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  • 1
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    Completion of the tuberculosis care cascade in a community‐based HIV linkage‐to‐care study in South Africa and Uganda
    Wiley ; 2018
    In:  Journal of the International AIDS Society Vol. 21, No. 1 ( 2018-01)
    Details
    In: Journal of the International AIDS Society, Wiley, Vol. 21, No. 1 ( 2018-01)
    Abstract: Tuberculosis ( TB ) is the leading cause of HIV ‐associated mortality in Africa. As HIV testing, linkage to care and antiretroviral treatment initiation intensify to meet UNAIDS targets, it is not known what effect these efforts will have on TB detection and prevention. We aimed to characterize the TB care cascade of screening, diagnostic testing, treatment and provision of isoniazid preventive therapy ( IPT ) in a study of community‐based HIV screening and linkage to care and determine whether symptom screening results affected progress along the cascade. Methods Between June 2013 and March 2015, HIV ‐infected adults enrolled in the Linkages study, a multi‐site, community‐based, randomized HIV screening and linkage‐to‐care study in South Africa and Uganda. All participants were screened for TB symptoms at entry after testing positive for HIV and referred to local clinics for care. During the 9 month follow‐up, participants were periodically surveyed about clinic linkage and initiation of HIV care as well as subsequent TB testing, treatment, or IPT . We compared outcomes between persons with and without a positive symptom screen at baseline using descriptive statistics and Poisson regression to calculate relative risks of outcomes along the care cascade. Results and discussion Of the 1,325 HIV ‐infected adults enrolled, 26% reported at least one TB symptom at the time of HIV diagnosis. Loss of appetite and fever were the most commonly reported symptoms on a TB symptom screen. Despite 92% HIV linkage success, corresponding TB linkage was incomplete. Baseline TB symptoms were associated with an increased risk of a TB diagnosis (relative risk 3.23, 95% CI 1.51 to 6.91), but only 34% of symptomatic persons had sputum TB testing. Fifty‐five percent of participants diagnosed with TB started TB treatment. In South Africa, only 18% of asymptomatic participants initiated IPT after linkage to HIV care, and presence of symptoms was not associated with IPT initiation (relative risk 0.86 95% CI 0.6 to 1.23). Conclusions HIV linkage to care interventions provide an opportunity to improve completion of the TB care cascade, but will require additional support to realize full benefits.
    Type of Medium: Online Resource
    ISSN: 1758-2652 , 1758-2652
    URL: Issue
    URL: Article
    DOI: 10.1002/jia2.2018.21.issue-1
    DOI: 10.1002/jia2.25065
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2467110-1
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  • 2
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    HIV pre‐exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery
    Wiley ; 2019
    In:  Journal of the International AIDS Society Vol. 22, No. S4 ( 2019-07)
    Details
    In: Journal of the International AIDS Society, Wiley, Vol. 22, No. S4 ( 2019-07)
    Abstract: Adolescent girls and young women (AGYW) in Africa have high HIV incidence despite scale‐up of HIV testing and HIV treatment. Placebo‐controlled trials of tenofovir‐based pre‐exposure prophylaxi (PrEP) in diverse populations demonstrated that PrEP works with close to 100% effectiveness if taken with high, but not perfect, adherence. Divergent efficacy estimates among African AGYW led to demonstration and implementation projects to better understand motivations for HIV prevention, uptake, adherence and persistence to PrEP. To inform PrEP programmes, the design and initial findings from PrEP demonstration projects for AGYW are reviewed. Discussion Early lessons from PrEP implementation projects among young African women include: (1) awareness and demand creation with positive messaging about the benefits of PrEP are critical to motivate AGYW to consider this novel prevention technology and to foster awareness among peers, partners, parents and guardians to support AGYW's effective PrEP use; (2) PrEP initiation is high in projects that are integrating PrEP into youth‐friendly clinics, family planning clinics and mobile clinics; (3) young African women at risk are initiating PrEP, based on behavioural characteristics, history of intimate partner violence, depression and 30% prevalence of chlamydia and/or gonorrhoea; (4) provision of youth‐friendly PrEP delivery programmes that integrate reproductive health services, including contraception and the diagnosis and treatment of sexually transmitted infections, increase health impact; (5) messages that emphasize the necessity for high adherence while at potential risk of HIV exposure and support strategies that addresses AGYW's adherence challenges are essential; and, (6) a substantial proportion of AGYW do not persist with PrEP, and strategies are needed to help AGYW assess their ongoing need, motivation and challenges with persisting with PrEP. Conclusions PrEP is feasible to implement in integrated reproductive health service delivery models to reach African AGYW. While PrEP demonstration projects indicate that women with behavioural risks and high rates of sexually transmitted diseases are initiating PrEP; effective strategies to support AGYW's adherence and persistence with PrEP are needed. Lessons learned from oral PrEP delivery, a novel first generation HIV prevention product, are relevant to longer‐acting and less adherence‐dependent strategies which are currently in clinical trials.
