scholarly journals An urgent need for a paradigm shift in HIV testing for older children: A sine qua non condition to achieve an AIDS-free generation

2020 ◽  
Author(s):  
H.A. Yumo ◽  
J.J.N. Ndenkeh ◽  
I. Sieleunou ◽  
D.N. Nsame ◽  
P.B. Kuwoh ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Pediatric Hiv ◽  
Hiv Care ◽  
Older Children ◽  
Chi Square ◽  
Treatment Services ◽  
Art Initiation ◽  
Testing Technology ◽  
Chi Square Test ◽  
Free Generation

AbstractBackgroundAchieving an AIDS-free generation requires effective pediatric testing and treatment services. While pediatric HIV testing has been more focused on children below 18 months through PMTCT, the yield of this approach remains unclear comparatively to testing children above 18 months through routine PITC. This study aimed at bridging this evidence gap and provide knowledge to guide pediatric HIV testing investments.Materials and MethodsParents visiting or receiving HIV care in three hospitals in Cameroon were invited to test their children for HIV. HIV testing was done using PCR and antibody rapid tests for children < 18 months and those ≥18 months, respectively. We compared HIV case detection and ART initiation between the two subgroups of children and this using Chi-square test at 5% significant level.ResultsA total of 4079 children aged 6 weeks-15 years were included in the analysis. Compared to children < 18 months, children group ≥18 months was 4-fold higher among those who enrolled in the study (80.3% vs 19.7%, p<0.001); 3.5-fold higher among those who tested for HIV (77.6% vs 22.4%, p<0.001); 6-fold higher among those who tested HIV+ (85.7% vs 14.3%, p=0.241) and 11-fold higher among those who enrolled on ART (91.7% vs 8.3%, p< 0.028).ConclusionsOur results show that 4 out of 5 children who tested HIV+ and over 90% of ART enrolled cases were children ≥ 18 months. Thus, while rolling out PCR HIV testing technology for neonates and infants, committing adequate and proportionate resources in antibody rapid testing for older children is a sine quo none condition to achieve an AIDS-free generation.

scholarly journals Integrated TB and HIV care for Mozambican children: temporal trends, site-level determinants of performance, and recommendations for improved TB preventive treatment

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
W. Chris Buck ◽  
Hanh Nguyen ◽  
Mariana Siapka ◽  
Lopa Basu ◽  
Jessica Greenberg Cowan ◽  
...  
Keyword(s):  
Temporal Trends ◽  
Scale Up ◽  
Preventive Treatment ◽  
Preventive Therapy ◽  
Pediatric Hiv ◽  
Hiv Care ◽  
Pediatric Care ◽  
P Value ◽  
Missed Opportunities ◽  
Art Initiation

Abstract Background Pediatric tuberculosis (TB), human immunodeficiency virus (HIV), and TB-HIV co-infection are health problems with evidence-based diagnostic and treatment algorithms that can reduce morbidity and mortality. Implementation and operational barriers affect adherence to guidelines in many resource-constrained settings, negatively affecting patient outcomes. This study aimed to assess performance in the pediatric HIV and TB care cascades in Mozambique. Methods A retrospective analysis of routine PEPFAR site-level HIV and TB data from 2012 to 2016 was performed. Patients 0–14 years of age were included. Descriptive statistics were used to report trends in TB and HIV indicators. Linear regression was done to assess associations of site-level variables with performance in the pediatric TB and HIV care cascades using 2016 data. Results Routine HIV testing and cotrimoxazole initiation for co-infected children in the TB program were nearly optimal at 99% and 96% in 2016, respectively. Antiretroviral therapy (ART) initiation was lower at 87%, but steadily improved from 2012 to 2016. From the HIV program, TB screening at the last consultation rose steadily over the study period, reaching 82% in 2016. The percentage of newly enrolled children who received either TB treatment or isoniazid preventive treatment (IPT) also steadily improved in all provinces, but in 2016 was only at 42% nationally. Larger volume sites were significantly more likely to complete the pediatric HIV and TB care cascades in 2016 (p value range 0.05 to < 0.001). Conclusions Mozambique has made significant strides in improving the pediatric care cascades for children with TB and HIV, but there were missed opportunities for TB diagnosis and prevention, with IPT utilization being particularly problematic. Strengthened TB/HIV programming that continues to focus on pediatric ART scale-up while improving delivery of TB preventive therapy, either with IPT or newer rifapentine-based regimens for age-eligible children, is needed.

