scholarly journals Understanding Engagement in HIV Programmes: How Health Services Can Adapt to Ensure No One Is Left Behind

2020 ◽  
Vol 17 (5) ◽  
pp. 458-466
Author(s):  
Anna Grimsrud ◽  
Lynne Wilkinson ◽  
Ingrid Eshun-Wilson ◽  
Charles Holmes ◽  
Izukanji Sikazwe ◽  
...  
Keyword(s):  
Quality Care ◽  
Treatment Interruption ◽  
Patient Choice ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Engagement In Care ◽  
Hiv Status ◽  
Hiv Care Cascade ◽  
Left Behind ◽  
Living With Hiv

Abstract Purpose of Review Despite the significant progress in the HIV response, gaps remain in ensuring engagement in care to support life-long medication adherence and viral suppression. This review sought to describe the different points in the HIV care cascade where people living with HIV were not engaging and highlight promising interventions. Recent Findings There are opportunities to improve engagement both between testing and treatment and to support re-engagement in care for those in a treatment interruption. The gap between testing and treatment includes people who know their HIV status and people who do not know their status. People in a treatment interruption include those who interrupt immediately following initiation, early on in their treatment (first 6 months) and late (after 6 months or more on ART). For each of these groups, specific interventions are required to support improved engagement. Summary There are diverse needs and specific populations of people living with HIV who are not engaged in care, and differentiated service delivery interventions are required to meet their needs and expectations. For the HIV response to realise the 2030 targets, engagement will need to be supported by quality care and patient choice combined with empowered patients who are treatment literate and have been supported to improve self-management.

scholarly journals Estimating the HIV undiagnosed population in Catalonia, Spain: descriptive and comparative data analysis to identify differences in MSM stratified by migrant and Spanish-born population

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018533 ◽  
Author(s):  
Juliana Maria Reyes-Urueña ◽  
Colin N J Campbell ◽  
Núria Vives ◽  
Anna Esteve ◽  
Juan Ambrosioni ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Retention In Care ◽  
Hiv And Aids ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Undiagnosed Hiv ◽  
Sex With Men ◽  
Living With Hiv

ObjectiveUndiagnosed HIV continues to be a hindrance to efforts aimed at reducing incidence of HIV. The objective of this study was to provide an estimate of the HIV undiagnosed population in Catalonia and compare the HIV care cascade with this step included between high-risk populations.MethodsTo estimate HIV incidence, time between infection and diagnosis and the undiagnosed population stratified by CD4 count, we used the ECDC HIV Modelling Tool V.1.2.2. This model uses data on new HIV and AIDS diagnoses from the Catalan HIV/AIDS surveillance system from 2001 to 2013. Data used to estimate the proportion of people enrolled, on ART and virally suppressed in the HIV care cascade were derived from the PISCIS cohort.ResultsThe total number of people living with HIV (PLHIV) in Catalonia in 2013 was 34 729 (32 740 to 36 827), with 12.3% (11.8 to 18.1) of whom were undiagnosed. By 2013, there were 8458 (8101 to 9079) Spanish-born men who have sex with men (MSM) and 2538 (2334 to 2918) migrant MSM living with HIV in Catalonia. A greater proportion of migrant MSM than local MSM was undiagnosed (32% vs 22%). In the subsequent steps of the HIV care cascade, migrants MSM experience greater losses than the Spanish-born MSM: in retention in care (74% vs 55%), in the proportion on combination antiretroviral treatment (70% vs 50%) and virally suppressed (65% vs 46%).ConclusionsBy the end of 2013, there were an estimated 34 729 PLHIV in Catalonia, of whom 4271 were still undiagnosed. This study shows that the Catalan epidemic of HIV has continued to expand with the key group sustaining HIV transmission being MSM living with undiagnosed HIV.

scholarly journals Reasons for Disclosure of HIV Status by People Living with HIV/AIDS and in HIV Care in Uganda: An Exploratory Study

2010 ◽  
Vol 24 (10) ◽  
pp. 675-681 ◽  
Author(s):  
Sarah N. Ssali ◽  
Lynn Atuyambe ◽  
Christopher Tumwine ◽  
Eric Segujja ◽  
Nicolate Nekesa ◽  
...  
Keyword(s):  
Exploratory Study ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Living With Hiv ◽  
Hiv Aids

scholarly journals Improving Engagement in the HIV Care Cascade: A Systematic Review of Interventions Involving People Living with HIV/AIDS as Peers

