scholarly journals Enhancing national prevention and treatment services for sex workers in Zimbabwe: a process evaluation of the SAPPH-IRe trial

2019 ◽  
Vol 34 (5) ◽  
pp. 337-345 ◽  
Author(s):  
Joanna Busza ◽  
Tarisai Chiyaka ◽  
Sithembile Musemburi ◽  
Elizabeth Fearon ◽  
Calum Davey ◽  
...  
Keyword(s):  
Viral Load ◽  
Process Evaluation ◽  
Sex Workers ◽  
Controlled Trial ◽  
Community Mobilization ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Policy Context ◽  
Significant Difference ◽  
Prevention And Treatment

Abstract Targeted HIV interventions for female sex workers (FSW) combine biomedical technologies, behavioural change and community mobilization with the aim of empowering FSW and improving prevention and treatment. Understanding how to deliver combined interventions most effectively in sub-Saharan Africa is critical to the HIV response. The Sisters’ Antiretroviral Programme for Prevention of HIV: an Integrated Response (SAPPH-Ire) randomized controlled trial in Zimbabwe tested an intervention to improve FSW engagement with HIV services. After 2 years, results of the trial showed no significant difference between study arms in proportion of FSW with HIV viral load ≥1000 copies/ml as steep declines occurred in both. We present the results of a process evaluation aiming to track the intervention’s implementation, assess its feasibility and accessibility, and situate trial results within the national HIV policy context. We conducted a mixed methods study using data from routine programme statistics, qualitative interviews with participants and respondent driven surveys. The intervention proved feasible to deliver and was acceptable to FSW and providers. Intervention clinics saw more new FSW (4082 vs 2754), performed over twice as many HIV tests (2606 vs 1151) and nearly double the number of women were diagnosed with HIV (1042 vs 546). Community mobilization meetings in intervention sites also attracted higher numbers. We identified some gaps in programme fidelity: offering pre-exposure prophylaxis took time to engage FSW, viral load monitoring was not performed, and ratio of peer educators to FSW was lower than intended. During the trial, reaching FSW with HIV testing and treatment became a national priority, leading to increasing attendance at both intervention and control clinics. Throughout Zimbabwe, antiretroviral therapy coverage improved and HIV-stigma declined. Zimbabwe’s changing HIV policy context appeared to contribute to positive improvements across the HIV care continuum for all FSW over the course of the trial. More intense community-based interventions for FSW may be needed to make further gains.

scholarly journals Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

2019 ◽  
Author(s):  
Soori Nnko ◽  
Daniel Nyato ◽  
Evodius Kuringe ◽  
Caterina Casalini ◽  
Amani Shao ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Exploratory Study ◽  
Female Sex Workers ◽  
Health Care Facilities ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Female Sex ◽  
Self Testing ◽  
Study Participants

Abstract Background: HIV testing is a gateway to HIV care and treatment for those testing positive and can link those with negative results to HIV preventive services. Despite the importance of HIV testing services (HTS) in HIV control, uptake of HTS among female sex workers (FSWs) across sub-Saharan Africa (SSA) remains sub optimal. Concerns about stigma associated with sex work and fear of loss of livelihood if HIV status becomes known, are some of the restrictions for FSWs to utilize HTS offered through health care facilities. Introduction of HIV self-testing (HIVST) may mitigate some of the barriers for the uptake of HTS. This study explored perspectives of FSWs towards HIVST in Tanzania. Methods: We conducted an exploratory study employing in-depth interviews (IDI) and participatory group discussions (PGD) with FSWs in selected regions of Tanzania. Study participants were recruited through snowball sampling. Data were thematically analysed by two analysts using NVivo software. Emerging themes were explored in the tradition of Grounded Theory. The analysis was informed by the social ecological model and focused on factors associated with the feasibility of scaling up HIVST. Results: A total of 23 PGD sessions were conducted involving 227 FSWs. Data from PGDs were complemented by 21 IDI. FSWs were enthusiastic toward HIVST. Convenience (time and cost saved), and belief that HIVST will increase privacy and confidentiality motivated participants’ support for the self-testing approach. Participants did express concerns about their ability to interpret and trust the results of the test. Participants also expressed concern that HIVST could cause personal harm, including severe distress and self-harm for individuals with reactive test. This was linked to the study participants’ perception that HIVST would be provided only through unassisted modality. Conclusions: FSWs demonstrated high enthusiasm to use the HIVST once it becomes available. Increased confidentiality, reduced opportunity costs, and increased autonomy were among the key factors for the intended use of HIVST. Major concerns included fear of HIV reactive test and not trusting self-diagnoses. Our findings underscore the importance of providing adequate access to counselling and referral services in conjunction with HIVST.