scholarly journals Implications of the human immunodeficiency virus test and treat strategy on antiretroviral treatment uptake and retention outcomes in Cameroon

2019 ◽  
Vol 6 (11) ◽  
pp. 4716
Author(s):  
Rogers A. Awoh ◽  
Halle G. Ekane ◽  
Anastase Dzudie ◽  
Egbe O. Thomas ◽  
Adebola Adedimeji ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Retrospective Chart Review ◽  
Hiv Care ◽  
Retention Data ◽  
Hiv Diagnosis ◽  
Chi Square ◽  
Test And Treat ◽  
Art Initiation ◽  
Hiv Test ◽  
Immunodeficiency Virus

Background: Success of the human immunodeficiency virus (HIV) test-and-treat (T&T) strategy requires high antiretroviral (ART) uptake and retention. However, low ART uptake and retention continue to be reported in ART programs. This study assessed ART uptake and retention outcomes of the HIV T&T strategy in three HIV clinics in Cameroon.Methods: A retrospective chart review was done for 423 patients who initiated HIV care within a period of three months prior to the implementation of the HIV T&T strategy, and for another 423 patients who initiated HIV care within a three-month period following the HIV T&T strategy implementation. For each group, sociodemographic, ART uptake and retention data were collected. Chi square and Student T tests were used to test for differences proportions and means between the two groups at p <0.05 and 95% confidence interval.Results: The mean ages (years) in the pre-T&T and the T&T groups were 39.73 and 39.72, and the proportion of female were 65.85% and 65.08% respectively. ART uptake proportion was higher amongst those enrolled under the T&T strategy (98.08% vs 95.39%, p=0.02). A greater proportion of the patients in the T&T group initiated ART within 2 weeks following HIV diagnosis (55.84% vs 48.17%, p=0.03). However, ART retention at 24th month was lower in the T&T group (78.83% vs. 85.79%, p=0.01).Conclusions: The findings suggest that the T&T strategy is associated with higher ART uptake, earlier ART initiation, and lower ART retention. This underscores a need for strategies to improve ART retention under the HIV T&T guidelines. 

scholarly journals Students’ Perception on Government Policy of Routine HIV Testing: A Case of University of Zambia Ridgeway Campus

2021 ◽  
Vol 1 (3) ◽  
Author(s):  
Chibochi Kaminsa ◽  
Chirwa Simon ◽  
Kalembwe Vincent ◽  
Mukomenji Celestine ◽  
Martha Mbewe Mwelwa ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Descriptive Analysis ◽  
Structured Interview ◽  
Chi Square ◽  
Cross Sectional ◽  
Chi Square Test ◽  
Good Policy ◽  
Routine Hiv Testing ◽  
Voluntary Counselling And Testing ◽  
Design And Methods

Background HIV Routine testing to all hospital attendants offers testing to all patients irrespective of their presenting illness even if it has nothing to do with HIV. This approach differs from voluntary counselling and testing, which is client-initiated. Adolescents and young adults especially those in colleges are a sexually active group of people which makes them prone to HIV infection. Therefore, there was need to conduct this study to determine the perception of students on routine HIV testing at the University of Zambia (Ridgeway campus) to determine their attitude towards HIV testing. Design and Methods A cross sectional quantitative study was conducted at UNZARidgeway hostels using stratified random sampling to select study participants which included all males and females who were on campus. A semi-structured interview questionnaire was applied to collect data which was analyzed using SPSS version 23software. A Chi-square test was applied for descriptive analysis and results were presented in tables and charts. Results Majority indicated that routine HIV testing was a good policy and supported it; though surprisingly 94% of the students were knowledgeable about routine HIV testing and yet their knowledge did not affect their perception of the policy. However, their experiences, expectations and beliefs affected students’ perception on routine HIV testing. Conclusion Health practitioners should have positive attitude and good work culture in order to uphold students’ positive perception so as to encourage a culture of HIV testing and is free from stigma.