2016 ◽  
Vol 20 (10) ◽  
pp. 2452-2463 ◽  
Author(s):  
Becky L. Genberg ◽  
Sylvia Shangani ◽  
Kelly Sabatino ◽  
Beth Rachlis ◽  
Juddy Wachira ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Living With Hiv ◽  
Hiv Aids

scholarly journals Trends in HIV care cascade engagement among diagnosed people living with HIV in Ontario, Canada: A retrospective, population-based cohort study

PLoS ONE ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. e0210096 ◽  
Author(s):  
James Wilton ◽  
Juan Liu ◽  
Ashleigh Sullivan ◽  
Beth Rachlis ◽  
Alex Marchand-Austin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Population Based ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Living With Hiv

scholarly journals Undetectable equals untransmittable (U = U): awareness and associations with health outcomes among people living with HIV in 25 countries

2020 ◽  
pp. sextrans-2020-054551 ◽  
Author(s):  
Chinyere Okoli ◽  
Nicolas Van de Velde ◽  
Bruce Richman ◽  
Brent Allan ◽  
Erika Castellanos ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Standard Of Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Missed Opportunities ◽  
Suboptimal Adherence ◽  
Health Related ◽  
Living With Hiv ◽  
The Impact

Objectives‘Undetectable equals Untransmittable’ (U=U) is an empowering message that may enable people living with HIV (PLHIV) to reach and maintain undetectability. We estimated the percentage of PLHIV who ever discussed U=U with their main HIV care provider, and measured associations with health-related outcomes. Secondarily, we evaluated whether the impact of the U=U message varied between those who heard it from their healthcare provider (HCP) vs from elsewhere.MethodsData were from the 25-country 2019 Positive Perspectives Survey of PLHIV on treatment (n=2389). PLHIV were classified as having discussed U=U with their HCP if they indicated that their HCP had ever told them about U=U. Those who had not discussed U=U with their HCP but were nonetheless aware that ‘My HIV medication prevents me from passing on HIV to others’ were classified as being made aware of U=U from non-HCP sources. Multivariable logistic regression was used to measure associations between exposure to U=U messages and health outcomes.ResultsOverall, 66.5% reported ever discussing U=U with their HCP, from 38.0% (South Korea) to 87.3% (Switzerland). Prevalence was lowest among heterosexual men (57.6%) and PLHIV in Asia (51.3%). Compared with those unaware of U=U, those reporting U=U discussions with their HCP had lower odds of suboptimal adherence (AOR=0.59, 95% CI 0.44 to 0.78) and higher odds of self-reported viral suppression (AOR=2.34, 95% CI 1.72 to 3.20), optimal sexual health (AOR=1.48, 95% CI 1.14 to 1.92) and reporting they ‘always shared’ their HIV status (AOR=2.99, 95% CI 1.42 to 6.28). While exposure to U=U information from non-HCP sources was beneficial too, the observed associations were attenuated relative to those seen with reported discussions with HCPs.ConclusionHCP discussion of U=U with PLHIV was associated with favourable health outcomes. However, missed opportunities exist since a third of PLHIV reported not having any U=U discussion with their HCP. U=U discussions with PLHIV should be considered as a standard of care in clinical guidelines.

scholarly journals Stigma and discrimination: barriers to the utilisation of a nutritional program in HIV care services in the Tigray region, Ethiopia.

2020 ◽  
Author(s):  
Fisaha Tesfay ◽  
Sara Javanparast ◽  
Lillian Mwanri ◽  
Anna Ziersch
Keyword(s):  
Family Members ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Hiv Services ◽  
Tigray Region ◽  
Stigma And Discrimination ◽  
Hiv Status Disclosure ◽  
Living With Hiv ◽  
Status Disclosure