    Type of Medium: Online Resource
    ISSN: 1758-2652 , 1758-2652
    URL: Issue
    URL: Article
    DOI: 10.1002/jia2.2019.22.issue-S4
    DOI: 10.1002/jia2.25298
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2467110-1
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  • 3
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    Self-Assessed Severity as a Determinant of Coronavirus Disease 2019 Symptom Specificity: A Longitudinal Cohort Study
    Oxford University Press (OUP) ; 2022
    In:  Clinical Infectious Diseases Vol. 75, No. 1 ( 2022-08-24), p. e1180-e1183
    Details
    In: Clinical Infectious Diseases, Oxford University Press (OUP), Vol. 75, No. 1 ( 2022-08-24), p. e1180-e1183
    Abstract: Coronavirus disease 2019 symptom definitions rarely include symptom severity. We collected daily nasal swab samples and symptom diaries from contacts of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) case patients. Requiring ≥1 moderate or severe symptom reduced sensitivity to predict SARS-CoV-2 shedding from 60.0% (95% confidence interval [CI], 52.9%−66.7%) to 31.5% (95% CI, 25.7%− 38.0%) but increased specificity from 77.5% (95% CI, 75.3%−79.5%) to 93.8% (95% CI, 92.7%−94.8%).
    Type of Medium: Online Resource
    ISSN: 1058-4838 , 1537-6591
    URL: Article
    DOI: 10.1093/cid/ciac129
    RVK:
    XA 10000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2002229-3
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  • 4
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    How home HIV testing and counselling with follow‐up support achieves high testing coverage and linkage to treatment and prevention: a qualitative analysis from Uganda
    Wiley ; 2016
    In:  Journal of the International AIDS Society Vol. 19, No. 1 ( 2016-01)
    Details
    In: Journal of the International AIDS Society, Wiley, Vol. 19, No. 1 ( 2016-01)
    Abstract: The successes of HIV treatment scale‐up and the availability of new prevention tools have raised hopes that the epidemic can finally be controlled and ended. Reduction in HIV incidence and control of the epidemic requires high testing rates at population levels, followed by linkage to treatment or prevention. As effective linkage strategies are identified, it becomes important to understand how these strategies work. We use qualitative data from The Linkages Study, a recent community intervention trial of community‐based testing with linkage interventions in sub‐Saharan Africa, to show how lay counsellor home HIV testing and counselling (home HTC) with follow‐up support leads to linkage to clinic‐based HIV treatment and medical male circumcision services. Methods We conducted 99 semi‐structured individual interviews with study participants and three focus groups with 16 lay counsellors in Kabwohe, Sheema District, Uganda. The participant sample included both HIV+ men and women ( N =47) and HIV‐uncircumcised men ( N =52). Interview and focus group audio‐recordings were translated and transcribed. Each transcript was summarized. The summaries were analyzed inductively to identify emergent themes. Thematic concepts were grouped to develop general constructs and framing propositional statements. Results Trial participants expressed interest in linking to clinic‐based services at testing, but faced obstacles that eroded their initial enthusiasm. Follow‐up support by lay counsellors intervened to restore interest and inspire action. Together, home HTC and follow‐up support improved morale, created a desire to reciprocate, and provided reassurance that services were trustworthy. In different ways, these functions built links to the health service system. They worked to strengthen individuals’ general sense of capability, while making the idea of accessing services more manageable and familiar, thus reducing linkage barriers. Conclusions Home HTC with follow‐up support leads to linkage by building “social bridges,” interpersonal connections established and developed through repeated face‐to‐face contact between counsellors and prospective users of HIV treatment and male circumcision services. Social bridges link communities to the service system, inspiring individuals to overcome obstacles and access care.