scholarly journals HUBUNGAN BUDAYA MASYARAKAT DENGAN TINGKAT KECEMASAN PADA PASANGAN INFERTIL DI RSIA ANNISA JAMBI TAHUN 2015

2018 ◽  
Vol 18 (1) ◽  
pp. 161
Author(s):  
Bri Novrika
Keyword(s):  
Supportive Therapy ◽  
Sampling Technique ◽  
Infertile Couple ◽  
Chi Square ◽  
Cross Sectional ◽  
Community Culture ◽  
Treatment Services ◽  
Chi Square Test ◽  
Infertile Couples ◽  
The Relationship

Differences in the culture of patriarchal or matriarchal society can influence the way people view the couple with infertility problems and the importance of the existence of children in a family. This study aims to determine the relationship between the culture of the community with anxiety levels in infertile couples at RSIA Annisa Jambi. The type of this study was cross sectional, with a sample of 76 female infertile couples who experienced anxiety with total sampling technique. Data analysis with chi square test. The result of this research shows that there is a cultural relation (p = 0,000) with anxiety level on infertile couple. It is expected that hospitals providing infertility treatment services to provide therapy through psychiatric nursing psychoeducation therapy and / or supportive therapy to infertile couples so as to assist in minimizing the anxiety experienced and support the treatment program undergone infertile couples.Keyword : Community culture, Anxiety, Infertile couples

scholarly journals They are likely to be there: using a family-centered index testing approach to identify children living with HIV in Kenya

2020 ◽  
Vol 31 (11) ◽  
pp. 1028-1033
Author(s):  
Nicollate Okoko ◽  
Jayne L Kulzer ◽  
Kristen Ohe ◽  
Margaret Mburu ◽  
Hellen Muttai ◽  
...  
Keyword(s):  
High Volume ◽  
Absolute Number ◽  
Hiv Care ◽  
Chi Square ◽  
Relative Contribution ◽  
Art Initiation ◽  
Family Testing ◽  
Testing Approach ◽  
Living With Hiv ◽  
Family Centered

In Kenya, only half of children with a parent living with HIV have been tested for HIV. The effectiveness of family-centered index testing to identify children (0–14 years) living with HIV was examined. A retrospective record review was conducted among adult index patients newly enrolled in HIV care between May and July 2015; family testing, results, and linkage to treatment outcomes were followed through May 2016 at 60 high-volume clinics in Kenya. Chi square test compared yield (percentage of HIV tests positive) among children tested through family-centered index testing, outpatient and inpatient testing. Review of 1937 index client charts led to 3005 eligible children identified for testing. Of 2848 (94.8%) children tested through family-centered index testing, 127 (4.5%) had HIV diagnosed, 100 (78.7%) were linked to care, and 85 of those eligible (91.4%) initiated antiretroviral therapy (ART).Family testing resulted in higher yield compared to inpatient (1.8%, p < 0.001) or outpatient testing (1.6%, p < 0.001). The absolute number of children living with HIV identified was highest with outpatient testing. The relative contribution of testing approach to total children identified with HIV was outpatient testing (69%), family testing (26%), and inpatient testing (5%). The family testing approach demonstrated promise in achieving the first two “90s” (identification and ART initiation) of the 90–90–90 targets for children, with additional effort required to improve linkage from testing to treatment.