scholarly journals Outcome of Fixed Dose Combination of Tenofovir, Lamivudine and Dolutegravir in Rural HIV Care Facility in Nigeria

2021 ◽  
Vol 11 (12) ◽  
pp. 1-8
Author(s):  
Ogbuagu Chukwuanugo Nkemakonam ◽  
Ogbuagu Ekenechukwu Nkiloka ◽  
Okoh Emeka Emmanuel
Keyword(s):  
Viral Load ◽  
Combination Therapy ◽  
Sub Saharan Africa ◽  
Fixed Dose Combination ◽  
Hiv Care ◽  
Fixed Dose ◽  
People Living With Hiv ◽  
Age Group ◽  
Cd4 Counts ◽  
Dose Combination

Background: Antiretroviral therapy (ART) has significantly increased the lifespan of people living with HIV. Currently, fixed dosed combination therapy (Tenofovir, Lamivudine, and Dolutegravir) is being introduced in most countries in the Sub- Saharan Africa. There is need for a clinical and immunological assessment of HIV patients transitioned to this new therapy over a period of 2 years. Objectives: To determine the proportion of patients whose viral load was suppressed to <20 copies/ml following two years therapy with Dolutegravir-based fixed-dose combination therapy. Methods: This retrospective cohort study was carried out in a Comprehensive Healthcare Centre (CHC), a facility affiliated with Nnamdi Azikiwe University Teaching Hospital Nigeria. The primary outcome measure was the proportion of patients whose viral load was suppressed to <20 copies/ml. The plasma viral load (HIV-RNA) assay was done using real time PCR and CD4+ T- lymphocyte (CD4+) counts were estimated using Flow Cytometry. The exclusion criteria were patients who has invalid data base and patients with comorbidities associated with HIV. Results: A total of 537 HIV1 sero-positive patients were enrolled for ART care over a period of 2 years (2017-2018). Females in the age group (41-50 years) constituted the bulk (36.9%) of the patients whilst the least (5.3%) were males in the age group (8 to 30 years). The mean CD4 count of patients was 847.35cells/mm3. More females (45.9%) had CD4+counts over 500cells/mm3 whilst the percentage of males with CD4+ cell counts over 500cells/mm3 was 43.8%. Majority, 405 constituting 75.4% of the patients have suppressed viral load (<20 copies/ml) signifying that the centre is achieving success with respect to service delivery and ART. Patients with unsuppressed viral loads were more among Females with CD4+ counts in the range of 200-499 cells/mm3and this may be as a result of other associated factors which will be elucidated in future studies. Conclusion: Dolutegravir-based fixed-dose combination therapy suppressed viral load to <20 copies/ml in more than 75% of patients receiving the therapy. Enhanced adherence and effective doctor-patient relationship could be associated with the viral suppression observed in this study. Key words: Immunology, virology, HIV Outcome, Dolutegravir-based combination therapy, anti retroviral therapy.

scholarly journals Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

2019 ◽  
Author(s):  
Soori Nnko ◽  
Daniel Nyato ◽  
Evodius Kuringe ◽  
Caterina Casalini ◽  
Amani Shao ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Exploratory Study ◽  
Female Sex Workers ◽  
Health Care Facilities ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Female Sex ◽  
Self Testing ◽  
Study Participants

Abstract Background: HIV testing is a gateway to HIV care and treatment for those testing positive and can link those with negative results to HIV preventive services. Despite the importance of HIV testing services (HTS) in HIV control, uptake of HTS among female sex workers (FSWs) across sub-Saharan Africa (SSA) remains sub optimal. Concerns about stigma associated with sex work and fear of loss of livelihood if HIV status becomes known, are some of the restrictions for FSWs to utilize HTS offered through health care facilities. Introduction of HIV self-testing (HIVST) may mitigate some of the barriers for the uptake of HTS. This study explored perspectives of FSWs towards HIVST in Tanzania. Methods:We conducted an exploratory study employing in-depth interviews (IDI) and participatory group discussions (PGD) with FSWs in selected regions of Tanzania. Study participants were recruited through snowball sampling. Data were thematically analysed by two analysts using NVivo software. Emerging themes were explored in the tradition of Grounded Theory. The analysis was informed by the social ecological model and focused on factors associated with the feasibility of scaling up HIVST. Results:A total of 23 PGD sessions were conducted involving 227 FSWs. Data from PGDs were complemented by 21 IDI. FSWs were enthusiastic toward HIVST. Convenience (time and cost saved), and belief that HIVST will increase privacy and confidentiality motivated participants’ support for the self-testing approach. Participants did express concerns about their ability to interpret and trust the results of the test. Participants also expressed concern that HIVST could cause personal harm, including severe distress and self-harm for individuals with reactive test. This was linked to the study participants’ perception that HIVST would be provided only through unassisted modality. Conclusions: FSWs demonstrated high enthusiasm to use the HIVST once it becomes available. Increased confidentiality, reduced opportunity costs, and increased autonomy were among the key factors for the intended use of HIVST. Major concerns included fear of HIV reactive test and not trusting self-diagnoses. Our findings underscore the importance of providing adequate access to counselling and referral services in conjunction with HIVST.

