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Lorenzetti L, Dinh N, van der Straten A, Fonner V, Ridgeway K, Rodolph M, Schaefer R, Schmidt HA, Baggaley R. Systematic review of the values and preferences regarding the use of injectable pre-exposure prophylaxis to prevent HIV acquisition. J Int AIDS Soc 2023; 26 Suppl 2:e26107. [PMID: 37439057 PMCID: PMC10805120 DOI: 10.1002/jia2.26107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/04/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) is an important HIV prevention option. Two randomized trials have provided efficacy evidence for long-acting injectable cabotegravir (CAB-LA) as PrEP. In considering CAB-LA as an additional PrEP modality for people at substantial risk of HIV, it is important to understand community response to injectable PrEP. We conducted a systematic review of values, preferences and perceptions of acceptability for injectable PrEP to inform global guidance. METHODS We searched nine databases and conference websites for peer-reviewed and grey literature (January 2010-September 2021). There were no restrictions on location. A two-stage review process assessed references against eligibility criteria. Data from included studies were organized by constructs from the Theoretical Framework of Acceptability. RESULTS We included 62 unique references. Most studies were observational, cross-sectional and qualitative. Over half of the studies were conducted in North America. Men who have sex with men were the most researched group. Most studies (57/62) examined injectable PrEP, including hypothetical injectables (55/57) or placebo products (2/57). Six studies examined CAB-LA specifically. There was overall interest in and often a preference for injectable PrEP, though there was variation within and across groups and regions. Many stakeholders indicated that injectable PrEP could help address adherence challenges associated with daily or on-demand dosing for oral PrEP and may be a better lifestyle fit for individuals seeking privacy, discretion and infrequent dosing. End-users reported concerns, including fear of needles, injection site pain and body location, logistical challenges and waning or incomplete protection. DISCUSSION Despite an overall preference for injectable PrEP, heterogeneity across groups and regions highlights the importance of enabling end-users to choose a PrEP modality that supports effective use. Like other products, preference for injectable PrEP may change over time and end-users may switch between prevention options. There will be a greater understanding of enacted preference as more end-users are offered anti-retroviral (ARV)-containing injectables. Future research should focus on equitable implementation, including real-time decision-making and how trained healthcare providers can support choice. CONCLUSIONS Given overall acceptability, injectable PrEP should be included as part of a menu of prevention options, allowing end-users to select the modality that suits their preferences, needs and lifestyle.
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Affiliation(s)
- Lara Lorenzetti
- Global Health and Population ResearchFHI 360DurhamNorth CarolinaUSA
| | - Nhi Dinh
- Global Health and Population ResearchFHI 360DurhamNorth CarolinaUSA
| | - Ariane van der Straten
- ASTRA ConsultingKensingtonCaliforniaUSA
- Center for AIDS Prevention StudiesDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Virginia Fonner
- Global Health and Population ResearchFHI 360DurhamNorth CarolinaUSA
| | | | - Michelle Rodolph
- World Health OrganizationGlobal HIVHepatitis and STI ProgrammesGenevaSwitzerland
| | - Robin Schaefer
- World Health OrganizationGlobal HIVHepatitis and STI ProgrammesGenevaSwitzerland
| | - Heather‐Marie A. Schmidt
- World Health OrganizationGlobal HIVHepatitis and STI ProgrammesGenevaSwitzerland
- UNAIDS Regional Office for Asia and the PacificBangkokThailand
| | - Rachel Baggaley
- World Health OrganizationGlobal HIVHepatitis and STI ProgrammesGenevaSwitzerland
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Warren M, Nyagah W, Verde Hashim C, Rodolph M, Schaefer R, Schmidt HA, Baggaley R. Shaping and coordinating the implementation science agenda for injectable cabotegravir for PrEP: the role of the Biomedical Prevention Implementation Collaborative (BioPIC). J Int AIDS Soc 2023; 26 Suppl 2:e26094. [PMID: 37439050 PMCID: PMC10805117 DOI: 10.1002/jia2.26094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/27/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Data from two randomized controlled trials (RCTs) showed that injectable cabotegravir (CAB) for pre-exposure prophylaxis (PrEP) was efficacious in reducing HIV acquisition. The US Food and Drug Administration approved CAB for PrEP in December 2021; Australia in August 2022; Zimbabwe in October 2022; South Africa in November 2022; Malawi in March 2023; and regulatory approvals are being sought in additional countries. The World Health Organization (WHO) recommended CAB be offered to people at substantial risk of HIV in July 2022. However, implementation experience beyond RCTs is limited. As countries consider CAB implementation, questions remain regarding delivery and involvement of populations excluded from the trials. A coordinated approach is needed to ensure these are addressed and CAB can be introduced in low- and middle-income countries in timely, acceptable and effective ways. DISCUSSION Beginning in 2018, the Biomedical Prevention Implementation Collaborative (BioPIC) convened over 100 global health experts to develop a comprehensive introduction strategy for CAB. Using this roadmap, country landscaping for CAB introduction and lessons from oral PrEP implementation, AVAC and WHO co-convened 50 researchers, donors, implementers and civil society in September 2021 to: (1) identify questions and evidence gaps related to CAB across contexts and partners; (2) define the implementation science agenda; and (3) agree on mechanism(s) for future coordination. As a result, CAB-related questions were identified, including: defining optimal and feasible HIV testing strategies that expand access; delivery models; integration with a range of services, including family planning and antenatal care; and embedding CAB in demand generation for HIV prevention choices. Through convenings and mapping of implementation research, BioPIC identified gaps in populations, geographies and delivery approaches. CONCLUSIONS The introduction strategy refined by BioPIC lays the groundwork for future HIV prevention products. Ongoing policy and implementation dialogue is critical to accelerate the design of CAB implementation studies that adequately address priority knowledge gaps. Additional long-acting HIV prevention products may be available over the next 5 years, increasing choice, but potentially making delivery and stakeholder engagement more complex. Ongoing coordination with WHO will accelerate the adoption of evidence-based policies and wide-scale implementation, and lessons from BioPIC can inform introduction processes for long-acting HIV prevention products.
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Affiliation(s)
| | | | | | - Michelle Rodolph
- Global HIV, Hepatitis, and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Robin Schaefer
- Global HIV, Hepatitis, and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Heather‐Marie A Schmidt
- Global HIV, Hepatitis, and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
- UNAIDS Regional Office for Asia and the PacificBangkokThailand
| | - Rachel Baggaley
- Global HIV, Hepatitis, and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
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14
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Gotsche CI, Steyn PS, Narasimhan M, Rodolph M, Baggaley R, Kiarie JN. Integrating pre-exposure prophylaxis of HIV infection into family planning services: a scoping review. BMJ Sex Reprod Health 2023; 49:210-218. [PMID: 36581443 PMCID: PMC10359582 DOI: 10.1136/bmjsrh-2021-201356] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/12/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The aim of this review was to map evidence of integrating pre-exposure prophylaxis (PrEP) for HIV prevention into family planning services. A comprehensive package, using a combination of PrEP and contraceptive delivery, could reduce the number of new HIV infections and/or unintended pregnancies for at-risk women and adolescent girls. METHODS A scoping literature search was conducted between August 2020 and October 2020. After developing the review question, electronic databases (MEDLINE, Embase, Cochrane Library, Global Health, Web of Science) were systematically reviewed. All types of articles published from 2012 to August 2020 in English were included. The intended outcome was to identify barriers and enablers of integrating services at the client-level and provider-level. RESULTS 38 articles met inclusion criteria, with 16 from low-and middle-income countries and 22 from high-income countries. Barriers at the client-level included a lack of risk perception associated with low uptake and continuation of PrEP and pill burden; and at the provider-level, barriers included a lack of studies on cost-effectiveness of integrating services and provider training and knowledge. Facilitators included the initiation of PrEP and contraception at the same time and by the same provider or HIV self-testing. CONCLUSION Mapping and synthesising current evidence, this review identified key barriers and facilitators for the integration of PrEP into family planning services for women and adolescent girls. In order to address these factors, more implementation research in a variety of settings is needed to meet women's sexual and reproductive health needs globally.
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Affiliation(s)
- Caroline I Gotsche
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Petrus S Steyn
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
| | - Michelle Rodolph
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneve, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneve, Switzerland
| | - James N Kiarie
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
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15
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Kennedy CE, Yeh PT, Verster A, Luhmann N, Konath NM, de Mello MB, Baggaley R, Macdonald V. Counselling behavioural interventions for HIV, STI and viral hepatitis among key populations: a systematic review of effectiveness, values and preferences, and cost studies. J Int AIDS Soc 2023; 26:e26085. [PMID: 37221978 PMCID: PMC10206411 DOI: 10.1002/jia2.26085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Key populations (sex workers, men who have sex with men, people who inject drugs, people in prisons and other closed settings, and trans and gender diverse individuals) are disproportionately affected by HIV, sexually transmitted infections (STIs) and viral hepatitis (VH). Counselling behavioural interventions are widely used, but their impact on HIV/STI/VH acquisition is unclear. METHODS To inform World Health Organization guidelines, we conducted a systematic review and meta-analysis of effectiveness, values and preferences, and cost studies about counselling behavioural interventions with key populations. We searched CINAHL, PsycINFO, PubMed and EMBASE for studies published between January 2010 and December 2022; screened abstracts; and extracted data in duplicate. The effectiveness review included randomized controlled trials (RCTs) with HIV/STI/VH incidence outcomes; secondary review outcomes of unprotected sex, needle/syringe sharing and mortality were captured if studies also included primary review outcomes. We assessed the risk of bias using the Cochrane Collaboration tool, generated pooled risk ratios through random effects meta-analysis and summarized findings in GRADE evidence profiles. Values and preferences and cost data were summarized descriptively. RESULTS We identified nine effectiveness, two values and preferences, and two cost articles. Meta-analysis of six RCTs showed no statistically significant effect of counselling behavioural interventions on HIV incidence (1280 participants; combined risk ratio [RR]: 0.70, 95% confidence interval [CI]: 0.41-1.20) or STI incidence (3783 participants; RR: 0.99; 95% CI: 0.74-1.31). One RCT with 139 participants showed possible effects on hepatitis C virus incidence. There was no effect on secondary review outcomes of unprotected (condomless) sex (seven RCTs; 1811 participants; RR: 0.82, 95% CI: 0.66-1.02) and needle/syringe sharing (two RCTs; 564 participants; RR 0.72; 95% CI: 0.32-1.63). There was moderate certainty in the lack of effect across outcomes. Two values and preferences studies found that participants liked specific counselling behavioural interventions. Two cost studies found reasonable intervention costs. DISCUSSION Evidence was limited and mostly on HIV, but showed no effect of counselling behavioural interventions on HIV/VH/STI incidence among key populations. CONCLUSIONS While there may be other benefits, the choice to provide counselling behavioural interventions for key populations should be made with an understanding of the potential limitations on incidence outcomes.
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Affiliation(s)
- Caitlin E. Kennedy
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Ping Teresa Yeh
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Annette Verster
- Department of Global HIVHepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Niklas Luhmann
- Department of Global HIVHepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | | | - Maeve Brito de Mello
- Department of Global HIVHepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Rachel Baggaley
- Department of Global HIVHepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Virginia Macdonald
- Department of Global HIVHepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
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16
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Fonner VA, Ridgeway K, van der Straten A, Lorenzetti L, Dinh N, Rodolph M, Schaefer R, Schmidt HMA, Nguyen VTT, Radebe M, Peralta H, Baggaley R. Safety and efficacy of long-acting injectable cabotegravir as preexposure prophylaxis to prevent HIV acquisition. AIDS 2023; 37:957-966. [PMID: 36723489 PMCID: PMC10090368 DOI: 10.1097/qad.0000000000003494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVE HIV remains a significant burden, despite expanding HIV prevention tools. Long-acting injectable cabotegravir (CAB-LA) is a new preexposure prophylaxis (PrEP) product. We reviewed existing evidence to determine the efficacy and safety of CAB-LA as PrEP to inform global guidelines. DESIGN Systematic review and meta-analysis. METHODS We systematically reviewed electronic databases and conference abstracts for citations on CAB-LA from January 2010 to September 2021. Outcomes included HIV infection, adverse events, drug resistance, pregnancy-related adverse events, and sexual behavior. We calculated pooled effect estimates using random-effects meta-analysis and summarized other results narratively. RESULTS We identified 12 articles/abstracts representing four multisite randomized controlled trials. Study populations included cisgender men, cisgender women, and transgender women. The pooled relative risk of HIV acquisition comparing CAB-LA to oral PrEP within efficacy studies was 0.21 (95% confidence interval: 0.07-0.61), resulting in a 79% reduction in HIV risk. Rates of adverse events were similar across study groups. Of 19 HIV infections among those randomized to CAB-LA with results available, seven had integrase strand transfer inhibitor (INSTI) resistance. Data on pregnancy-related adverse events were sparse. No studies reported on sexual behavior. CONCLUSIONS CAB-LA is highly efficacious for HIV prevention with few safety concerns. CAB-LA may lead to an increased risk of INSTI resistance among those who have acute HIV infection at initiation or become infected while taking CAB-LA. However, results are limited to controlled studies; more research is needed on real-world implementation. Additional data are needed on the safety of CAB-LA during pregnancy (for mothers and infants) and among populations not included in the trials.