    Type of Medium: Online Resource
    ISSN: 1758-2652 , 1758-2652
    URL: Article
    DOI: 10.7448/IAS.19.1.20929
    Language: English
    Publisher: Wiley
    Publication Date: 2016
    detail.hit.zdb_id: 2467110-1
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  • 5
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    An implementation study of oral and blood‐based HIV self‐testing and linkage to care among men in rural and peri‐urban KwaZulu‐Natal, South Africa
    Wiley ; 2020
    In:  Journal of the International AIDS Society Vol. 23, No. S2 ( 2020-06)
    Details
    In: Journal of the International AIDS Society, Wiley, Vol. 23, No. S2 ( 2020-06)
    Abstract: In South Africa, HIV‐infected men are less likely than women to test and know their status (the first UNAIDS “90‐90‐90” target), and men have worse outcomes across the HIV care cascade. HIV self‐testing (HIVST) may address this testing disparity but questions remain over the most effective distribution strategy and linkage following a positive test result. We implemented a men‐focused HIVST distribution programme to evaluate components contributing to participation and retention. Methods We conducted an implementation study of multi‐venue HIVST kit distribution in rural and peri‐urban KwaZulu‐Natal (KZN), South Africa. We distributed HIVST kits at community points, workplaces and social venues for on site or take‐home use. Clients could choose blood‐based or oral‐fluid‐based HIVST kits and elect to watch an in‐person or video demonstration. We provided a USD2 incentive to facilitate reporting test results by phone or SMS. Persons with reactive HIVST results were provided immediate confirmatory tests (if used HIVST on site) or were referred for confirmatory testing (if took HIVST off site) and linkage to care for ART initiation. We describe the testing and linkage cascade in this sample and describe predictors of reactive HIVST results and linkage. Results Between July and November 2018, we distributed 4496 HIVST kits in two regions of KZN (96% to men, median age 28 (IQR 23 to 35). Most participants (58%) chose blood‐based HIVST and 42% chose oral‐swab kits. 11% of men were testing for the first time. A total of 3902 (83%) of testers reported their test result to the study team, with 314 (8%) screening positive for HIV. Among 274 men with reactive HIVST results, 68% linked to ART; no significant predictors of linkage were identified. 10% of kit users reported they would prefer a different type (oral vs. blood) of kit for repeat testing than the type they used. Conclusions HIVST is acceptable to men and rapid distribution with optional testing support is feasible in rural and peri‐urban settings. HIVST kits successfully reached younger men and identified undetected infections. Both oral and blood‐based HIVST were selected. Scaling up HIVST distribution and guidance may increase the number of first‐time testers among men and help achieve the first UNAIDS “90” for men in South Africa.
    Type of Medium: Online Resource
    ISSN: 1758-2652 , 1758-2652
    URL: Issue
    URL: Article
    DOI: 10.1002/jia2.v23.s2
    DOI: 10.1002/jia2.25514
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2467110-1
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  • 6
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    Lottery incentives have short‐term impact on ART initiation among men: results from a randomized pilot study
    Wiley ; 2020
    In:  Journal of the International AIDS Society Vol. 23, No. S2 ( 2020-06)
    Details
    In: Journal of the International AIDS Society, Wiley, Vol. 23, No. S2 ( 2020-06)
    Abstract: Among people living with HIV in South Africa, viral suppression is lower among men than women. The study aim was to test the impact of lottery incentives, which reward positive health choice (e.g. antiretroviral therapy (ART) linkage) with a chance to win a prize, on strengthening the HIV care continuum including ART initiation and viral suppression for men. Methods We conducted a randomized, prospective trial of lottery incentives in the context of HIV testing and linkage to ART in rural KwaZulu‐Natal, South Africa. Men living with HIV were randomly allocated to: lottery incentives and motivational text messages or motivational text messages only. Lottery prize eligibility was conditional on clinic registration, ART initiation, or viral suppression by one, three and six months respectively. After completing each continuum step, participants in the lottery group were notified whether they had won and were encouraged to continue in care. Lottery prizes were either a mobile phone, data or a gift card (valued at R1000/$100). Kaplan–Meier curves were plotted to determine time to ART initiation by study group. The primary outcome was viral suppression at six months. Results Between November 2017 and December 2018, we tested 740 men for HIV and enrolled 131 HIV‐positive men who reported not being on ART. At baseline, 100 (76%) participants were 30 years and older, 95 (73%) were unemployed and the median CD4 count was 472 cells/μL. At study exit, 84% (110/131) of participants had visited a clinic and 62% (81/131) were virally suppressed. Compared to motivational text messages, lottery incentives decreased the median time to ART initiation from 126 to 66 days ( p  = 0.0043, age‐adjusted Cox regression) among all participants, and, from 134 days to 20 days ( p  = 0.0077) among participants who were not virally suppressed at baseline. Lottery incentives had an inconclusive effect on clinic registration (RR = 1.21, 95% CI: 0.83 to 1.76) and on viral suppression at six months (RR = 1.13, 95% CI: 0.73 to 1.75) compared to motivational text messages. Conclusions Conditional lottery incentives shortened the time to ART initiation among South African men. Behavioural economics strategies strengthen linkage to ART, but the study power was limited to see an impact on viral suppression. Clinical Trial Number NCT03808194.