scholarly journals Care Facilitation Advances Movement Along The Hepatitis C Care Continuum For Persons With Hiv, Hepatitis C And Substance Use: A Randomized Clinical Trial (Ctn-0064)

2021 ◽  
Author(s):  
Lisa R Metsch ◽  
Daniel J Feaster ◽  
Lauren K Gooden ◽  
Carmen Masson ◽  
David C Perlman ◽  
...  
Keyword(s):  
Substance Use ◽  
Viral Load ◽  
Hepatitis C ◽  
Controlled Trial ◽  
Sustained Viral Response ◽  
Hiv Care ◽  
Control Group ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Viral Response

Abstract Background Direct-acting antivirals can cure HCV. Persons with HCV/HIV and living with substance use are disadvantaged in benefitting from advances in HCV treatment. Methods In this randomized controlled trial, participants with HCV/HIV were randomized between February 2016 and January 2017 to either care facilitation or control. Twelve-month follow-up assessments completed in January 2018. Care facilitation group participants received motivation and strengths-based case-management addressing retrieval of HCV load results, engagement in HCV/HIV care and medication adherence. Control group participants received referral to HCV evaluation and an offer of assistance in making care appointments. Primary outcome was number of steps achieved along a series of 8 clinical steps (e.g., receiving HCV results, initiating treatment, sustained viral response) of the HCV/HIV care continuum over 12 months post-randomization. Results Three hundred and eighty-one individuals were screened and 113 randomized. Median age was 51 years; 58.4% male and 72.6% Black/African American. Median HIV-1 viral load was 27,209 copies/ml with 69% having a detectable viral load. Mean number of steps completed was statistically significantly higher in the intervention (2.44 steps) vs. control group (1.68 steps) [χ 2(1)=7.36, p=0.0067]. Men in the intervention (vs. control) group completed a statistically significantly higher number of steps. Eleven participants achieved sustained viral response with no difference by treatment group. Conclusions The care facilitation intervention increased progress along the HCV/HIV care continuum, as observed for men and not women. Study findings also highlight the continued challenges to achieve individual patient sustained viral responses and population level HCV elimination.

scholarly journals Retention in Care and Viral Load Improvement After Discharge Among Hospitalized Out-of-Care People With HIV Infection: A Post Hoc Analysis of a Randomized Controlled Trial

2020 ◽  
Vol 7 (6) ◽  
Author(s):  
Kellee English ◽  
Sarah B May ◽  
Jessica A Davila ◽  
Jeffrey A Cully ◽  
Lilian Dindo ◽  
...  
Keyword(s):  
Viral Load ◽  
Drug Use ◽  
Controlled Trial ◽  
Retention In Care ◽  
The United States ◽  
Hiv Care ◽  
Study Cohort ◽  
Post Hoc Analysis ◽  
Modifiable Factors ◽  
Post Hoc