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Affiliation(s)
| | - Kathleen Ridgeway
- FHI 360 Global Health and Population Research, Durham, North Carolina
| | - Ariane van der Straten
- ASTRA Consulting and Center for AIDS prevention Studies (CAPS), Department of Medicine, San Francisco, California, USA
| | - Lara Lorenzetti
- FHI 360 Global Health and Population Research, Durham, North Carolina
| | - Nhi Dinh
- FHI 360 Global Health and Population Research, Durham, North Carolina
| | - Michelle Rodolph
- World Health Organization, Global HIV, Hepatitis and STIs Programmes, Geneva, Switzerland
| | - Robin Schaefer
- World Health Organization, Global HIV, Hepatitis and STIs Programmes, Geneva, Switzerland
| | - Heather-Marie A. Schmidt
- World Health Organization, Global HIV, Hepatitis and STIs Programmes, Geneva, Switzerland
- UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand
| | | | - Mopo Radebe
- World Health Organization, Country Office, Pretoria, South Africa
| | | | - Rachel Baggaley
- World Health Organization, Global HIV, Hepatitis and STIs Programmes, Geneva, Switzerland
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Malhotra S, Baggaley R, Lynch S, Pérez‐Casas C, Raphael Y, Stranix‐Chibanda L. Antibodies for HIV prevention: the path forward. J Int AIDS Soc 2023; 26:e26097. [PMID: 37195217 PMCID: PMC10191127 DOI: 10.1002/jia2.26097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/18/2023] Open
Affiliation(s)
| | | | | | | | - Yvette Raphael
- Advocacy for the Prevention of HIV in AfricaJohannesburgSouth Africa
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Saleem K, Ting EL, Loh AJW, Baggaley R, Mello MB, Jamil MS, Barr‐Dichiara M, Johnson C, Gottlieb SL, Fairley CK, Chow EPF, Ong JJ. Missed opportunities for HIV testing among those who accessed sexually transmitted infection (STI) services, tested for STIs and diagnosed with STIs: a systematic review and meta-analysis. J Int AIDS Soc 2023; 26:e26049. [PMID: 37186451 PMCID: PMC10131090 DOI: 10.1002/jia2.26049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/16/2022] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Of 37.7 million people living with HIV in 2020, 6.1 million still do not know their HIV status. We synthesize evidence on concurrent HIV testing among people who tested for other sexually transmitted infections (STIs). METHODS We conducted a systematic review using five databases, HIV conferences and clinical trial registries. We included publications between 2010 and May 2021 that reported primary data on concurrent HIV/STI testing. We conducted a random-effects meta-analysis and meta-regression of the pooled proportion for concurrent HIV/STI testing. RESULTS We identified 96 eligible studies. Among those, 49 studies had relevant data for a meta-analysis. The remaining studies provided data on the acceptability, feasibility, barriers, facilitators, economic evaluation and social harms of concurrent HIV/STI testing. The pooled proportion of people tested for HIV among those attending an STI service (n = 18 studies) was 71.0% (95% confidence intervals: 61.0-80.1, I2 = 99.9%), people tested for HIV among those who were tested for STIs (n = 15) was 61.3% (53.9-68.4, I2 = 99.9%), people tested for HIV among those who were diagnosed with an STI (n = 13) was 35.3% (27.1-43.9, I2 = 99.9%) and people tested for HIV among those presenting with STI symptoms (n = 3) was 27.1% (20.5-34.3, I2 = 92.0%). The meta-regression analysis found that heterogeneity was driven mainly by identity as a sexual and gender minority, the latest year of study, country-income level and region of the world. DISCUSSION This review found poor concurrent HIV/STI testing among those already diagnosed with an STI (35.3%) or who had symptoms with STIs (27.1%). Additionally, concurrent HIV/STI testing among those tested for STIs varied significantly according to the testing location, country income level and region of the world. A few potential reasons for these observations include differences in national STI-related policies, lack of standard operation procedures, clinician-level factors, poor awareness and adherence to HIV indicator condition-guided HIV testing and stigma associated with HIV compared to other curable STIs. CONCLUSIONS Not testing for HIV among people using STI services presents a significant missed opportunity, particularly among those diagnosed with an STI. Stronger integration of HIV and STI services is urgently needed to improve prevention, early diagnosis and linkage to care services.
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Affiliation(s)
- Kanwal Saleem
- Melbourne Sexual Health CentreAlfred HealthMelbourneVictoriaAustralia
| | - Ee Lynn Ting
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Andre J. W. Loh
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Rachel Baggaley
- Global HIV, Hepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Maeve B. Mello
- Global HIV, Hepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Muhammad S. Jamil
- Global HIV, Hepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | | | - Cheryl Johnson
- Global HIV, Hepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Sami L. Gottlieb
- Global HIV, Hepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Christopher K. Fairley
- Melbourne Sexual Health CentreAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Eric P. F. Chow
- Melbourne Sexual Health CentreAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Jason J. Ong
- Melbourne Sexual Health CentreAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
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19
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Manoharan L, Latham NH, Munari SC, Traeger MW, Menon V, Luhmann N, Baggaley R, Macdonald V, Verster A, Siegfried N, Matthews GV, Stoové M, Hellard ME, Doyle JS. Immediate treatment for recent hepatitis C infection in people with high-risk behaviors: a systematic review and meta-analysis. Hepatol Commun 2023; 7:02009842-202304010-00002. [PMID: 36930865 PMCID: PMC10027039 DOI: 10.1097/hc9.0000000000000082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/27/2022] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND AND AIMS Direct-acting antivirals (DAAs) are almost exclusively approved for the treatment of chronic HCV. This poses a significant barrier to the treatment of recently acquired HCV because of the limited access to DAAs. This review seeks to address this issue by synthesizing evidence of the benefits and harms of immediate treatment after the detection of recently acquired HCV in people at higher risk of infection. APPROACH AND RESULTS A systematic review and meta-analysis were conducted reporting on populations with recently acquired HCV at higher risk of infection. Studies were included if they assessed standard duration DAA treatment regimens and reported on the benefits and harms of immediate treatment (within one year of diagnosis). Outcomes included sustained virological response at 12 weeks post-treatment (SVR12), incidence, treatment initiation and adherence, overtreatment, engagement in care, and adverse events. Eight cohort studies, 3 open-label trials, and 1 case series study were included, reporting on 2085 participants with recently acquired HCV infection. No studies included a comparison group. Eight studies assessed DAA treatment in either men who have sex with men or men who have sex with men with HIV, 2 studies assessed treatment in people who inject drugs, and 2 among people living with HIV. Immediate treatment of HCV was associated with a pooled SVR12 of 95.9% (95% CI, 92.6%-99.3%). Three studies reported on hepatitis C incidence, where most participants were treated in the chronic phase of infection. A treatment completion rate of 100% was reported in 2 studies, and only 1 serious adverse event was described. CONCLUSIONS High rates of cure were achieved with the treatment of recently acquired hepatitis C in people at higher risk of infection. Serious adverse events were rare, highlighting individual benefits consistent with the treatment of chronic hepatitis C. The impact of immediate treatment on HCV incidence requires further evaluation.
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Affiliation(s)
| | | | | | - Michael W Traeger
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Niklas Luhmann
- World Health Organization, Global HIV, Geneva, Switzerland
| | | | | | | | | | - Gail V Matthews
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mark Stoové
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret E Hellard
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, the Alfred Hospital and Monash University, Melbourne, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Joseph S Doyle
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, the Alfred Hospital and Monash University, Melbourne, Australia
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20
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Kim CM, Zhao V, Brito De Mello M, Baggaley R, Johnson CC, Spielman E, Fairley CK, Zhang L, de Vries H, Klausner J, Zhao R, Ong JJ. Determining the screening frequency for sexually transmitted infections for people who use HIV pre-exposure prophylaxis: a systematic review and meta-analysis. Int J Infect Dis 2023; 129:181-187. [PMID: 36690140 DOI: 10.1016/j.ijid.2023.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Although the World Health Organization recommends 'frequent' screening of sexually transmitted infections (STI) for people who use pre-exposure prophylaxis for HIV, there is no evidence for optimal frequency. METHODS We searched five databases and used random-effects meta-analysis to calculate pooled estimates of STI test positivity. We narratively synthesized data on secondary outcomes, including adherence to recommended STI screening frequency and changes in STI epidemiology. RESULTS Of 7477 studies, we included 38 for the meta-analysis and 11 for secondary outcomes. With 2-3 monthly STI screening, the pooled positivity was 0.20 (95% confidence interval [CI]: 0.15-0.25) for chlamydia, 0.17 (95% CI: 0.12-0.22) for gonorrhea, and 0.07 (95% CI: 0.05-0.08) for syphilis. For chlamydia and gonorrhea, the positivity was approximately 50% and 75% lower, respectively, in studies that screened 4-6 monthly vs 2-3 monthly. There was no significant difference in the positivity for syphilis in studies that screened 4-6 monthly compared to 2-3 monthly. Adherence of clients to recommended screening frequency varied significantly (39-94%) depending on population and country. Modeling studies suggest more frequent STI screening could reduce incidence. CONCLUSION Although more frequent STI screening could reduce delayed diagnoses and incidence, there remain significant knowledge gaps regarding the optimal STI screening frequency.
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Affiliation(s)
- Cham-Mill Kim
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Victor Zhao
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Maeve Brito De Mello
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl C Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Erica Spielman
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Lei Zhang
- Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Henry de Vries
- Amsterdam UMC location University of Amsterdam, Department of Dermatology, Amsterdam, The Netherlands; Amsterdam Institute for Infection and Immunology, Infectious Diseases, Amsterdam, The Netherlands; Center for Sexual Health, Department of Infectious Diseases, Public Health Service Amsterdam, The Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Jeffrey Klausner
- Keck School of Medicine of University of Southern California, Los Angeles, United States
| | - Rui Zhao
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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21
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Wagner AD, Njuguna IN, Neary J, Lawley KA, Louden DKN, Tiwari R, Jiang W, Kalu N, Burke RM, Mangale D, Obermeyer C, Escudero JN, Bulterys MA, Waters C, Mollo B, Han H, Barr-DiChiara M, Baggaley R, Jamil MS, Shah P, Wong VJ, Drake AL, Johnson CC. Demand creation for HIV testing services: A systematic review and meta-analysis. PLoS Med 2023; 20:e1004169. [PMID: 36943831 PMCID: PMC10030044 DOI: 10.1371/journal.pmed.1004169] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/05/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND HIV testing services (HTS) are the first steps in reaching the UNAIDS 95-95-95 goals to achieve and maintain low HIV incidence. Evaluating the effectiveness of different demand creation interventions to increase uptake of efficient and effective HTS is useful to prioritize limited programmatic resources. This review was undertaken to inform World Health Organization (WHO) 2019 HIV testing guidelines and assessed the research question, "Which demand creation strategies are effective for enhancing uptake of HTS?" focused on populations globally. METHODS AND FINDINGS The following electronic databases were searched through September 28, 2021: PubMed, PsycInfo, Cochrane CENTRAL, CINAHL Complete, Web of Science Core Collection, EMBASE, and Global Health Database; we searched IAS and AIDS conferences. We systematically searched for randomized controlled trials (RCTs) that compared any demand creation intervention (incentives, mobilization, counseling, tailoring, and digital interventions) to either a control or other demand creation intervention and reported HTS uptake. We pooled trials to evaluate categories of demand creation interventions using random-effects models for meta-analysis and assessed study quality with Cochrane's risk of bias 1 tool. This study was funded by the WHO and registered in Prospero with ID CRD42022296947. We screened 10,583 records and 507 conference abstracts, reviewed 952 full texts, and included 124 RCTs for data extraction. The majority of studies were from the African (N = 53) and Americas (N = 54) regions. We found that mobilization (relative risk [RR]: 2.01, 95% confidence interval [CI]: [1.30, 3.09], p < 0.05; risk difference [RD]: 0.29, 95% CI [0.16, 0.43], p < 0.05, N = 4 RCTs), couple-oriented counseling (RR: 1.98, 95% CI [1.02, 3.86], p < 0.05; RD: 0.12, 95% CI [0.03, 0.21], p < 0.05, N = 4 RCTs), peer-led interventions (RR: 1.57, 95% CI [1.15, 2.15], p < 0.05; RD: 0.18, 95% CI [0.06, 0.31], p < 0.05, N = 10 RCTs), motivation-oriented counseling (RR: 1.53, 95% CI [1.07, 2.20], p < 0.05; RD: 0.17, 95% CI [0.00, 0.34], p < 0.05, N = 4 RCTs), short message service (SMS) (RR: 1.53, 95% CI [1.09, 2.16], p < 0.05; RD: 0.11, 95% CI [0.03, 0.19], p < 0.05, N = 5 RCTs), and conditional fixed value incentives (RR: 1.52, 95% CI [1.21, 1.91], p < 0.05; RD: 0.15, 95% CI [0.07, 0.22], p < 0.05, N = 11 RCTs) all significantly and importantly (≥50% relative increase) increased HTS uptake and had medium risk of bias. Lottery-based incentives and audio-based interventions less importantly (25% to 49% increase) but not significantly increased HTS uptake (medium risk of bias). Personal invitation letters and personalized message content significantly but not importantly (<25% increase) increased HTS uptake (medium risk of bias). Reduced duration counseling had comparable performance to standard duration counseling (low risk of bias) and video-based interventions were comparable or better than in-person counseling (medium risk of bias). Heterogeneity of effect among pooled studies was high. This study was limited in that we restricted to randomized trials, which may be systematically less readily available for key populations; additionally, we compare only pooled estimates for interventions with multiple studies rather than single study estimates, and there was evidence of publication bias for several interventions. CONCLUSIONS Mobilization, couple- and motivation-oriented counseling, peer-led interventions, conditional fixed value incentives, and SMS are high-impact demand creation interventions and should be prioritized for programmatic consideration. Reduced duration counseling and video-based interventions are an efficient and effective alternative to address staffing shortages. Investment in demand creation activities should prioritize those with undiagnosed HIV or ongoing HIV exposure. Selection of demand creation interventions must consider risks and benefits, context-specific factors, feasibility and sustainability, country ownership, and universal health coverage across disease areas.
