scholarly journals Perceived efficacy of HIV treatment-as-prevention among university students in Johannesburg, South Africa

2021 ◽  
pp. sextrans-2021-055031
Author(s):  
Jacob Bor ◽  
Nozipho Musakwa ◽  
Dorina Onoya ◽  
Denise Evans
Keyword(s):  
South Africa ◽  
University Students ◽  
Hiv Testing ◽  
Hiv Transmission ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Transmission Risk ◽  
Treatment As Prevention ◽  
Relative Reduction ◽  
Objective Reduction

ObjectiveAntiretroviral therapy (ART) nearly eliminates HIV transmission. Yet information on treatment as prevention (TasP) has been slow to diffuse in sub-Saharan Africa. We assessed TasP knowledge among university students in South Africa.MethodsWe conducted a cross-sectional survey of first-year university students at a large public university in Johannesburg, South Africa, all of whom would have recently completed secondary school HIV curricula. Respondents were asked to consider the likelihood of HIV transmission in a serodiscordant couple having condomless sex with and without virally suppressive ART. Beliefs were elicited using a 0–20 visual scale. Perceived TasP efficacy was computed as the relative reduction in risk associated with virally suppressive ART. We compared beliefs with estimates from the scientific literature and assessed associations with demographics, HIV testing history and qualitative measures of HIV knowledge and risk perception.ResultsThe analysis included 365 university students ages 18-25 years (48% female, 56% from Gauteng Province). On average, perceived annual risk of HIV transmission with virally suppressive ART was 73%; the objective risk is <1%. On average, respondents perceived that virally suppressive ART reduced annual transmission risk by 17%; the objective reduction in risk is >96%. We observed no differences in perceived TasP efficacy by participant characteristics and testing history. Perceived TasP efficacy was correlated with the (correct) belief that HIV risk increases with sexual frequency.ConclusionsUniversity students in South Africa underestimated the prevention benefits of HIV treatment. Low knowledge of TasP could limit demand for HIV testing and treatment among young adults.

scholarly journals Zwakala Ndoda: a cluster and individually randomised aimed at improving testing, linkage and adherence to treatment for hard-to reach men in KwaZulu-Natal, South Africa

2019 ◽  
Author(s):  
Heidi van Rooyen ◽  
Tawanda Makusha ◽  
Phillip Joseph ◽  
Thulani Ngubane ◽  
Michal Kulich ◽  
...  
Keyword(s):  
South Africa ◽  
Viral Load ◽  
Hiv Testing ◽  
Randomised Trial ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Cluster Randomised Trial ◽  
Evidence Based ◽  
Care Services ◽  
Kwazulu Natal

Abstract Background Men in sub-Saharan Africa are less likely than women to get tested for HIV, less likely to present for treatment, less likely to be maintained in treatment, more likely to have detectable viral load, more likely to transmit HIV with unprotected intercourse, and more likely to progress to AIDS and die sooner from HIV. The ultimate objective of this research is to provide evidence-based strategies to improve HIV testing and treatment of HIV-infected men. Methods This study is being conducted in the Greater Edendale Area and Vulindlela region in KwaZulu-Natal, South Africa. It is a two-stage design of a cluster-randomised trial and an individual randomised trial to test how structural and individual-level interventions address the demand-side factors that affect HIV testing and treatment for hard-to reach, high-risk men. It combines male-focused mobilization, community-based mobile HIV Testing Services and a small incentive to determine if the strategies singly and in combination can result in more men diagnosed with HIV, and more men linked to and maintained in care with undetectable viral load. Discussion A priority for sub-Sahara Africa is developing and evaluating novel and cost-effective strategies for identifying hard-to-reach groups such as men, linking them to HIV testing and care services and maintaining them in care to the point of viral suppression. We propose a combination prevention intervention that addresses men’s individual, interpersonal, and structural barriers to testing and care. This includes male-led mobilization to encourage uptake of testing and treatment; male-focused testing venues; male-only counselors; developing counseling models that are flexible and responsive to men; and strategies for adhering to clinic visits without missing work and navigating the health care system. By thoughtfully combining male-focused mobilization, testing and addressing some of the barriers to male engagement with health facilities, this study hopes to add to the growing evidence based about how to reach, test, link and maintain a hard to reach group such as men in HIV treatment and care services.