scholarly journals Patterns of engagement in HIV care during pregnancy and breastfeeding: findings from a cohort study in North-Eastern South Africa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
David Etoori ◽  
Brian Rice ◽  
Georges Reniers ◽  
Francesc Xavier Gomez-Olive ◽  
Jenny Renju ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Cox Regression ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Factors Associated ◽  
Art Initiation ◽  
Risk Period ◽  
Hiv Care Engagement ◽  
Engagement In Hiv Care

Abstract Background Eliminating mother-to-child transmission of HIV (MTCT) in sub-Saharan Africa is hindered by limited understanding of HIV-testing and HIV-care engagement among pregnant and breastfeeding women. Methods We investigated HIV-testing and HIV-care engagement during pregnancy and breastfeeding from 2014 to 2018 in the Agincourt Health and Demographic Surveillance System (HDSS). We linked HIV patient clinic records to HDSS pregnancy data. We modelled time to a first recorded HIV-diagnosis following conception, and time to antiretroviral therapy (ART) initiation following diagnosis using Kaplan-Meier methods. We performed sequence and cluster analyses for all pregnancies linked to HIV-related clinic data to categorise MTCT risk period engagement patterns and identified factors associated with different engagement patterns using logistic regression. We determined factors associated with ART resumption for women who were lost to follow-up (LTFU) using Cox regression. Results Since 2014, 15% of 10,735 pregnancies were recorded as occurring to previously (51%) or newly (49%) HIV-diagnosed women. New diagnoses increased until 2016 and then declined. We identified four MTCT risk period engagement patterns (i) early ART/stable care (51.9%), (ii) early ART/unstable care (34.1%), (iii) late ART initiators (7.6%), and (iv) postnatal seroconversion/early, stable ART (6.4%). Year of delivery, mother’s age, marital status, and baseline CD4 were associated with these patterns. A new pregnancy increased the likelihood of treatment resumption following LTFU. Conclusion Almost half of all pregnant women did not have optimal ART coverage during the MTCT risk period. Programmes need to focus on improving retention, and leveraging new pregnancies to re-engage HIV-positive women on ART.

scholarly journals Pediatric HIV care and treatment services in Tanzania: implications for survival

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
G Somi ◽  
M Majigo ◽  
J Manyahi ◽  
J Nondi ◽  
J Agricola ◽  
...  
Keyword(s):  
Pediatric Hiv ◽  
Hiv Care ◽  
Treatment Services ◽  
Care And Treatment ◽  
Pediatric Hiv Care

scholarly journals Integrating HIV services and other health services: A systematic review and meta-analysis

PLoS Medicine ◽  
2021 ◽  
Vol 18 (11) ◽  
pp. e1003836
Author(s):  
Caroline A. Bulstra ◽  
Jan A. C. Hontelez ◽  
Moritz Otto ◽  
Anna Stepanova ◽  
Erik Lamontagne ◽  
...  
Keyword(s):  
Health Services ◽  
Hiv Testing ◽  
Integrated Services ◽  
Hiv Care ◽  
Hiv Services ◽  
Hiv Care Cascade ◽  
Art Initiation ◽  
Care Cascade ◽  
Hiv Testing And Counselling ◽  
Meta Analyses