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Affiliation(s)
- Anjuli D. Wagner
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Irene N. Njuguna
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Jillian Neary
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Kendall A. Lawley
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Diana K. N. Louden
- University Libraries, University of Washington, Seattle, Washington, United States of America
| | - Ruchi Tiwari
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Wenwen Jiang
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Ngozi Kalu
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rachael M. Burke
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Dorothy Mangale
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Chris Obermeyer
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Jaclyn N. Escudero
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Michelle A. Bulterys
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Chloe Waters
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Bastien Mollo
- Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Hannah Han
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | | | - Rachel Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S. Jamil
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Purvi Shah
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
- UNAIDS, Asia Pacific, Regional Support Team, Bangkok, Thailand
| | - Vincent J. Wong
- USAID, Division of HIV Prevention, Care and Treatment, Office of HIV/AIDS, Washington DC, United States of America
| | - Alison L. Drake
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Cheryl C. Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
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22
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Fonner VA, Luhmann N, Siegfried N, Johnson C, Baggaley R, Ford N, Jamil MS. Use of indirect evidence from HIV self-testing to inform the WHO hepatitis C self-testing recommendation. BMJ Glob Health 2023; 8:bmjgh-2022-011633. [PMID: 36787960 PMCID: PMC9930562 DOI: 10.1136/bmjgh-2022-011633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/07/2023] [Indexed: 02/16/2023] Open
Affiliation(s)
- Virginia A Fonner
- Global Health and Population Research, FHI 360, Durham, North Carolina, USA
| | - Niklas Luhmann
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Nandi Siegfried
- Independent Clinical Epidemiologist, Cape Town, South Africa
| | - Cheryl Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Nathan Ford
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S Jamil
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
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23
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Shaw G, Schaefer R, Schmidt HMA, Madden A, Chang J, Mozalevskis A, Msimanga-Radebe B, Mangadan Konath N, Verster A, Baggaley R, Rodolph M, Macdonald V. Pre-exposure prophylaxis (PrEP) for HIV prevention among people who inject drugs: a global mapping of service delivery. Harm Reduct J 2023; 20:16. [PMID: 36782321 PMCID: PMC9924874 DOI: 10.1186/s12954-023-00729-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/03/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends oral pre-exposure prophylaxis (PrEP) for all people at substantial risk of HIV as part of combination prevention. The extent to which this recommendation has been implemented globally for people who inject drugs is unclear. This study mapped global service delivery of PrEP for people who inject drugs. METHODS Between October and December 2021, a desk review was conducted to obtain information on PrEP services for people who inject drugs from drug user-led networks and HIV, harm reduction, and human rights stakeholders. Websites of organizations involved in HIV prevention or services for people who inject drugs were searched. Models of service delivery were described in terms of service location, provider, and package. RESULTS PrEP services were identified in 27 countries (15 high-income). PrEP delivery models varied within and across countries. In most services, PrEP services were implemented in healthcare clinics without direct links to other harm reduction services. In three countries, PrEP services were also provided at methadone clinics. In 14 countries, PrEP services were provided through community-based models (outside of clinic settings) that commonly involved peer-led outreach activities and integration with harm reduction services. CONCLUSIONS This study indicates limited PrEP availability for people who inject drugs. There is potential to expand PrEP services for people who inject drugs within harm reduction programs, notably through community-based and peer-led services. PrEP should never be offered instead of evidence-based harm reduction programs for people who inject drugs; however, it could be offered as an additional HIV prevention choice as part of a comprehensive harm reduction program.
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Affiliation(s)
| | - Robin Schaefer
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland.
| | - Heather-Marie A Schmidt
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland ,UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand
| | - Annie Madden
- International Network of People who Use Drugs, London, UK
| | - Judy Chang
- International Network of People who Use Drugs, London, UK
| | - Antons Mozalevskis
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | | | | | - Annette Verster
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Rachel Baggaley
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Michelle Rodolph
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Virginia Macdonald
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
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24
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Eysenbach G, Kennedy CE, Minamitani A, Baggaley R, Shah P, Verster A, Luhmann N, de Mello MB, Macdonald V. Web-Based Service Provision of HIV, Viral Hepatitis, and Sexually Transmitted Infection Prevention, Testing, Linkage, and Treatment for Key Populations: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e40150. [PMID: 36548036 PMCID: PMC9816952 DOI: 10.2196/40150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/30/2022] [Accepted: 10/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Despite the growth of web-based interventions for HIV, viral hepatitis (VH), and sexually transmitted infections (STIs) for key populations, the evidence for the effectiveness of these interventions has not been reported. OBJECTIVE This study aimed to inform the World Health Organization guidelines for HIV, VH, and STI prevention, diagnosis, and treatment services for key populations by systematically reviewing the effectiveness, values and preferences, and costs of web-based outreach, web-based case management, and targeted web-based health information for key populations (men who have sex with men, sex workers, people who inject drugs, trans and gender-diverse people, and people in prisons and other closed settings). METHODS We searched CINAHL, PsycINFO, PubMed, and Embase in May 2021 for peer-reviewed studies; screened abstracts; and extracted data in duplicate. The effectiveness review included randomized controlled trials (RCTs) and observational studies. We assessed the risk of bias using the Cochrane Collaboration tool for RCTs and the Evidence Project and Risk of Bias in Non-randomized Studies of Interventions tools for non-RCTs. Values and preferences and cost data were summarized descriptively. RESULTS Of 2711 records identified, we included 13 (0.48%) articles in the effectiveness review (3/13, 23% for web-based outreach; 7/13, 54% for web-based case management; and 3/13, 23% for targeted web-based health information), 15 (0.55%) articles in the values and preferences review, and 1 (0.04%) article in the costs review. Nearly all studies were conducted among men who have sex with men in the United States. These articles provided evidence that web-based approaches are as effective as face-to-face services in terms of reaching new people, use of HIV, VH, and STI prevention services, and linkage to and retention in HIV care. A meta-analysis of 2 RCTs among men who have sex with men in China found increased HIV testing after web-based outreach (relative risk 1.39, 95% CI 1.21-1.60). Among men who have sex with men in the United States, such interventions were considered feasible and acceptable. One cost study among Canadian men who have sex with men found that syphilis testing campaign advertisements had the lowest cost-per-click ratio on hookup platforms compared with more traditional social media platforms. CONCLUSIONS Web-based services for HIV, VH, and STIs may be a feasible and acceptable approach to expanding services to key populations with similar outcomes as standard of care, but more research is needed in low-resource settings, among key populations other than men who have sex with men, and for infections other than HIV (ie, VH and STIs).
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Affiliation(s)
| | - Caitlin Elizabeth Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ayako Minamitani
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Rachel Baggaley
- Testing, Prevention and Population Unit, Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Purvi Shah
- Testing, Prevention and Population Unit, Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland.,Regional Support Team Asia Pacific, Joint United Nations Programme on HIV/AIDS, New Delhi, India
| | - Annette Verster
- Testing, Prevention and Population Unit, Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Niklas Luhmann
- Testing, Prevention and Population Unit, Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Maeve Brito de Mello
- Testing, Prevention and Population Unit, Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Virginia Macdonald
- Testing, Prevention and Population Unit, Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
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25
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 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.
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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
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Simo Fotso A, Johnson C, Vautier A, Kouamé KB, Diop PM, Silhol R, Maheu-Giroux M, Boily MC, Rouveau N, Doumenc-Aïdara C, Baggaley R, Ehui E, Larmarange J. Routine programmatic data show a positive population-level impact of HIV self-testing: the case of Côte d'Ivoire and implications for implementation. AIDS 2022; 36:1871-1879. [PMID: 35848584 PMCID: PMC9594126 DOI: 10.1097/qad.0000000000003328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES We estimate the effects of ATLAS's HIV self-testing (HIVST) kit distribution on conventional HIV testing, diagnoses, and antiretroviral treatment (ART) initiations in Côte d'Ivoire. DESIGN Ecological study using routinely collected HIV testing services program data. METHODS We used the ATLAS's programmatic data recorded between the third quarter of 2019 and the first quarter of 2021, in addition to data from the President's Emergency Plan for AIDS Relief dashboard. We performed ecological time series regression using linear mixed models. Results are presented per 1000 HIVST kits distributed through ATLAS. RESULTS We found a negative but nonsignificant effect of the number of ATLAS' distributed HIVST kits on conventional testing uptake (-190 conventional tests; 95% confidence interval [CI]: -427 to 37). The relationship between the number of HIVST kits and HIV diagnoses was significant and positive (+8 diagnosis; 95% CI: 0 to 15). No effect was observed on ART initiation (-2 ART initiations; 95% CI: -8 to 5). CONCLUSIONS ATLAS' HIVST kit distribution had a positive impact on HIV diagnoses. Despite the negative signal on conventional testing, even if only 20% of distributed kits are used, HIVST would increase access to testing. The methodology used in this paper offers a promising way to leverage routinely collected programmatic data to estimate the effects of HIVST kit distribution in real-world programs.
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Affiliation(s)
- Arlette Simo Fotso
- Centre Population & Développement, Université Paris-Cité, IRD, Inserm, Paris
- French Institute for Demographic Studies, INED, Aubervilliers, France
| | | | - Anthony Vautier
- Solidarité Thérapeutique et Initiatives pour la Santé, Solthis, Dakar, Sénégal
| | | | - Papa Moussa Diop
- Solidarité Thérapeutique et Initiatives pour la Santé, Solthis, Dakar, Sénégal
| | - Romain Silhol
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Marie-Claude Boily
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Nicolas Rouveau
- Centre Population & Développement, Université Paris-Cité, IRD, Inserm, Paris
| | | | | | - Eboi Ehui
- Programme National de Lutte contre le Sida, Abidjan, Côte d’Ivoire
| | - Joseph Larmarange
- Centre Population & Développement, Université Paris-Cité, IRD, Inserm, Paris
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Macdonald V, Verster A, Mello MB, Blondeel K, Amin A, Luhmann N, Baggaley R, Doherty M. The World Health Organization's work and recommendations for improving the health of trans and gender diverse people. J Int AIDS Soc 2022; 25 Suppl 5:e26004. [PMID: 36225136 PMCID: PMC9990390 DOI: 10.1002/jia2.26004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/30/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The World Health Organization (WHO) is guided by its global programme of work and the goal that a billion more people have universal health coverage (UHC). To achieve UHC, access for those most vulnerable must be guaranteed and prioritized. WHO is committed to developing evidence-based guidance to work towards UHC for trans and gender diverse (TGD) people. This commentary describes WHO's work related to TGD people over the last decade. DISCUSSION In 2011, WHO developed guidelines for the prevention and treatment of HIV and sexually transmitted infections (STIs) in men who have sex with men and TGD people. In 2013, the "HIV civil society reference group" called on WHO to provide specific guidance for TGD people. Values and preferences of TGD people were considered by WHO for the first time, which informed the development of the 2014 WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations. The 2014 Guidelines included a comprehensive package of HIV-related health and enabling interventions with specific considerations for TGD people, as well as a specific policy brief in 2015. Regional WHO offices developed and/or supported the development of blueprints on transgender health and HIV in 2014 and 2016. A 2015 WHO report on sexual health, human rights and the law elucidated the harmful impacts of discriminatory laws on the basis of sexual orientation and gender identity. In 2019, the 11th edition of the international classification of diseases saw the removal of "transsexualism" as a mental and behavioural disorder. WHO's first guideline on self-care interventions, updated in 2021, included key considerations concerning TGD people. In 2022, WHO's updated key populations guidelines include a prioritized package of not just HIV, but also viral hepatitis and STI health interventions for TGD people. Still, a broader and more specific health approach and a greater focus on social issues are needed to better serve the health needs of TGD people. CONCLUSIONS WHO's understanding and commitment to TGD people's health has evolved and improved over the past decade. Together with professional and community trans health organizations, WHO should now start developing evidence-informed global guidance on TGD health as part of its remit to support UHC to all.