Abstract Background: In Ethiopia, stigmatising attitudes towards people living with HIV have reduced over time due to improved HIV knowledge and the expansion of services. However, HIV stigma and discrimination remain a key challenge and have negative impacts on access to and utilisation of HIV services including nutritional programs. A small number of studies have examined the experience of stigma related to nutritional programs, but this is limited. This study explored HIV status disclosure and experience of stigma related to a nutritional program in HIV care settings in Ethiopia and impacts on nutritional program utilisation. Methods: As part of a larger study, qualitative in-depth interviews were conducted with 20 adults living with HIV, 15 caregivers of children living with HIV and 13 program staff working in the nutritional program in three hospitals in the Tigray region of Ethiopia. Framework thematic analysis using NVivo was employed to analyse the data. Results: The study found varying levels of positive HIV status disclosure, depending on who the target of disclosure was. Disclosing to family members was reported to be less problematic by most participants. Despite reported benefits of the nutritional program in terms of improving weight and overall health status, adults and caregivers of children living with HIV revealed experiences of stigma and discrimination that were amplified by enrolment to the nutritional program. This was due to: a) transporting, consuming and disposing of the nutritional support itself, which is associated with HIV in the broader community; b) required increased frequency of visits to HIV services for those enrolled in the nutritional program and associated. Conclusion: There was evidence of concerns about HIV-related stigma and discrimination among individuals enrolled in this program and their family members, which in turn negatively affected the utilisation of the nutritional program. Stigma and discrimination are a source of health inequity and undermine access to the nutritional program. Nutritional programs in HIV care should include strategies to take these concerns into account by mainstreaming stigma prevention and mitigation activities. Further research should be done to identify innovative ways of facilitating social inclusion to mitigate stigma and improve utilisation.

Stigma and discrimination: A barrier to the utilisation of a nutritional program in HIV care services in Ethiopia

2019 ◽  
Author(s):  
Fisaha Tesfay ◽  
Sara Javanparast ◽  
Lillian Mwanri ◽  
Anna Ziersch
Keyword(s):  
Social Inclusion ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Northern Ethiopia ◽  
Hiv Status ◽  
Framework Analysis ◽  
Stigma And Discrimination ◽  
Hiv Status Disclosure ◽  
Living With Hiv ◽  
Status Disclosure

Abstract Background In Ethiopia, stigmatizing attitudes towards people living with HIV have reduced over time. This is mainly due to improved HIV knowledge and the expansion of access to HIV care and support services. However, HIV stigma and discrimination remain a key challenge, and have negative impacts on access to and utilisation of HIV services including nutritional programs. A small number of studies have examined the experience of stigma related to nutritional programs provided to people living with HIV, but this is limited. This study explored HIV status disclosure and experience of stigma among people living with HIV enrolled in a nutritional program in HIV care setting in Ethiopia and impacts on program utilisation.Methods and participants As part of a larger study, qualitative in-depth interviews were conducted with 20 adults living with HIV, 15 caregivers of children living with HIV and 13 program staff in the nutritional program in three hospitals in the Tigray region of Northern Ethiopia. Framework analysis was employed to analyse the data and NVivo 11 was used to assist data analysis.Results The study found varying levels of positive HIV status disclosure, depending on who the target of disclosure was. Disclosing to family members was reported to be less problematic by most participants. Despite reported benefits of the nutritional in terms of improving their weight and overall health status, adults and caregivers of children living with HIV revealed experience of stigma and discrimination and fear of discovery of positive HIV status due to: a) nutritional support (Plumpynut/sup) to HIV by the community; b) increased frequency of visits to HIV services.Conclusion There is evidence that enrolment in the nutritional program is associated with increased concern about stigma and discrimination, which in turn negatively affected the utilisation of the nutritional program and HIV service more broadly. Nutritional programs in HIV care should include strategies which take these concerns into account by mainstreaming stigma prevention and mitigation activities. Further research should be done to identify innovative ways of social inclusion to mitigate stigma and improve utilisation.

scholarly journals HIV point-of-care diagnostics: meeting the special needs of sub-Saharan Africa

2014 ◽  
Vol 8 (10) ◽  
pp. 1231-1243 ◽  
Author(s):  
Godwin Abazho Aleku ◽  
Moses P Adoga ◽  
Simon M Agwale
Keyword(s):  
Point Of Care ◽  
Quality Care ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Implementation Challenges ◽  
Laboratory Services ◽  
Point Of Care Diagnostics ◽  
Sub Saharan ◽  
Living With Hiv

Sub-Saharan Africa, accounting for 70% of the 35 million people living with HIV worldwide, obviously carries the heaviest burden of the HIV epidemic. Moreover, the region’s poor health system occasioned by limited resources and inadequate skilled clinical personnel usually makes decentralization of HIV care difficult. Therefore, quality diagnostics that are easy to use, inexpensive, and amenable for use at point of care (POC) are a dire necessity. Clearly, such diagnostics will significantly lessen the pressure on the existing over-stretched centralized HIV laboratory services. Thankfully, some POC diagnostics are already being validated, while others are in the pipeline. As POC test kits emerge, implementation hurdles should be envisaged and planned for. This review examines emerging HIV diagnostic platforms, HIV POC product pipelines, gaps, perceived POC implementation challenges, and general recommendations for quality care.

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