Abstract Background Understanding factors influencing retention in care (RIC) and viral load improvement (VLI) in people with HIV (PWH) who are out of care and hospitalized will assist in intervention development for this vulnerable population. Methods The study was a post hoc analysis of prospectively collected data. Hospitalized participants were enrolled if they were newly diagnosed with HIV during the hospitalization or out of HIV care. Participants completed surveys at baseline and 6 months postenrollment and laboratory studies of viral load (VL). Outcomes were RIC (2 completed visits, 1 within 30 days of discharge) and VLI (VL &lt;400 or at least a 1-log10 decrease) 6 months after discharge. Univariate and multivariate regression analyses were conducted examining the contributions of predisposing, enabling, and need factors to outcomes. Results The study cohort included 417 participants enrolled between 2010 and 2013. The population was 73% male, 67% non-Hispanic black, 19% Hispanic, and 70% uninsured. Sixty-five percent had a baseline CD4 &lt;200 cells/mm3, 79% had a VL &gt;400 copies/mL or missing, and the population was generally poor with low educational attainment. After discharge from the hospital, 60% did not meet the definition for RIC, and 49% did not have VLI. Modifiable factors associated with the outcomes include drug use (including marijuana alone and other drugs), life instability (eg, housing, employment, and life chaos), and using avoidance coping strategies in coping with HIV. Conclusions Hospitalized out-of-care PWH in the United States are at high risk of poor re-engagement in care after discharge. Interventions for this population should focus on improving socioeconomic stability and coping with HIV and reducing drug use.

scholarly journals Differentiated Prevention And Care To Reduce The Risk of HIV Acquisition And Transmission Among Female Sex Workers In Zimbabwe: Study Protocol For The ‘AMETHIST’ Cluster Randomised Trial

2021 ◽  
Author(s):  
Frances Cowan ◽  
Fortunate Machingura ◽  
Sungai T Chabata ◽  
Sanni Ali ◽  
Joanna Busza ◽  
...  
Keyword(s):  
At Risk ◽  
Hiv Prevention ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Sub Saharan Africa ◽  
Total N ◽  
Female Sex ◽  
Prevention And Treatment ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition

Abstract Background: Female sex workers (FSW) in sub-Saharan Africa are disproportionately affected by HIV and are critical to engage in both HIV prevention and care. Here we describe our approach to evaluation of the AMETHIST intervention for FSW, adapted to the African context and set in Zimbabwe where there is a nationally-scaled programme for sex workers (Sisters). We hypothesise this intervention will raise uptake and adherence to prevention and treatment among FSW resulting in a reduction in their risk of HIV acquisition/transmission.Methods: The AMETHIST intervention (Adapted Microplanning to Eliminate Transmission of HIV in Sex Transactions) aims to provide risk differentiated prevention and care to FSW through microplanning and self help groups. Twenty two towns with the Sisters programme were randomised using restricted randomisation to either the Sisters programme or the Sister programme plus AMETHIST. The primary outcome is composite and is defined as the proportion of HIV positive FSW at risk of HIV transmission combined with the proportion of HIV negative FSW at risk of HIV acquisition. The outcome will be assessed after two years of intervention delivery in a respondent-driven sampling survey (total n=4400; n=200 FSW recruited at each site). Primary analysis will use the ‘RDS-2’ method to estimate cluster summaries and will adapt Hayes and Moulton’s ‘2-step’ method to adjust effect estimates for individual-level confounders and further adjust for cluster baseline prevalence. An in-depth process evaluation guided by our project trajectory will be undertaken.Discussion: Innovative pragmatic trials are needed to generate evidence on effectiveness of combination interventions in HIV prevention and treatment in different contexts. We describe the design and analysis of such a study.Trial Registration: The trial was registered at Pan African Clinical Trials Registry (PACTR202007818077777) on 2 July 2020.

scholarly journals Kabasura Kudineer (KSK), a poly-herbal Siddha medicine, reduced SARS-CoV-2 viral load in asymptomatic COVID-19 individuals as compared to vitamin C and zinc supplementation: findings from a prospective, exploratory, open-labeled, comparative, randomized controlled trial, Tamil Nadu, India

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
S. Natarajan ◽  
C. Anbarasi ◽  
P. Sathiyarajeswaran ◽  
P. Manickam ◽  
S. Geetha ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Viral Load ◽  
Vitamin C ◽  
Tamil Nadu ◽  
Controlled Trial ◽  
Control Group ◽  
Rt Pcr ◽  
Randomized Controlled ◽  
Ct Value ◽  
Significant Difference