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Affiliation(s)
- Virginia Macdonald
- Global Programme for HIV, Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Annette Verster
- Global Programme for HIV, Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Maeve B Mello
- Global Programme for HIV, Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Karel Blondeel
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Avni Amin
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Niklas Luhmann
- Global Programme for HIV, Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Rachel Baggaley
- Global Programme for HIV, Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Meg Doherty
- Global Programme for HIV, Hepatitis and STIs, World Health Organization, Geneva, Switzerland
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Coomes D, Green D, Barnabas R, Sharma M, Barr-DiChiara M, Jamil MS, Baggaley R, Owiredu MN, Macdonald V, Nguyen VTT, Vo SH, Taylor M, Wi T, Johnson C, Drake AL. Cost-effectiveness of implementing HIV and HIV/syphilis dual testing among key populations in Viet Nam: a modelling analysis. BMJ Open 2022; 12:e056887. [PMID: 35953255 PMCID: PMC9379490 DOI: 10.1136/bmjopen-2021-056887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Key populations, including sex workers, men who have sex with men, and people who inject drugs, have a high risk of HIV and sexually transmitted infections. We assessed the health and economic impacts of different HIV and syphilis testing strategies among three key populations in Viet Nam using a dual HIV/syphilis rapid diagnostic test (RDT). SETTING We used the spectrum AIDS impact model to simulate the HIV epidemic in Viet Nam and evaluated five testing scenarios among key populations. We used a 15-year time horizon and a provider perspective for costs. PARTICIPANTS We simulate the entire population of Viet Nam in the model. INTERVENTIONS We modelled five testing scenarios among key populations: (1) annual testing with an HIV RDT, (2) annual testing with a dual RDT, (3) biannual testing using dual RDT and HIV RDT, (4) biannual testing using HIV RDT and (5) biannual testing using dual RDT. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome is incremental cost-effectiveness ratios. Secondary outcomes include HIV and syphilis cases. RESULTS Annual testing using a dual HIV/syphilis RDT was cost-effective (US$10 per disability-adjusted life year (DALY)) and averted 3206 HIV cases and treated 27 727 syphilis cases compared with baseline over 15 years. Biannual testing using one dual test and one HIV RDT (US$1166 per DALY), or two dual tests (US$5672 per DALY) both averted an additional 875 HIV cases, although only the former scenario was cost-effective. Annual or biannual HIV testing using HIV RDTs and separate syphilis tests were more costly and less effective than using one or two dual RDTs. CONCLUSIONS Annual HIV and syphilis testing using dual RDT among key populations is cost-effective in Vietnam and similar settings to reach global reduction goals for HIV and syphilis.
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Affiliation(s)
- David Coomes
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Dylan Green
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Ruanne Barnabas
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Magdalena Barr-DiChiara
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S Jamil
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - R Baggaley
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Morkor Newman Owiredu
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Virginia Macdonald
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | | | - Son Hai Vo
- Viet Nam Authority for HIV/AIDS Prevention and Control, Government of Viet Nam Ministry of Health, Hanoi, Viet Nam
| | - Melanie Taylor
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Teodora Wi
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl Johnson
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Alison L Drake
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
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29
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Schmidt HMA, Rodolph M, Schaefer R, Baggaley R, Doherty M. Long-acting injectable cabotegravir: implementation science needed to advance this additional HIV prevention choice. J Int AIDS Soc 2022; 25:e25963. [PMID: 35903882 PMCID: PMC9334859 DOI: 10.1002/jia2.25963] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/05/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Heather-Marie Ann Schmidt
- Global HIV, Hepatitis and STIs Programme, World Health Organization (WHO), Geneva, Switzerland.,UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand
| | - Michelle Rodolph
- Global HIV, Hepatitis and STIs Programme, World Health Organization (WHO), Geneva, Switzerland
| | - Robin Schaefer
- Global HIV, Hepatitis and STIs Programme, World Health Organization (WHO), Geneva, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programme, World Health Organization (WHO), Geneva, Switzerland
| | - Meg Doherty
- Global HIV, Hepatitis and STIs Programme, World Health Organization (WHO), Geneva, Switzerland
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30
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Hamidouche M, Ante-Testard PA, Baggaley R, Temime L, Jean K. Monitoring socioeconomic inequalities across HIV knowledge, attitudes, behaviours and prevention in 18 sub-Saharan African countries. AIDS 2022; 36:871-879. [PMID: 35190511 DOI: 10.1097/qad.0000000000003191] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Socioeconomic inequalities in HIV prevention services coverage constitute important barriers to global prevention targets, especially in sub-Saharan Africa (SSA). We aimed at monitoring these inequalities from population-based survey data in 18 SSA countries between 2010 and 2018. METHODS We defined eight HIV indicators aimed at capturing uptake of HIV prevention services among adult participants. Country-specific wealth-related inequalities were measured using the Relative and Slope Index of Inequalities (RII and SII, respectively) and then pooled using random-effects meta-analyses. We compared inequalities between African regions using the Wilcoxon rank-sum test. RESULTS The sample consisted of 358 591 participants (66% women). Despite variability between countries and indicators, the meta-analysis revealed significant levels of relative and absolute inequalities in six out of eight indicators: HIV-related knowledge, positive attitudes toward people with HIV (PWH), condom use at last sexual intercourse, participation to prevention of mother-to-child transmission programs, medical male circumcision and recent HIV testing. The largest inequalities were reported in condom use, with condom use reported five times more among the richest versus the poorest [RII = 5.02, 95% confidence interval (CI) 2.79-9.05] and in positive attitudes toward PWH, with a 32-percentage point difference between the richest and poorest (SII = 0.32, 95% CI 0.26-0.39). Conversely, no significant inequalities were observed in multipartnership and HIV seropositivity among youth. Overall, inequalities tended to be larger in West and Central vs. East and Southern African countries. CONCLUSION Despite efforts to scale-up HIV-prevention programs, socioeconomic inequalities remain substantial over the continuum of HIV primary and secondary prevention in several SSA countries.
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Affiliation(s)
- Mohamed Hamidouche
- Laboratoire MESuRS, Conservatoire national des Arts et Metiers
- Unité PACRI, Institut Pasteur, Conservatoire national des Arts et Métiers, Paris, France
| | - Pearl Anne Ante-Testard
- Laboratoire MESuRS, Conservatoire national des Arts et Metiers
- Unité PACRI, Institut Pasteur, Conservatoire national des Arts et Métiers, Paris, France
| | - Rachel Baggaley
- World Health Organization, Global HIV, Hepatitis and STI Programmes, Geneva, Switzerland
| | - Laura Temime
- Laboratoire MESuRS, Conservatoire national des Arts et Metiers
- Unité PACRI, Institut Pasteur, Conservatoire national des Arts et Métiers, Paris, France
| | - Kevin Jean
- Laboratoire MESuRS, Conservatoire national des Arts et Metiers
- Unité PACRI, Institut Pasteur, Conservatoire national des Arts et Métiers, Paris, France
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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Phillips AN, Bershteyn A, Revill P, Bansi-Matharu L, Kripke K, Boily MC, Martin-Hughes R, Johnson LF, Mukandavire Z, Jamieson L, Meyer-Rath G, Hallett TB, Ten Brink D, Kelly SL, Nichols BE, Bendavid E, Mudimu E, Taramusi I, Smith J, Dalal S, Baggaley R, Crowley S, Terris-Prestholt F, Godfrey-Faussett P, Mukui I, Jahn A, Case KK, Havlir D, Petersen M, Kamya M, Koss CA, Balzer LB, Apollo T, Chidarikire T, Mellors JW, Parikh UM, Godfrey C, Cambiano V. Cost-effectiveness of easy-access, risk-informed oral pre-exposure prophylaxis in HIV epidemics in sub-Saharan Africa: a modelling study. Lancet HIV 2022; 9:e353-e362. [PMID: 35489378 PMCID: PMC9065367 DOI: 10.1016/s2352-3018(22)00029-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Approaches that allow easy access to pre-exposure prophylaxis (PrEP), such as over-the-counter provision at pharmacies, could facilitate risk-informed PrEP use and lead to lower HIV incidence, but their cost-effectiveness is unknown. We aimed to evaluate conditions under which risk-informed PrEP use is cost-effective. METHODS We applied a mathematical model of HIV transmission to simulate 3000 setting-scenarios reflecting a range of epidemiological characteristics of communities in sub-Saharan Africa. The prevalence of HIV viral load greater than 1000 copies per mL among all adults (HIV positive and negative) varied from 1·1% to 7·4% (90% range). We hypothesised that if PrEP was made easily available without restriction and with education regarding its use, women and men would use PrEP, with sufficient daily adherence, during so-called seasons of risk (ie, periods in which individuals are at risk of acquiring infection). We refer to this as risk-informed PrEP. For each setting-scenario, we considered the situation in mid-2021 and performed a pairwise comparison of the outcomes of two policies: immediate PrEP scale-up and then continuation for 50 years, and no PrEP. We estimated the relationship between epidemic and programme characteristics and cost-effectiveness of PrEP availability to all during seasons of risk. For our base-case analysis, we assumed a 3-monthly PrEP cost of US$29 (drug $11, HIV test $4, and $14 for additional costs necessary to facilitate education and access), a cost-effectiveness threshold of $500 per disability-adjusted life-year (DALY) averted, an annual discount rate of 3%, and a time horizon of 50 years. In sensitivity analyses, we considered a cost-effectiveness threshold of $100 per DALY averted, a discount rate of 7% per annum, the use of PrEP outside of seasons of risk, and reduced uptake of risk-informed PrEP. FINDINGS In the context of PrEP scale-up such that 66% (90% range across setting-scenarios 46-81) of HIV-negative people with at least one non-primary condomless sex partner take PrEP in any given period, resulting in 2·6% (0·9-6·0) of all HIV negative adults taking PrEP at any given time, risk-informed PrEP was predicted to reduce HIV incidence by 49% (23-78) over 50 years compared with no PrEP. PrEP was cost-effective in 71% of all setting-scenarios, and cost-effective in 76% of setting-scenarios with prevalence of HIV viral load greater than 1000 copies per mL among all adults higher than 2%. In sensitivity analyses with a $100 per DALY averted cost-effectiveness threshold, a 7% per year discount rate, or with PrEP use that was less well risk-informed than in our base case, PrEP was less likely to be cost-effective, but generally remained cost-effective if the prevalence of HIV viral load greater than 1000 copies per mL among all adults was higher than 3%. In sensitivity analyses based on additional setting-scenarios in which risk-informed PrEP was less extensively used, the HIV incidence reduction was smaller, but the cost-effectiveness of risk-informed PrEP was undiminished. INTERPRETATION Under the assumption that making PrEP easily accessible for all adults in sub-Saharan Africa in the context of community education leads to risk-informed use, PrEP is likely to be cost-effective in settings with prevalence of HIV viral load greater than 1000 copies per mL among all adults higher than 2%, suggesting the need for implementation of such approaches, with ongoing evaluation. FUNDING US Agency for International Development, US President's Emergency Plan for AIDS Relief, and Bill & Melinda Gates Foundation.
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Affiliation(s)
| | - Anna Bershteyn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Paul Revill
- Centre for Health Economics, University of York, York, UK
| | | | | | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | | | - Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Zindoga Mukandavire
- Centre for Data Science and Artificial Intelligence, Emirates Aviation University, Dubai, United Arab Emirates
| | - Lise Jamieson
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Medical Microbiology, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Gesine Meyer-Rath
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Global Health, School of Public Health, Boston University, Boston, MA, USA
| | - Timothy B Hallett
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | | | | | - Brooke E Nichols
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Medical Microbiology, Amsterdam University Medical Centre, Amsterdam, Netherlands; Department of Global Health, School of Public Health, Boston University, Boston, MA, USA
| | - Eran Bendavid
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Edinah Mudimu
- Department of Decision Sciences, University of South Africa, Pretoria, South Africa
| | | | - Jennifer Smith
- Institute for Global Health, University College London, London, UK
| | - Shona Dalal
- World Health Organisation, Geneva, Switzerland
| | | | - Siobhan Crowley
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | | | - Peter Godfrey-Faussett
- Joint UN Programme on HIV/AIDS, Geneva, Switzerland; London School of Hygiene & Tropical Medicine, London, UK
| | - Irene Mukui
- Drugs for Neglected Diseases Initiative, Nairobi, Kenya
| | | | - Kelsey K Case
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Diane Havlir
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Maya Petersen
- Divisions of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Moses Kamya
- Department of Medicine, Makerere University, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Catherine A Koss
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Laura B Balzer
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | | | | | - John W Mellors
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, USA
| | - Urvi M Parikh
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine Godfrey
- Office of the Global AIDS Coordinator, Department of State, Washington, DC, USA
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Schmidt HMA, Schaefer R, Nguyen VTT, Radebe M, Sued O, Rodolph M, Ford N, Baggaley R. Scaling up access to HIV pre-exposure prophylaxis (PrEP): should nurses do the job? Lancet HIV 2022; 9:e363-e366. [PMID: 35358418 PMCID: PMC9046094 DOI: 10.1016/s2352-3018(22)00006-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 12/14/2022]
Abstract
Task sharing has been one of the most important enabling policies supporting the global expansion of access to HIV testing and treatment. The WHO public health approach, which relies on delivery of antiretroviral therapy (ART) by nurses, has enabled a trebling of the number of people receiving ART during the past decade. WHO recognises that HIV pre-exposure prophylaxis (PrEP) can also be provided by nurses; however, many countries still do not have policies in place that support nurse provision of PrEP. In sub-Saharan Africa, most countries allow nurses to prescribe ART, but only a few countries have policies in place that allow nurses to prescribe PrEP. Nurse-led PrEP delivery is particularly low in the Asia-Pacific region, which has some of the world's fastest growing epidemics. Even in many high-income countries, PrEP scale-up has been limited because policies often require medical doctors or specialists to prescribe. Service providers in many countries are coming to realise that scaling up access to PrEP cannot be achieved by medical doctors alone, and nurse-led PrEP delivery can help to lay the groundwork for supporting uptake of other HIV prevention approaches that will become available in the future. Countries with policies that authorise nurses to prescribe ART could be early adopters and help to pave the way for wider adoption of nurse-led PrEP delivery.