    Type of Medium: Online Resource
    ISSN: 1758-2652 , 1758-2652
    URL: Issue
    URL: Article
    DOI: 10.1002/jia2.v23.s2
    DOI: 10.1002/jia2.25519
    Language: English
    Publisher: Wiley
    Publication Date: 2020
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  • 7
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    Cost‐effectiveness of pre‐exposure prophylaxis targeted to high‐risk serodiscordant couples as a bridge to sustained ART use in Kampala, Uganda
    Wiley ; 2015
    In:  Journal of the International AIDS Society Vol. 18, No. 4S3 ( 2015-07)
    Details
    In: Journal of the International AIDS Society, Wiley, Vol. 18, No. 4S3 ( 2015-07)
    Abstract: Despite scale‐up of antiretroviral therapy (ART) for treating HIV‐positive persons, HIV incidence remains elevated among those at high risk such as persons in serodiscordant partnerships. Antiretrovirals taken by HIV‐negative persons as pre‐exposure prophylaxis (PrEP) has the potential to avert infections in individuals in serodiscordant partnerships. Evaluating the cost‐effectiveness of implementing time‐limited PrEP as a short‐term bridge during the first six months of ART for the HIV‐positive partner to prevent HIV transmission compared to increasing ART coverage is crucial to informing policy‐makers considering PrEP implementation. Methods To estimate the real world delivery costs of PrEP, we conducted micro‐costing and time and motion analyses in an open‐label prospective study of PrEP and ART delivery targeted to high‐risk serodiscordant couples in Uganda (the Partners Demonstration Project). The cost (in USD, in 2012) of PrEP and ART for serodiscordant couples was assessed, with and without research components, in the study setting. Using Ministry of Health costs, the cost of PrEP and ART provision within a government programme was estimated, as was the cost of providing PrEP in addition to ART. We parameterized an HIV transmission model to estimate the health and economic impacts of 1) PrEP and ART targeted to high‐risk serodiscordant couples in the context of current ART use and 2) increasing ART coverage to 55% of HIV‐positive persons with CD4 ≤500 cells/µL without PrEP. The incremental cost‐effectiveness ratios (ICERs) per HIV infection and disability‐adjusted life year (DALY) averted were calculated over 10 years. Results The annual cost of PrEP and ART delivery for serodiscordant couples was $1058 per couple in the study setting and $453 in the government setting. The portion of the programme cost due to PrEP was $408 and $92 per couple per year in the study and government settings, respectively. Over 10 years, a programme of PrEP and ART for high‐risk serodiscordant couples was projected to avert 43% of HIV infections compared to current practice with an ICER of $1340 per infection averted. This was comparable to ART expansion alone, which would avert 37% of infections with an ICER of $1452. Conclusions Using Uganda's gross domestic product per capita of $1681 as a threshold, PrEP and ART for high‐risk persons have the potential for synergistic action and are cost‐effective in preventing HIV infections in high prevalence settings. The annual cost of PrEP in this programme is less than $100 per serodiscordant couple if implemented in public clinics.
    Type of Medium: Online Resource
    ISSN: 1758-2652 , 1758-2652
    URL: Article
    DOI: 10.7448/IAS.18.4.20013
    Language: English
    Publisher: Wiley
    Publication Date: 2015
    detail.hit.zdb_id: 2467110-1
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