Abstract Introduction Despite several ongoing efforts in biomedicine and traditional medicine, there are no drugs or vaccines for coronavirus disease 2019 (COVID-19) as of May 2020; Kabasura Kudineer (KSK), a polyherbal formulation from India’s Siddha system of medicine, has been traditionally used for clinical presentations similar to that of COVID-19. We explored the efficacy of KSK in reducing viral load and preventing the disease progression in asymptomatic, COVID-19 cases. Methods A prospective, single-center, open-labeled, randomized, controlled trial was conducted in a COVID Care Centre in Chennai, India. We recruited reverse-transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 of 18 to 55 years of age, without clinical symptoms and co-morbidities. They were randomized (1:1 ratio) to KSK (60 mL twice daily for 7 days) or standard of care (7 days supplementation of vitamin C 60,000 IU morning daily and zinc 100 mg evening daily) groups. The primary outcomes were reduction in the SARS-CoV-2 load [as measured by cyclic threshold (CT) value of RT-PCR], prevention of progression of asymptomatic to symptomatic state, and changes in the immunity markers including interleukins (IL-6, IL-10, IL-2), interferon gamma (IFNγ), and tumor necrosis factor (TNF α). Siddha clinical assessment and the occurrence of adverse effects were documented as secondary outcomes. Paired t-test was used in statistical analysis. Results Viral load in terms of the CT value (RdRp: 95% CI = 1.89 to 5.74) declined significantly on the seventh day in the KSK group and that of the control group, more pronounced in the study group. None progressed to the symptomatic state. There was no significant difference in the biochemical parameters. We did not observe any changes in the Siddha-based clinical examination and adverse events in both groups. Conclusion KSK significantly reduced SARS-CoV-2 viral load among asymptomatic COVID-19 cases and did not record any adverse effect, indicating the use of KSK in the strategy against COVID-19. Larger, multi-centric trials can strengthen the current findings. Trial registration Clinical Trial Registry of India CTRI2020/05/025215. Registered on 16 May 2020

scholarly journals Determining virological suppression and resuppression by point-of-care viral load testing in a HIV care setting in sub-Saharan Africa

2020 ◽  
Vol 18 ◽  
pp. 100231
Author(s):  
Giovanni Villa ◽  
Adam Abdullahi ◽  
Dorcas Owusu ◽  
Colette Smith ◽  
Marilyn Azumah ◽  
...  
Keyword(s):  
Viral Load ◽  
Care Setting ◽  
Point Of Care ◽  
Virological Suppression ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Load Testing ◽  
Viral Load Testing ◽  
Sub Saharan

scholarly journals Use of an antiviral mouthwash as an additional barrier measure in the SARS-CoV-2 transmission in adults with asymptomatic to mild COVID-19: A multicenter, randomized, double-blind controlled trial

2021 ◽  
Author(s):  
Carrouel ◽  
Valette ◽  
Gadea ◽  
Esparcieux ◽  
Illes ◽  
...  
Keyword(s):  
Viral Load ◽  
Controlled Trial ◽  
P Value ◽  
Rt Pcr ◽  
Double Blind ◽  
Median Percentage ◽  
Percentage Decrease ◽  
Viral Load Reduction ◽  
Significant Difference ◽  
Additional Barrier

Abstract Background The research hypothesis is that commercially available mouthwash with ß-cyclodextrin and citrox (bioflavonoids) could decrease the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) salivary viral load in adults with asymptomatic to mild COVID-19. Methods In this RCT, SARS-CoV-2 PCR-positive patients aged 18-85 years with asymptomatic to mild COVID-19 symptoms <8 days were recruited. A total of 154 eligible patients were randomly assigned (1:1) to antiviral ß-cyclodextrin and citrox mouthwash (CDCM) or placebo. Three rinses daily were performed for 7 days. Saliva sampling was performed on day 1 at 9 a.m. (T1), 1 p.m. (T2) and 6 p.m. (T3). On the following 6 days, one sample was taken at 3 p.m. Quantitative RT-PCR was used to detect SARS-CoV-2. The trial is registered at ClinicalTrials.gov (NCT04349592). Findings CDCM was significantly more effective than placebo 4 hours after the first intake (p<0·001), with a median percentage decrease T1-T2 of -14·25% [95% CI; -32·68% - 0·06%]. In patients with an initial salivary load > 2·95 log10 copies/mL, there was a significant difference in the reduction in viral load at T2. Over the course of one day, the first mouthwash rinse significantly reduced the viral load, and the second dose maintained this low value, compared to placebo. At day 7, there was still a greater decrease in salivary viral load over time in the CDCM group. In individuals with an initial viral SARS-CoV-2 load higher than 4·12 log10 copies/mL or 5·16 log10 copies/mL, CDCM reduced the salivary viral load more quickly than placebo (MLM p-value = 0·03; 0·029). Interpretation This trial supports the relevance of using mouthwash with ß-cyclodextrin and citrox as an additional barrier measure on day 1 to reduce the dissemination of SARS-CoV-2. Over 7 days, the use of this mouthwash showed a benefit of viral load reduction for patients with the highest initial loads.

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