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Affiliation(s)
- Heather-Marie A Schmidt
- UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand; Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Robin Schaefer
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | | | - Mopo Radebe
- World Health Organization, Pretoria, South Africa
| | - Omar Sued
- Pan American Health Organization, Washington, DC, USA
| | - Michelle Rodolph
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Nathan Ford
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland.
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
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Schaefer R, Amparo da Costa Leite PH, Silva R, Abdool Karim Q, Akolo C, Cáceres CF, Dourado I, Green K, Hettema A, Hoornenborg E, Jana S, Kerschberger B, Mahler H, Matse S, McManus H, Molina JM, Reza-Paul S, Azwa I, Shahmanesh M, Taylor D, Vega-Ramirez H, Veloso VG, Baggaley R, Dalal S. Kidney function in tenofovir disoproxil fumarate-based oral pre-exposure prophylaxis users: a systematic review and meta-analysis of published literature and a multi-country meta-analysis of individual participant data. Lancet HIV 2022; 9:e242-e253. [PMID: 35271825 PMCID: PMC8964504 DOI: 10.1016/s2352-3018(22)00004-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous WHO guidance on tenofovir disoproxil fumarate-based oral pre-exposure prophylaxis (PrEP) suggests measuring creatinine levels at PrEP initiation and regularly afterwards, which might represent barriers to PrEP implementation and uptake. We aimed to systematically review published literature on kidney toxicity among tenofovir disoproxil fumarate-based oral PrEP users and conducted an individual participant data meta-analysis (IPDMA) on kidney function among PrEP users in a global implementation project dataset. METHODS In this systematic review and meta-analysis we searched PubMed up to June 30, 2021, for randomised controlled trials (RCTs) or cohort studies that reported on graded kidney-related adverse events among oral PrEP users (tenofovir disoproxil fumarate-based PrEP alone or in combination with emtricitabine or lamivudine). We extracted summary data and conducted meta-analyses with random-effects models to estimate relative risks of grade 1 and higher and grade 2 and higher kidney-related adverse events, measured by elevated serum creatinine or decline in estimated creatinine clearance or estimated glomerular filtration rate. The IPDMA included (largely unpublished) individual participant data from 17 PrEP implementation projects and two RCTs. Estimated baseline creatinine clearance and creatinine clearance change after initiation were described by age, gender, and comorbidities. We used random-effects regressions to estimate the risk in decline of creatinine clearance to less than 60 mL/min. FINDINGS We identified 62 unique records and included 17 articles reporting on 11 RCTs with 13 523 participants in meta-analyses. PrEP use was associated with increased risk of grade 1 and higher kidney adverse events (pooled odds ratio [OR] 1·49, 95% CI 1·22-1·81; I2=25%) and grade 2 and higher events (OR 1·75, 0·68-4·49; I2=0%), although the grade 2 and higher association was not statistically significant and events were rare (13 out of 6764 in the intervention group vs six out of 6782 in the control group). The IPDMA included 18 676 individuals from 15 countries (1453 [7·8%] from RCTs) and 79 (0·42%) had a baseline estimated creatinine clearance of less than 60 mL/min (increasing proportions with increasing age). Longitudinal analyses included 14 368 PrEP users and 349 (2·43%) individuals had a decline to less than 60 mL/min creatinine clearance, with higher risks associated with increasing age and baseline creatinine clearance of 60·00-89·99 mL/min (adjusted hazard ratio [aHR] 8·49, 95% CI 6·44-11·20) and less than 60 mL/min (aHR 20·83, 12·83-33·82). INTERPRETATION RCTs suggest that risks of kidney-related adverse events among tenofovir disoproxil fumarate-based oral PrEP users are increased but generally mild and small. Our global PrEP user analysis found varying risks by age and baseline creatinine clearance. Kidney function screening and monitoring might focus on older individuals, those with baseline creatinine clearance of less than 90 mL/min, and those with kidney-related comorbidities. Less frequent or optional screening among younger individuals without kidney-related comorbidities may reduce barriers to PrEP implementation and use. FUNDING Unitaid, Bill & Melinda Gates Foundation, WHO.
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Affiliation(s)
- Robin Schaefer
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland.
| | | | - Ronaldo Silva
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Quarraisha Abdool Karim
- CAPRISA, Nelson R Mandela School of Medicine; University of KwaZulu-Natal, Durban, South Africa
| | | | - Carlos F Cáceres
- Centro de Investigación Interdisciplinaria en Sexualidad, SIDA y Sociedad, Universidad Cayetano Heredia, Lima, Peru
| | - Inês Dourado
- Collective Health Institute, Federal University of Bahia, Brazil
| | | | | | - Elske Hoornenborg
- Center for Sexual Health, Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, Netherlands
| | | | | | | | | | - Hamish McManus
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Jean-Michel Molina
- Department of Infectious Diseases, St-Louis and Lariboisière Hospitals, University of Paris, INSERM U944, Paris, France
| | - Sushena Reza-Paul
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Ashodaya Samithi, Mysuru, India
| | - Iskandar Azwa
- Infectious Diseases Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maryam Shahmanesh
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Institute for Global Health, University College London, London, UK
| | | | - Hamid Vega-Ramirez
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Valdiléa G Veloso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Shona Dalal
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
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Xu Y, Aboud L, Chow EP, Mello MB, Wi T, Baggaley R, Fairley CK, Peeling R, Ong JJ. The diagnostic accuracy of pooled testing from multiple individuals for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review. Int J Infect Dis 2022; 118:183-193. [DOI: 10.1016/j.ijid.2022.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 11/25/2022] Open
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Abstract
INTRODUCTION Novel mechanisms of service delivery are needed to expand access to pre-exposure prophylaxis (PrEP) for HIV prevention. Providing PrEP directly through pharmacies could offer an additional option for reaching potential users. METHODS We conducted a systematic review of studies examining effectiveness, values and preferences of end users and health workers, and cost of PrEP initiation and continuation through pharmacies (pharmacy access). We searched PubMed, CINAHL, LILACS and EMBASE through 2 December 2020. We also searched clinical trial registries and recent HIV conference abstracts. Standardised methods were used to search, screen and extract data from included studies. RESULTS No studies met the inclusion criteria for the effectiveness review, for either PrEP initiation or continuation. However, six 'case studies' presenting non-comparative data from PrEP pharmacy programmes demonstrated feasibility of this model in the USA. Eleven studies reported values and preferences of end users and health workers. In the USA, Kenya and South Africa, potential PrEP clients generally supported pharmacy access, although some preferred clinics. One study of PrEP pharmacy clients found all would 'definitely recommend' the programme. Six studies found pharmacists were generally supportive of offering PrEP; one study including doctors found more limited favour, while one study of diverse Kenyan stakeholders found broad support. Three studies reported cost data indicating client willingness to pay in the USA and Kenya and initial sustainability of a clinic financial model in the USA. CONCLUSION Provision of PrEP through pharmacies has been demonstrated to be feasible in the USA and acceptable to potential end users and stakeholders in multiple settings. Limited evidence on effectiveness and requirements for laboratory testing and assurance of high-quality services may limit enthusiasm for this approach. Further research is needed to determine if pharmacy access is a safe and effective way to help achieve global HIV prevention goals. PROSPERO REGISTRATION NUMBER CRD42021231650.
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Affiliation(s)
- Caitlin E Kennedy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kaitlyn Atkins
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura Ferguson
- Keck School of Medicine, Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Rachel Baggaley
- Department of HIV, Viral Hepatitis, and STIs, World Health Organization, Geneva, Switzerland
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Sibanda E, Shapiro A, Mathers B, Verster A, Baggaley R, Gaffield ME, Macdonald V. Values and preferences of contraceptive methods: a mixed-methods study among sex workers from diverse settings. Sex Reprod Health Matters 2021; 29:1913787. [PMID: 33949283 PMCID: PMC8118510 DOI: 10.1080/26410397.2021.1913787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
There is limited information on contraceptive values and preferences of sex workers. We conducted a mixed-method study to explore contraceptive values and preferences among sex workers. We conducted an online survey with individuals from 38 countries (n = 239), 6 focus group discussions (FGD, n = 68) in Zimbabwe, and 12 in-depth phone interviews (IDI) across 4 world regions, in June and July of 2019. Participants were asked about awareness of contraceptives, methods they had used in the past, and the determinants of their choices. Differences between respondents from high-, low- and middle- income countries were examined. Qualitative data were analysed thematically. Survey participants reported an awareness of modern contraceptive methods. FGDs found that younger women had lower awareness. Reports of condomless sex were common and modern contraceptive use was inconsistent. Determinants of contraceptive choices differed by setting according to results of the survey, FGD, and IDI. Regardless of country income level, determinants of contraceptive choices included ease of use, ease of access to a contraceptive method, and fewer side effects. Healthcare provider attitudes, availability of methods, and clinic schedules were important considerations. Most sex workers are aware of contraceptives, but barriers include male partners/clients, side effects, and health system factors such as access and clinic attitudes towards sex workers.
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Affiliation(s)
- Euphemia Sibanda
- Project Director, The Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe (CeSHHAR Zimbabwe); Senior Lecturer, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ania Shapiro
- Consultant, World Health Organization, Geneva, Switzerland
| | | | - Annette Verster
- Technical Officer, World Health Organization, Geneva, Switzerland
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Aboud L, Xu Y, Chow EPF, Wi T, Baggaley R, Mello MB, Fairley CK, Ong JJ. Diagnostic accuracy of pooling urine, anorectal, and oropharyngeal specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review and meta-analysis. BMC Med 2021; 19:285. [PMID: 34819068 PMCID: PMC8614052 DOI: 10.1186/s12916-021-02160-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/13/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) at genital and extragenital sites is needed for most key populations, but molecular diagnostic tests for CT/NG are costly. We aimed to determine the accuracy of pooled samples from multiple anatomic sites from one individual to detect CT/NG using the testing of a single sample from one anatomic site as the reference. METHODS In this systematic review and meta-analysis, we searched five databases for articles published from January 1, 2000, to February 4, 2021. Studies were included if they contained original data describing the diagnostic accuracy of pooled testing compared with single samples, resource use, benefits and harms of pooling, acceptability, and impact on health equity. We present the pooled sensitivities and specificities for CT and NG using a bivariate mixed-effects logistic regression model. The study protocol is registered in PROSPERO, an international database of prospectively registered systematic reviews (CRD42021240793). We used GRADE to evaluate the quality of evidence. RESULTS Our search yielded 7814 studies, with 17 eligible studies included in our review. Most studies were conducted in high-income countries (82.6%, 14/17) and focused on men who have sex with men (70.6%, 12/17). Fourteen studies provided 15 estimates for the meta-analysis for CT with data from 5891 individuals. The pooled sensitivity for multisite pooling for CT was 93.1% [95% confidence intervals (CI) 90.5-95.0], I2=43.3, and pooled specificity was 99.4% [99.0-99.6], I2=52.9. Thirteen studies provided 14 estimates for the meta-analysis for NG with data from 6565 individuals. The pooled sensitivity for multisite pooling for NG was 94.1% [95% CI 90.9-96.3], I2=68.4, and pooled specificity was 99.6% [99.1-99.8], I2=83.6. Studies report significant cost savings (by two thirds to a third). CONCLUSION Multisite pooled testing is a promising approach to improve testing coverage for CT/NG in resource-constrained settings with a small compromise in sensitivity but with a potential for significant cost savings.
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Affiliation(s)
- Lily Aboud
- College of Medicine and Dentistry, James Cook University, Townsville, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Yangqi Xu
- Central Clinical School, Monash University, Melbourne, Australia
| | - Eric P F Chow
- Central Clinical School, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Teodora Wi
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Maeve B Mello
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Christopher K Fairley
- College of Medicine and Dentistry, James Cook University, Townsville, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, Australia. .,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia. .,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Barr-DiChiara M, Tembo M, Harrison L, Quinn C, Ameyan W, Sabin K, Jani B, Jamil MS, Baggaley R, Johnson C. Adolescents and age of consent to HIV testing: an updated review of national policies in sub-Saharan Africa. BMJ Open 2021; 11:e049673. [PMID: 34489284 PMCID: PMC8442095 DOI: 10.1136/bmjopen-2021-049673] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES In sub-Saharan Africa (SSA) where HIV burden is highest, access to testing, a key entry point for prevention and treatment, remains low for adolescents (aged 10-19). Access may be hampered by policies requiring parental consent for adolescents to receive HIV testing services (HTS). In 2013, the WHO recommended countries to review HTS age of consent policies. Here, we investigate country progress and policies on age of consent for HIV testing. DESIGN Comprehensive policy review. DATA SOURCES Policies addressing HTS were obtained through searching WHO repositories and governmental and non-governmental websites and consulting country and regional experts. ELIGIBILITY CRITERIA HTS policies published by SSA governments before 2019 that included age of consent. DATA EXTRACTION AND SYNTHESIS Data were extracted on HTS age of consent including exceptions based on risk and maturity. Descriptive analyses of included policies were disaggregated by Eastern and Southern Africa (ESA) and Western and Central Africa (WCA) subregions. RESULTS Thirty-nine policies were reviewed, 38 were eligible; 19/38 (50%) permitted HTS for adolescents ≤16 years old without parental consent. Of these, six allowed HTS at ≥12 years old, two at ≥13, two at ≥14, five at ≥15 and four at ≥16. In ESA, 71% (n=15/21) allowed those of ≤16 years old to access HTS, while only 24% (n=6/25) of WCA countries allowed the same. Maturity exceptions including marriage, sexual activity, pregnancy or key population were identified in 18 policies. In 2019, 63% (n=19/30) of policies with clear age-based criteria allowed adolescents of 12-16 years old to access HIV testing without parental consent, an increase from 37% (n=14/38) in 2013. CONCLUSIONS While many countries in SSA have revised their HTS policies, many do not specify age of consent. Revision of SSA consent to HTS policies, particularly in WCA, remains a priority to achieve the 2025 goal of 95% of people with HIV knowing their status.