Background Integration of HIV services with other health services has been proposed as an important strategy to boost the sustainability of the global HIV response. We conducted a systematic and comprehensive synthesis of the existing scientific evidence on the impact of service integration on the HIV care cascade, health outcomes, and cost-effectiveness. Methods and findings We reviewed the global quantitative empirical evidence on integration published between 1 January 2010 and 10 September 2021. We included experimental and observational studies that featured both an integration intervention and a comparator in our review. Of the 7,118 unique peer-reviewed English-language studies that our search algorithm identified, 114 met all of our selection criteria for data extraction. Most of the studies (90) were conducted in sub-Saharan Africa, primarily in East Africa (55) and Southern Africa (24). The most common forms of integration were (i) HIV testing and counselling added to non-HIV services and (ii) non-HIV services added to antiretroviral therapy (ART). The most commonly integrated non-HIV services were maternal and child healthcare, tuberculosis testing and treatment, primary healthcare, family planning, and sexual and reproductive health services. Values for HIV care cascade outcomes tended to be better in integrated services: uptake of HIV testing and counselling (pooled risk ratio [RR] across 37 studies: 1.67 [95% CI 1.41–1.99], p < 0.001), ART initiation coverage (pooled RR across 19 studies: 1.42 [95% CI 1.16–1.75], p = 0.002), time until ART initiation (pooled RR across 5 studies: 0.45 [95% CI 0.20–1.00], p = 0.050), retention in HIV care (pooled RR across 19 studies: 1.68 [95% CI 1.05–2.69], p = 0.031), and viral suppression (pooled RR across 9 studies: 1.19 [95% CI 1.03–1.37], p = 0.025). Also, treatment success for non-HIV-related diseases and conditions and the uptake of non-HIV services were commonly higher in integrated services. We did not find any significant differences for the following outcomes in our meta-analyses: HIV testing yield, ART adherence, HIV-free survival among infants, and HIV and non-HIV mortality. We could not conduct meta-analyses for several outcomes (HIV infections averted, costs, and cost-effectiveness), because our systematic review did not identify sufficient poolable studies. Study limitations included possible publication bias of studies with significant or favourable findings and comparatively weak evidence from some world regions and on integration of services for key populations in the HIV response. Conclusions Integration of HIV services and other health services tends to improve health and health systems outcomes. Despite some scientific limitations, the global evidence shows that service integration can be a valuable strategy to boost the sustainability of the HIV response and contribute to the goal of ‘ending AIDS by 2030’, while simultaneously supporting progress towards universal health coverage.

scholarly journals Financial Incentives to Increase Uptake of Pediatric HIV Testing (FIT): study protocol for a randomised controlled trial in Kenya

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e024310 ◽  
Author(s):  
Anjuli D Wagner ◽  
Irene N Njuguna ◽  
Jillian Neary ◽  
Vincent O Omondi ◽  
Verlinda A Otieno ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Hiv Testing ◽  
Financial Incentives ◽  
Controlled Trial ◽  
Pediatric Hiv ◽  
Hiv Care ◽  
Financial Barriers ◽  
Infected Female ◽  
Study Sites ◽  
Randomised Controlled

IntroductionIndex case testing (ICT) to identify HIV-infected children is efficient but has suboptimal uptake. Financial incentives (FI) have overcome financial barriers in other populations by offsetting direct and indirect costs. A pilot study found FI to be feasible for motivating paediatric ICT among HIV-infected female caregivers. This randomised trial will determine the effectiveness of FI to increase uptake of paediatric ICT.Methods and analysisThe Financial Incentives to Increase Uptake of Pediatric HIV Testing trial is a five-arm, unblinded, randomised controlled trial that determines whether FI increases timely uptake of paediatric ICT. The trial will be conducted in multiple public health facilities in western Kenya. Each HIV-infected adult enrolled in HIV care will be screened for eligibility: primary caregiver to one or more children of unknown HIV status aged 0–12 years. Eligible caregivers will be individually randomised at the time of recruitment in equal 1:1:1:1:1 allocation to one of five arms (US$0 (control), US$1.25, US$2.50, US$5.00 and US$10.00). The trial aims to randomise 800 caregivers. Incentives will be disbursed at the time of child HIV testing using mobile money transfer or cash. Arms will be compared in terms of the proportion of adults who complete testing for at least one child within 2 months of randomisation and time to testing. A cost-effectiveness analysis of FI for paediatric ICT will also be conducted.Ethics and disseminationThis study was reviewed and approved by the University of Washington Institutional Review Board and the Kenyatta National Hospital Ethics and Research Committee. Trial results will be disseminated to healthcare workers at study sites, regional and national policymakers, and with patient populations at study sites (regardless of enrolment in the trial). Randomised trials of caregiver-child FI interventions pose unique study design, ethical and operational challenges, detailed here as a resource for future investigations.Trial registration numberNCT03049917; Pre-results.

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