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Affiliation(s)
| | - Mandikudza Tembo
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Lisa Harrison
- South West Screening and Immunisations, Public Health England, London, UK
| | - Caitlin Quinn
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Wole Ameyan
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Keith Sabin
- Strategic Information and Evaluation, UNAIDS, Geneva, Switzerland
| | - Bhavin Jani
- World Health Organization, Dar es Salaam, Tanzania
| | - Muhammad S Jamil
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
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Schaefer R, Schmidt HMA, Ravasi G, Mozalevskis A, Rewari BB, Lule F, Yeboue K, Brink A, Mangadan Konath N, Sharma M, Seguy N, Hermez J, Alaama AS, Ishikawa N, Dongmo Nguimfack B, Low-Beer D, Baggaley R, Dalal S. Adoption of guidelines on and use of oral pre-exposure prophylaxis: a global summary and forecasting study. Lancet HIV 2021; 8:e502-e510. [PMID: 34265283 PMCID: PMC8332196 DOI: 10.1016/s2352-3018(21)00127-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 04/12/2023]
Abstract
BACKGROUND In 2016, the UN General Assembly set a global target of 3 million oral pre-exposure prophylaxis (PrEP) users by 2020. With this target at an end, we aimed to assess global trends in the adoption of WHO PrEP recommendations into national guidelines and numbers of PrEP users, defined as people who received oral PrEP at least once in a given year, and to estimate future trajectories of PrEP use. METHODS In this global summary and forecasting study, data on adoption of WHO PrEP recommendations and numbers of PrEP users were obtained through the Global AIDS Monitoring system and WHO regional offices. Trends in these indicators for 2016-19 by region and for 2019 by country were described, including by gender and priority populations where data were available. PrEP user numbers were forecasted until 2023 by selecting countries with at least 3 years of PrEP user data as example countries in each region to represent possible future PrEP user trajectories. PrEP user growth rates observed in example countries were applied to countries in corresponding regions under different scenarios, including a COVID-19 disruption scenario with static global PrEP use in 2020. FINDINGS By the end of 2019, 120 (67%) of 180 countries with data had adopted the WHO PrEP recommendations into national guidelines (23 in 2019 and 30 in 2018). In 2019, there were about 626 000 PrEP users across 77 countries, including 260 000 (41·6%) in the region of the Americas and 213 000 (34·0%) in the African region; this is a 69% increase from about 370 000 PrEP users across 66 countries in 2018. Without COVID-19 disruptions, 0·9-1·1 million global PrEP users were projected by the end of 2020 and 2·4-5·3 million are projected by the end of 2023. If COVID-19 disruptions resulted in no PrEP user growth in 2020, the projected number of PrEP users in 2023 is 2·1-3·0 million. INTERPRETATION Widespread adoption of WHO PrEP recommendations coincided with a global increase in PrEP use. Although the 2020 global PrEP target will be missed, strong future growth in PrEP use is possible. New PrEP products could expand the PrEP user base, and, with greater expansion of oral PrEP, further adoption of WHO PrEP recommendations, and simplified delivery, PrEP could contribute to ending AIDS by 2030. FUNDING Unitaid, Bill & Melinda Gates Foundation, and WHO.
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Affiliation(s)
- Robin Schaefer
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland.
| | - Heather-Marie A Schmidt
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland; UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand
| | | | - Antons Mozalevskis
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Bharat B Rewari
- World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Frank Lule
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Kouadio Yeboue
- World Health Organization Regional Office for Africa, Inter-Country Support Team, Ouagadougou, Burkina Faso
| | - Anne Brink
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | | | - Mukta Sharma
- World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Nicole Seguy
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Joumana Hermez
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Ahmed S Alaama
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Naoko Ishikawa
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | | | - Daniel Low-Beer
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Shona Dalal
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
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Jamil MS, Eshun-Wilson I, Witzel TC, Siegfried N, Figueroa C, Chitembo L, Msimanga-Radebe B, Pasha MS, Hatzold K, Corbett E, Barr-DiChiara M, Rodger AJ, Weatherburn P, Geng E, Baggaley R, Johnson C. Examining the effects of HIV self-testing compared to standard HIV testing services in the general population: A systematic review and meta-analysis. EClinicalMedicine 2021; 38:100991. [PMID: 34278282 PMCID: PMC8271120 DOI: 10.1016/j.eclinm.2021.100991] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We updated a 2017 systematic review and compared the effects of HIV self-testing (HIVST) to standard HIV testing services to understand effective service delivery models among the general population. METHODS We included randomized controlled trials (RCTs) comparing testing outcomes with HIVST to standard testing in the general population and published between January 1, 2006 and June 4, 2019. Random effects meta-analysis was conducted and pooled risk ratios (RRs) were reported. The certainty of evidence was determined using the GRADE methodology. FINDINGS We identified 14 eligible RCTs, 13 of which were conducted in sub-Saharan Africa. Support provided to self-testers ranged from no/basic support to one-on-one in-person support. HIVST increased testing uptake overall (RR:2.09; 95% confidence interval: 1.69-2.58; p < 0.0001;13 RCTs; moderate certainty evidence) and by service delivery model including facility-based distribution, HIVST use at facilities, secondary distribution to partners, and community-based distribution. The number of persons diagnosed HIV-positive among those tested (RR:0.81, 0.45-1.47; p = 0.50; 8 RCTs; moderate certainty evidence) and number linked to HIV care/treatment among those diagnosed (RR:0.95, 0.79-1.13; p = 0.52; 6 RCTs; moderate certainty evidence) were similar between HIVST and standard testing. Reported harms/adverse events with HIVST were rare and appeared similar to standard testing (RR:2.52: 0.52-12.13; p = 0.25; 4 RCTs; very low certainty evidence). INTERPRETATION HIVST appears to be safe and effective among the general population in sub-Saharan Africa with a range of delivery models. It identified and linked additional people with HIV to care. These findings support the wider availability of HIVST to reach those who may not otherwise access testing.
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Affiliation(s)
- Muhammad S. Jamil
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
- Corresponding author.
| | - Ingrid Eshun-Wilson
- Washington University School of Medicine in St. Louis, St Louis, United States
| | - T. Charles Witzel
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nandi Siegfried
- Independent Clinical Epidemiologist, Cape Town, South Africa
| | - Carmen Figueroa
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Lastone Chitembo
- World Health Organization Country Office for Zambia, Lusaka, Zambia
| | | | - Muhammad S. Pasha
- World Health Organization Country Office for Pakistan, Islamabad, Pakistan
| | - Karin Hatzold
- Population Services International, Cape Town, South Africa
| | - Elizabeth Corbett
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- TB/HIV Group, Malawi–Liverpool–Wellcome Clinical Research Programme, Blantyre, Malawi
| | | | - Alison J. Rodger
- Institute for Global Health, University College London, London, United Kingdom
| | - Peter Weatherburn
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elvin Geng
- Washington University School of Medicine in St. Louis, St Louis, United States
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl Johnson
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
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Fonner VA, Sands A, Figueroa C, Baggaley R, Quinn C, Jamil MS, Johnson C. Country adherence to WHO recommendations to improve the quality of HIV diagnosis: a global policy review. BMJ Glob Health 2021; 5:bmjgh-2019-001939. [PMID: 32371571 PMCID: PMC7228476 DOI: 10.1136/bmjgh-2019-001939] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 02/17/2020] [Accepted: 02/28/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction Ensuring a correct and timely HIV diagnosis is critical. WHO publishes guidelines on HIV testing strategies that maximise the likelihood of correctly determining one’s HIV status. A review of national HIV testing policies in 2014 found low adherence to WHO guidelines. We updated this review to determine adherence to current recommendations. Methods We conducted a comprehensive policy review through April 2018. We extracted data on HIV testing strategies, recommendations on HIV retesting prior to antiretroviral therapy (ART) initiation and pre-exposure prophylaxis (PrEP)-related HIV testing information. Descriptive analyses disaggregated by region were conducted to ascertain adherence to recommendations and to describe testing strategy characteristics. Results Of 91 policies included, 26% (n=24/91) adhered to WHO recommendations. Having a two-assay testing strategy to rule-in HIV infection as opposed to the recommended three-assay testing strategy was a major reason for non-adherence. Of 72 country policies providing sufficient information, 31% (n=22) recommended retesting for HIV prior to initiating ART. Of 25 countries and two regions reporting PrEP-related HIV testing guidelines, almost all recommended testing prior to initiating PrEP and every 3 months during PrEP use. Conclusions Global adherence to WHO recommendations for HIV testing strategies have improved since 2014 but remain low. We found adherence existed on a continuum. Such a system provides insights into how countries can move towards adherence by making relatively minor changes to testing strategies. Guidance from WHO on the role of new HIV testing technologies within testing algorithms and identifying ways to simplify testing guidance is warranted.
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Affiliation(s)
- Virginia A Fonner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Anita Sands
- Department of Regulation and Prequalification, World Health Organization, Geneve, GE, Switzerland
| | - Carmen Figueroa
- Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, GE, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, GE, Switzerland
| | - Caitlin Quinn
- Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, GE, Switzerland
| | - Muhammad S Jamil
- Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, GE, Switzerland
| | - Cheryl Johnson
- Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, GE, Switzerland
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Drake AL, Quinn C, Kidula N, Sibanda E, Steyn P, Barr-DiChiara M, Jamil MS, Rodolph M, Gaffield ME, Kiarie J, Baggaley R, Johnson C. A Landscape Analysis of Offering HIV Testing Services Within Family Planning Service Delivery. Front Reprod Health 2021; 3:657728. [PMID: 36304029 PMCID: PMC9580748 DOI: 10.3389/frph.2021.657728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/01/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Offering HIV testing services (HTS) within sexual and reproductive health (SRH) services is a priority, especially for women who have a substantial risk. To reach women with HIV who do not know their status and prevent mother-to-child HIV transmission, the World Health Organization (WHO) recommends routinely offering HTS as part of family planning (FP) service delivery in high HIV burden settings. We conducted a landscape analysis to assess HTS uptake and HIV positivity in the context of FP/SRH services. Assessment of Research and Programs: We searched records from PubMed, four gray literature databases, and 13 organization websites, and emailed 24 organizations for data on HTS in FP/SRH services. We also obtained data from International Planned Parenthood Federation (IPPF) affiliates in Eswatini, Kenya, Lesotho, Malawi, Namibia, Uganda, Zambia, and Zimbabwe. Unique programs/studies from records were included if they provided data on, or barriers/facilitators to, offering HTS in FP/SRH. Overall, 2,197 records were screened and 12 unique programs/studies were eligible, including 10 from sub-Saharan Africa. Four reported on co-delivery of SRH services (including FP), with reported HTS uptake between 17 and 94%. Six reported data on HTS in FP services: four among general FP clients; one among couples; and one among female sex workers, adolescent girls, and young women. Two of the six reported HTS uptake >50% (51%, 419/814 Kenya; 63%, 5,930/9,439 Uganda), with positivity rates of 2% and 4.1%, respectively. Uptake was low (8%, 74/969 Kenya) in the one FP program offering pre-exposure prophylaxis. In the IPPF program, seven countries reported HTS uptake in FP services and ranged from 4% in Eswatini to 90% in Lesotho; between 0.6% (Uganda) and 8% (Eswatini) of those tested were HIV positive. Implications: Data on providing HTS in FP/SRH service delivery were sparse and HTS uptake varied widely across programs. Actionable Recommendations: As countries expand HTS in FP/SRH appropriate to epidemiology, they should ensure data are reported and monitored for progress and impact.
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Affiliation(s)
- Alison L. Drake
- Department of Global Health, University of Washington, Seattle, WA, United States
- *Correspondence: Alison L. Drake
| | - Caitlin Quinn
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Nancy Kidula
- WHO Regional Office for Africa, Intercounty Support Team for Eastern and Southern Africa, Harare, Zimbabwe
| | - Euphemia Sibanda
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
| | - Petrus Steyn
- The United Nations Development Programme/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), Geneva, Switzerland
| | - Magdalena Barr-DiChiara
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S. Jamil
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Michelle Rodolph
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Mary E. Gaffield
- The United Nations Development Programme/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), Geneva, Switzerland
| | - James Kiarie
- The United Nations Development Programme/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), Geneva, Switzerland
| | - Rachel Baggaley
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl Johnson
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
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Indravudh PP, Fielding K, Kumwenda MK, Nzawa R, Chilongosi R, Desmond N, Nyirenda R, Neuman M, Johnson CC, Baggaley R, Hatzold K, Terris-Prestholt F, Corbett EL. Effect of community-led delivery of HIV self-testing on HIV testing and antiretroviral therapy initiation in Malawi: A cluster-randomised trial. PLoS Med 2021; 18:e1003608. [PMID: 33974621 PMCID: PMC8112698 DOI: 10.1371/journal.pmed.1003608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 04/04/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Undiagnosed HIV infection remains substantial in key population subgroups including adolescents, older adults, and men, driving ongoing transmission in sub-Saharan Africa. We evaluated the impact, safety, and costs of community-led delivery of HIV self-testing (HIVST), aiming to increase HIV testing in underserved subgroups and stimulate demand for antiretroviral therapy (ART). METHODS AND FINDINGS This cluster-randomised trial, conducted between October 2018 and July 2019, used restricted randomisation (1:1) to allocate 30 group village head clusters in Mangochi district, Malawi to the community-led HIVST intervention in addition to the standard of care (SOC) or the SOC alone. The intervention involved mobilising community health groups to lead the design and implementation of 7-day HIVST campaigns, with cluster residents (≥15 years) eligible for HIVST. The primary outcome compared lifetime HIV testing among adolescents (15 to 19 years) between arms. Secondary outcomes compared: recent HIV testing (in the last 3 months) among older adults (≥40 years) and men; cumulative 6-month incidence of ART initiation per 100,000 population; knowledge of the preventive benefits of HIV treatment; and HIV testing stigma. Outcomes were measured through a post-intervention survey and at neighboring health facilities. Analysis used intention-to-treat for cluster-level outcomes. Community health groups delivered 24,316 oral fluid-based HIVST kits. The survey included 90.2% (3,960/4,388) of listed participants in the 15 community-led HIVST clusters and 89.2% (3,920/4,394) of listed participants in the 15 SOC clusters. Overall, the proportion of men was 39.0% (3,072/7,880). Most participants obtained primary-level education or below, were married, and reported a sexual partner. Lifetime HIV testing among adolescents was higher in the community-led HIVST arm (84.6%, 770/910) than the SOC arm (67.1%, 582/867; adjusted risk difference [RD] 15.2%, 95% CI 7.5% to 22.9%; p < 0.001), especially among 15 to 17 year olds and boys. Recent testing among older adults was also higher in the community-led HIVST arm (74.5%, 869/1,166) than the SOC arm (31.5%, 350/1,111; adjusted RD 42.1%, 95% CI 34.9% to 49.4%; p < 0.001). Similarly, the proportions of recently tested men were 74.6% (1,177/1,577) and 33.9% (507/1,495) in the community-led HIVST and SOC arms, respectively (adjusted RD 40.2%, 95% CI 32.9% to 47.4%; p < 0.001). Knowledge of HIV treatment benefits and HIV testing stigma showed no differences between arms. Cumulative incidence of ART initiation was respectively 305.3 and 226.1 per 100,000 population in the community-led HIVST and SOC arms (RD 72.3, 95% CI -36.2 to 180.8; p = 0.18). In post hoc analysis, ART initiations in the 3-month post-intervention period were higher in the community-led HIVST arm than the SOC arm (RD 97.7, 95% CI 33.4 to 162.1; p = 0.004). HIVST uptake was 74.7% (2,956/3,960), with few adverse events (0.6%, 18/2,955) and at US$5.70 per HIVST kit distributed. The main limitations include the use of self-reported HIV testing outcomes and lack of baseline measurement for the primary outcome. CONCLUSIONS In this study, we found that community-led HIVST was effective, safe, and affordable, with population impact and coverage rapidly realised at low cost. This approach could enable community HIV testing in high HIV prevalence settings and demonstrates potential for economies of scale and scope. TRIAL REGISTRATION Clinicaltrials.gov NCT03541382.
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Affiliation(s)
- Pitchaya P. Indravudh
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Katherine Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Moses K. Kumwenda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Rebecca Nzawa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Nicola Desmond
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Rose Nyirenda
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Melissa Neuman
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Cheryl C. Johnson
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organisation, Geneva, Switzerland
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rachel Baggaley
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organisation, Geneva, Switzerland
| | - Karin Hatzold
- Population Services International, Washington, District of Columbia, United States of America
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Elizabeth L. Corbett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Johnson C, Kumwenda M, Meghji J, Choko AT, Phiri M, Hatzold K, Baggaley R, Taegtmeyer M, Terris-Prestholt F, Desmond N, Corbett EL. 'Too old to test?': A life course approach to HIV-related risk and self-testing among midlife-older adults in Malawi. BMC Public Health 2021; 21:650. [PMID: 33812381 PMCID: PMC8019342 DOI: 10.1186/s12889-021-10573-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 03/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite the aging HIV epidemic, increasing age can be associated with hesitancy to test. Addressing this gap is a critical policy concern and highlights the urgent need to identify the underlying factors, to improve knowledge of HIV-related risks as well as uptake of HIV testing and prevention services, in midlife-older adults. METHODS We conducted five focus group discussions and 12 in-depth interviews between April 2013 and November 2016 among rural and urban Malawian midlife-older (≥30 years) men and women. Using a life-course theoretical framework we explored how age is enacted socially and its implications on HIV testing and sexual risk behaviours. We also explore the potential for HIV self-testing (HIVST) to be part of a broader strategy for engaging midlife-older adults in HIV testing, prevention and care. Thematic analysis was used to identify recurrent themes and variations. RESULTS Midlife-older adults (30-74 years of age) associated their age with respectability and identified HIV as "a disease of youth" that would not affect them, with age protecting them against infidelity and sexual risk-taking. HIV testing was felt to be stigmatizing, challenging age norms, threatening social status, and implying "lack of wisdom". These norms drove self-testing preferences at home or other locations deemed age and gender appropriate. Awareness of the potential for long-standing undiagnosed HIV to be carried forward from past relationships was minimal, as was understanding of treatment-as-prevention. These norms led to HIV testing being perceived as a threat to status by older adults, contributing to low levels of recent HIV testing compared to younger adults. CONCLUSIONS Characteristics associated with age-gender norms and social position encourage self-testing but drive poor HIV-risk perception and unacceptability of conventional HIV testing in midlife-older adults. There is an urgent need to provide targeted messages and services more appropriate to midlife-older adults in sub-Saharan Africa. HIVST which has often been highlighted as a tool for reaching young people, may be a valuable tool for engaging midlife-older age groups who may not otherwise test.
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Affiliation(s)
- Cheryl Johnson
- Global of HIV, Hepatitis and STIs Programmes, World Health Organization, 20 Ave Appia, 1211, Geneva, Switzerland. .,Department of Clinical Research and Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK.
| | - Moses Kumwenda
- Malawi Liverpool Wellcome Trust, HIV/TB Group, Blantyre, Malawi.,Helse Nord TB Initiative, College of Medicine, Blantyre, Malawi
| | - Jamilah Meghji
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Augustine T Choko
- Department of Clinical Research and Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK.,Malawi Liverpool Wellcome Trust, HIV/TB Group, Blantyre, Malawi
| | | | - Karin Hatzold
- Population Services International, Johannesburg, South Africa
| | - Rachel Baggaley
- Global of HIV, Hepatitis and STIs Programmes, World Health Organization, 20 Ave Appia, 1211, Geneva, Switzerland
| | - Miriam Taegtmeyer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Tropical Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Fern Terris-Prestholt
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicola Desmond
- Malawi Liverpool Wellcome Trust, HIV/TB Group, Blantyre, Malawi.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Elizabeth L Corbett
- Department of Clinical Research and Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK.,Malawi Liverpool Wellcome Trust, HIV/TB Group, Blantyre, Malawi
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Meisner J, Roberts DA, Rodriguez P, Sharma M, Newman Owiredu M, Gomez B, de Mello MB, Bobrik A, Vodianyk A, Storey A, Githuka G, Chidarikire T, Barnabas R, Farid S, Essajee S, Jamil MS, Baggaley R, Johnson C, Drake AL. Optimizing HIV retesting during pregnancy and postpartum in four countries: a cost-effectiveness analysis. J Int AIDS Soc 2021; 24:e25686. [PMID: 33787064 PMCID: PMC8010369 DOI: 10.1002/jia2.25686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION HIV retesting during late pregnancy and breastfeeding can help detect new maternal infections and prevent mother-to-child HIV transmission (MTCT), but the optimal timing and cost-effectiveness of maternal retesting remain uncertain. METHODS We constructed deterministic models to assess the health and economic impact of maternal HIV retesting on a hypothetical population of pregnant women, following initial testing in pregnancy, on MTCT in four countries: South Africa and Kenya (high/intermediate HIV prevalence), and Colombia and Ukraine (low HIV prevalence). We evaluated six scenarios with varying retesting frequencies from late in antenatal care (ANC) through nine months postpartum. We compared strategies using incremental cost-effectiveness ratios (ICERs) over a 20-year time horizon using country-specific thresholds. RESULTS We found maternal retesting once in late ANC with catch-up testing through six weeks postpartum was cost-effective in Kenya (ICER = $166 per DALY averted) and South Africa (ICER=$289 per DALY averted). This strategy prevented 19% (Kenya) and 12% (South Africa) of infant HIV infections. Adding one or two additional retests postpartum provided smaller benefits (1 to 2 percentage point increase in infections averted versus one retest). Adding three retests during the postpartum period averted additional infections (1 to 3 percentage point increase in infections averted versus one retest) but ICERs ($7639 and in Kenya and $11 985 in South Africa) greatly exceeded the cost-effectiveness thresholds. In Colombia and Ukraine, all retesting strategies exceeded the cost-effectiveness threshold and prevented few infant infections (up to 31 and 5 infections, respectively). CONCLUSIONS In high HIV burden settings with MTCT rates similar to those seen in Kenya and South Africa, HIV retesting once in late ANC, with subsequent intervention, is the most cost-effective strategy for preventing infant HIV infections. In these settings, two HIV retests postpartum marginally reduced MTCT and were less costly than adding three retests. Retesting in low-burden settings with MTCT rates similar to Colombia and Ukraine was not cost-effective at any time point due to very low HIV prevalence and limited breastfeeding.
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Affiliation(s)
| | - D Allen Roberts
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Patricia Rodriguez
- The Comparative Health Outcomes Policy & Economics InstituteUniversity of WashingtonSeattleWAUSA
| | - Monisha Sharma
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | | | - Bertha Gomez
- Pan American Health Organization/World Health OrganizationColombia OfficeBogotáColombia
| | - Maeve B de Mello
- Department of Communicable Diseases and Environmental Determinants of HealthPan American Health Organization/World Health OrganizationWashingtonDCUSA
| | - Alexey Bobrik
- Global Fund to Fight AIDS, Tuberculosis and MalariaGenevaSwitzerland
| | | | | | | | - Thato Chidarikire
- HIV Prevention ProgrammesNational Department of HealthPretoriaSouth Africa
| | - Ruanne Barnabas
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
| | - Shiza Farid
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | | | - Muhammad S Jamil
- Global HIV, Hepatitis and STI programmeWorld Health OrganizationGenevaSwitzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and STI programmeWorld Health OrganizationGenevaSwitzerland
| | - Cheryl Johnson
- Global HIV, Hepatitis and STI programmeWorld Health OrganizationGenevaSwitzerland
| | - Alison L Drake
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
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Velloza J, Kapogiannis B, Bekker LG, Celum C, Hosek S, Delany-Moretlwe S, Baggaley R, Dalal S. Interventions to improve daily medication use among adolescents and young adults: what can we learn for youth pre-exposure prophylaxis services? AIDS 2021; 35:463-475. [PMID: 33252486 PMCID: PMC7855564 DOI: 10.1097/qad.0000000000002777] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 10/30/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Oral pre-exposure prophylaxis (PrEP) is an important HIV prevention method and studies have shown that young people ages 15-24 have difficulty adhering to daily PrEP. The field of PrEP delivery for young people is relatively nascent and lessons about potential PrEP adherence interventions could be learned from the larger evidence base of adherence interventions for other daily medications among youth. DESIGN Systematic review of adherence support interventions for adolescents. METHODS We searched PubMed, CINAHL, EMBASE, and PsycINFO through January 2020 for oral contraceptive pill (OCP), antiretroviral therapy (ART), asthma, and diabetes medication adherence interventions. We reviewed primary articles about OCP adherence interventions and reviewed systematic reviews for ART, asthma, and diabetes medication adherence interventions. Studies were retained if they included participants' ages 10-24 years; measured OCP, ART, asthma, or diabetes medication adherence; and were systematic reviews, randomized trials, or quasi-experimental studies. RESULTS Fifteen OCP articles and 26 ART, diabetes, and asthma systematic reviews were included. Interventions that improved medication adherence for OCPs, ART, asthma, and diabetes treatment included reminder text messages, computer-based and phone-based support, and enhanced counseling. Multi-month prescriptions and same-day pill starts also were found to improve OCP adherence and continuation. Adolescent-friendly clinics and peer-based counseling significantly improved ART adherence, and telemedicine interventions improved diabetes medication adherence. CONCLUSION Interventions that improve medication adherence among youth include enhanced counseling, extended pill supply, adolescent-friendly services, and text message reminders. PrEP programs could incorporate and evaluate such interventions for their impact on PrEP adherence and continuation among at-risk adolescents.
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Affiliation(s)
- Jennifer Velloza
- Department of Global Health, University of Washington, Seattle, Washington
| | - Bill Kapogiannis
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Shona Dalal
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
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Holmes CB, Kilonzo N, Zhao J, Johnson LF, Kalua T, Hasen N, Morrison M, Marston M, Smith T, Benech I, Baggaley R, Carter A, Khasiani M, DePasse J, Mahy M, Ryan C, Garnett GP. Strengthening measurement and performance of HIV prevention programmes. Lancet HIV 2021; 8:e306-e310. [PMID: 33577781 DOI: 10.1016/s2352-3018(20)30278-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/04/2020] [Accepted: 10/09/2020] [Indexed: 10/22/2022]
Abstract
Indicators for the measurement of programmes for the primary prevention of HIV are less aligned than indicators for HIV treatment, which results in a high burden of data collection, often without a clear vision for its use. As new evidence becomes available, the opportunity arises to critically evaluate the way countries and global bodies monitor HIV prevention programmes by incorporating emerging data on the strength of the evidence linking various factors with HIV acquisition, and by working to streamline indicators across stakeholders to reduce burdens on health-care systems. Programmes are also using new approaches, such as targeting specific sexual networks that might require non-traditional approaches to measurement. Technological advances can support these new directions and provide opportunities to use real-time analytics and new data sources to more effectively understand and adapt HIV prevention programmes to reflect population movement, risks, and an evolving epidemic.
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Affiliation(s)
- Charles B Holmes
- Center for Innovation in Global Health, Georgetown University, Washington, DC, USA.
| | | | - Jinkou Zhao
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | | | - Thokozani Kalua
- Department of HIV and AIDS, Malawi Ministry of Health, Lilongwe, Malawi
| | - Nina Hasen
- Population Services International, Washington, DC, USA
| | | | - Milly Marston
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Irene Benech
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Anna Carter
- Center for Innovation in Global Health, Georgetown University, Washington, DC, USA
| | | | | | | | - Caroline Ryan
- US Centers for Disease Control and Prevention, Mbabane, Eswatini
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Stelzle D, Godfrey-Faussett P, Jia C, Amiesimaka O, Mahy M, Castor D, Hodges-Mameletzis I, Chitembo L, Baggaley R, Dalal S. Estimating HIV pre-exposure prophylaxis need and impact in Malawi, Mozambique and Zambia: A geospatial and risk-based analysis. PLoS Med 2021; 18:e1003482. [PMID: 33428611 PMCID: PMC7799816 DOI: 10.1371/journal.pmed.1003482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 12/07/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP), a WHO-recommended HIV prevention method for people at high risk for acquiring HIV, is being increasingly implemented in many countries. Setting programmatic targets, particularly in generalised epidemics, could incorporate estimates of the size of the population likely to be eligible for PrEP using incidence-based thresholds. We estimated the proportion of men and women who would be eligible for PrEP and the number of HIV infections that could be averted in Malawi, Mozambique, and Zambia using prioritisation based on age, sex, geography, and markers of risk. METHODS AND FINDINGS We analysed the latest nationally representative Demographic and Health Surveys (DHS) of Malawi, Mozambique, and Zambia to determine the proportion of adults who report behavioural markers of risk for HIV infection. We used prevalence ratios (PRs) to quantify the association of these factors with HIV status. Using a multiplier method, we combined these proportions with the number of new HIV infections by district, derived from district-level modelled HIV estimates. Based on these numbers, different scenarios were analysed for the minimum number of person-years on PrEP needed to prevent 1 HIV infection (NNP). An estimated total of 38,000, 108,000, and 46,000 new infections occurred in Malawi, Mozambique, and Zambia in 2016, corresponding with incidence rates of 0.43, 0.63, and 0.57 per 100 person-years. In these countries, 9%-20% of new infections occurred among people with a sexually transmitted infection (STI) in the past 12 months and 40%-42% among people with either an STI or a non-regular sexual partner (NP) in the past 12 months (STINP). The models estimate that around 50% of new infections occurred in districts with incidence rates ≥1.0% in Mozambique and Zambia and ≥0.5% in Malawi. In Malawi, Mozambique, and Zambia, 35.1%, 21.9%, and 12.5% of the population live in these high-incidence districts. In the most parsimonious scenario, if women aged 15-34 years and men 20-34 years with an STI in the past 12 months living in high-incidence districts were to take PrEP, it would take a minimum of 65.8 person-years on PrEP to avert 1 HIV infection per year in Malawi, 35.2 in Mozambique, and 16.4 in Zambia. Our findings suggest that 3,300, 5,200, and 1,700 new infections could be averted per year in the 3 countries, respectively. Limitations of our study are that these values are based on modelled estimates of HIV incidence and self-reported behavioural risk factors from national surveys. CONCLUSIONS A large proportion of new HIV infections in these 3 African countries were estimated to occur among people who had either an STI or an NP in the past year, providing a straightforward means to set PrEP targets. Greater prioritisation of PrEP by district, sex, age, and behavioural risk factors resulted in lower NNPs thereby increasing PrEP cost-effectiveness, but also diminished the overall impact on reducing new infections.
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Affiliation(s)
- Dominik Stelzle
- Center for Global Health, Department of Neurology, Technical University, Munich, Germany
- Chair of Epidemiology, Faculty of Sport and Health Sciences, Technical University, Munich, Germany
| | - Peter Godfrey-Faussett
- Strategic Information Department, UNAIDS, Geneva, Switzerland
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chuan Jia
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Obreniokibo Amiesimaka
- Center for Global Health, Department of Neurology, Technical University, Munich, Germany
| | - Mary Mahy
- Strategic Information Department, UNAIDS, Geneva, Switzerland
| | - Delivette Castor
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, United States of America
| | | | | | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Shona Dalal
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
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Rodriguez PJ, Roberts DA, Meisner J, Sharma M, Owiredu MN, Gomez B, Mello MB, Bobrik A, Vodianyk A, Storey A, Githuka G, Chidarikire T, Barnabas R, Barr-Dichiara M, Jamil MS, Baggaley R, Johnson C, Taylor MM, Drake AL. Cost-effectiveness of dual maternal HIV and syphilis testing strategies in high and low HIV prevalence countries: a modelling study. Lancet Glob Health 2021; 9:e61-e71. [PMID: 33227254 PMCID: PMC7783487 DOI: 10.1016/s2214-109x(20)30395-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dual HIV and syphilis testing might help to prevent mother-to-child transmission (MTCT) of HIV and syphilis through increased case detection and treatment. We aimed to model and assess the cost-effectiveness of dual testing during antenatal care in four countries with varying HIV and syphilis prevalence. METHODS In this modelling study, we developed Markov models of HIV and syphilis in pregnant women to estimate costs and infant health outcomes of maternal testing at the first antenatal care visit with individual HIV and syphilis tests (base case) and at the first antenatal care visit with a dual rapid diagnostic test (scenario one). We additionally evaluated retesting during late antenatal care and at delivery with either individual tests (scenario two) or a dual rapid diagnosis test (scenario three). We modelled four countries: South Africa, Kenya, Colombia, and Ukraine. Strategies with an incremental cost-effectiveness ratio (ICER) less than the country-specific cost-effectiveness threshold (US$500 in Kenya, $750 in South Africa, $3000 in Colombia, and $1000 in Ukraine) per disability-adjusted life-year averted were considered cost-effective. FINDINGS Routinely offering testing at the first antenatal care visit with a dual rapid diagnosis test was cost-saving compared with the base case in all four countries (ICER: -$26 in Kenya,-$559 in South Africa, -$844 in Colombia, and -$454 in Ukraine). Retesting during late antenatal care with a dual rapid diagnostic test (scenario three) was cost-effective compared with scenario one in all four countries (ICER: $270 in Kenya, $260 in South Africa, $2207 in Colombia, and $205 in Ukraine). INTERPRETATION Incorporating dual rapid diagnostic tests in antenatal care can be cost-saving across countries with varying HIV prevalence. Countries should consider incorporating dual HIV and syphilis rapid diagnostic tests as the first test in antenatal care to support efforts to eliminate MTCT of HIV and syphilis. FUNDING WHO, US Agency for International Development, and the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Patricia J Rodriguez
- The Comparative Health Outcomes Policy & Economics Institute, University of Washington, Seattle, WA, USA
| | - D Allen Roberts
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Julianne Meisner
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Morkor Newman Owiredu
- Global HIV, Hepatitis and Sexually Transmitted Infections Programme, WHO, Geneva, Switzerland
| | - Bertha Gomez
- Pan American Health Organization and WHO, Colombia Office, Bogotá DC, Colombia
| | - Maeve B Mello
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization and WHO, Washington DC, USA
| | - Alexey Bobrik
- Global Fund to Fight AIDS, Tuberculosis and Malaria, Grand-Saconnex, Switzerland
| | - Arkadii Vodianyk
- Department of Infectious Diseases, Ukraine Country Office, WHO, Kiev, Ukraine
| | - Andrew Storey
- Maternal and Neonatal Health, Clinton Health Access Initiative, Boston, MA, USA
| | | | - Thato Chidarikire
- HIV Prevention Programmes, National Department of Health, Pretoria, South Africa
| | - Ruanne Barnabas
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Magdalena Barr-Dichiara
- Global HIV, Hepatitis and Sexually Transmitted Infections Programme, WHO, Geneva, Switzerland
| | - Muhammad S Jamil
- Global HIV, Hepatitis and Sexually Transmitted Infections Programme, WHO, Geneva, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and Sexually Transmitted Infections Programme, WHO, Geneva, Switzerland
| | - Cheryl Johnson
- Global HIV, Hepatitis and Sexually Transmitted Infections Programme, WHO, Geneva, Switzerland; Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Melanie M Taylor
- Global HIV, Hepatitis and Sexually Transmitted Infections Programme, WHO, Geneva, Switzerland; Division of Sexually Transmitted Diseases Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alison L Drake
- Department of Global Health, University of Washington, Seattle, WA, USA.
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50
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Witzel TC, Eshun-Wilson I, Jamil MS, Tilouche N, Figueroa C, Johnson CC, Reid D, Baggaley R, Siegfried N, Burns FM, Rodger AJ, Weatherburn P. Comparing the effects of HIV self-testing to standard HIV testing for key populations: a systematic review and meta-analysis. BMC Med 2020; 18:381. [PMID: 33267890 PMCID: PMC7713313 DOI: 10.1186/s12916-020-01835-z] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We update a previous systematic review to inform new World Health Organization HIV self-testing (HIVST) recommendations. We compared the effects of HIVST to standard HIV testing services to understand which service delivery models are effective for key populations. METHODS We did a systematic review of randomised controlled trials (RCTs) which compared HIVST to standard HIV testing in key populations, published from 1 January 2006 to 4 June 2019 in PubMed, Embase, Global Index Medicus, Social Policy and Practice, PsycINFO, Health Management Information Consortium, EBSCO CINAHL Plus, Cochrane Library and Web of Science. We extracted study characteristic and outcome data and conducted risk of bias assessments using the Cochrane ROB tool version 1. Random effects meta-analyses were conducted, and pooled effect estimates were assessed along with other evidence characteristics to determine the overall strength of the evidence using GRADE methodology. RESULTS After screening 5909 titles and abstracts, we identified 10 RCTs which reported on testing outcomes. These included 9679 participants, of whom 5486 were men who have sex with men (MSM), 72 were trans people and 4121 were female sex workers. Service delivery models included facility-based, online/mail and peer distribution. Support components were highly diverse and ranged from helplines to training and supervision. HIVST increased testing uptake by 1.45 times (RR=1.45 95% CI 1.20, 1.75). For MSM and small numbers of trans people, HIVST increased the mean number of HIV tests by 2.56 over follow-up (mean difference = 2.56; 95% CI 1.24, 3.88). There was no difference between HIVST and SoC in regard to positivity among tested overall (RR = 0.91; 95% CI 0.73, 1.15); in sensitivity analysis of positivity among randomised HIVST identified significantly more HIV infections among MSM and trans people (RR = 2.21; 95% CI 1.20, 4.08) and in online/mail distribution systems (RR = 2.21; 95% CI 1.14, 4.32). Yield of positive results in FSW was not significantly different between HIVST and SoC. HIVST reduced linkage to care by 17% compared to SoC overall (RR = 0.83; 95% CI 0.74, 0.92). Impacts on STI testing were mixed; two RCTs showed no decreases in STI testing while one showed significantly lower STI testing in the intervention arm. There were no negative impacts on condom use (RR = 0.95; 95% CI 0.83, 1.08), and social harm was very rare. CONCLUSIONS HIVST is safe and increases testing uptake and frequency as well as yield of positive results for MSM and trans people without negative effects on linkage to HIV care, STI testing, condom use or social harm. Testing uptake was increased for FSW, yield of positive results were not and linkage to HIV care was worse. Strategies to improve linkage to care outcomes for both groups are crucial for effective roll-out.
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Affiliation(s)
- T Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | | | - Muhammad S Jamil
- Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, Switzerland
| | - Nerissa Tilouche
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Carmen Figueroa
- Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, Switzerland
| | - Cheryl C Johnson
- Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, Switzerland
| | - David Reid
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Rachel Baggaley
- Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, Switzerland
| | - Nandi Siegfried
- Independent Clinical Epidemiologist, Cape Town, Republic of South Africa
| | - Fiona M Burns
- Institute for Global Health, University College London, London, UK
| | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | - Peter Weatherburn
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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