scholarly journals Zwakala Ndoda: a cluster and individually randomised aimed at improving testing, linkage and adherence to treatment for hard-to reach men in KwaZulu-Natal, South Africa

2019 ◽  
Author(s):  
Heidi van Rooyen ◽  
Tawanda Makusha ◽  
Phillip Joseph ◽  
Thulani Ngubane ◽  
Michal Kulich ◽  
...  
Keyword(s):  
South Africa ◽  
Viral Load ◽  
Hiv Testing ◽  
Randomised Trial ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Cluster Randomised Trial ◽  
Evidence Based ◽  
Care Services ◽  
Kwazulu Natal

Abstract Background Men in sub-Saharan Africa are less likely than women to get tested for HIV, less likely to present for treatment, less likely to be maintained in treatment, more likely to have detectable viral load, more likely to transmit HIV with unprotected intercourse, and more likely to progress to AIDS and die sooner from HIV. The ultimate objective of this research is to provide evidence-based strategies to improve HIV testing and treatment of HIV-infected men. Methods This study is being conducted in the Greater Edendale Area and Vulindlela region in KwaZulu-Natal, South Africa. It is a two-stage design of a cluster-randomised trial and an individual randomised trial to test how structural and individual-level interventions address the demand-side factors that affect HIV testing and treatment for hard-to reach, high-risk men. It combines male-focused mobilization, community-based mobile HIV Testing Services and a small incentive to determine if the strategies singly and in combination can result in more men diagnosed with HIV, and more men linked to and maintained in care with undetectable viral load. Discussion A priority for sub-Sahara Africa is developing and evaluating novel and cost-effective strategies for identifying hard-to-reach groups such as men, linking them to HIV testing and care services and maintaining them in care to the point of viral suppression. We propose a combination prevention intervention that addresses men’s individual, interpersonal, and structural barriers to testing and care. This includes male-led mobilization to encourage uptake of testing and treatment; male-focused testing venues; male-only counselors; developing counseling models that are flexible and responsive to men; and strategies for adhering to clinic visits without missing work and navigating the health care system. By thoughtfully combining male-focused mobilization, testing and addressing some of the barriers to male engagement with health facilities, this study hopes to add to the growing evidence based about how to reach, test, link and maintain a hard to reach group such as men in HIV treatment and care services.

scholarly journals Zwakala Ndoda: a cluster and individually randomized trial aimed at improving testing, linkage, and adherence to treatment for hard-to reach men in KwaZulu-Natal, South Africa

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Heidi van Rooyen ◽  
Tawanda Makusha ◽  
Phillip Joseph ◽  
Thulani Ngubane ◽  
Michal Kulich ◽  
...  
Keyword(s):  
South Africa ◽  
Viral Load ◽  
Randomized Trial ◽  
Hiv Testing ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Structural Barriers ◽  
Combination Prevention ◽  
Care Services ◽  
Kwazulu Natal

Abstract Background Men in sub-Saharan Africa are less likely than women to get tested for HIV, less likely to present for treatment, less likely to be maintained in treatment, more likely to have detectable viral load, more likely to transmit HIV with unprotected intercourse, and more likely to progress to AIDS and die sooner from HIV. The ultimate objective of this research is to provide evidence-based strategies to improve HIV testing and treatment of HIV-infected men. Methods This study is being conducted in the Greater Edendale Area and Vulindlela region in KwaZulu-Natal, South Africa. It is a two-stage design of a cluster-randomized trial and an individual randomized trial to test how structural and individual-level interventions address the demand-side factors that affect HIV testing and treatment for hard-to reach, high-risk men. It combines male-focused mobilization, community-based mobile HIV testing services, and a small incentive to determine if the strategies singly and in combination can result in more men diagnosed with HIV, and more men linked to and maintained in care with undetectable viral load. Discussion A priority for sub-Sahara Africa is developing and evaluating novel and cost-effective strategies for identifying hard-to-reach groups such as men, linking them to HIV testing and care services, and maintaining them in care to the point of viral suppression. We propose a combination prevention intervention that addresses men’s individual, interpersonal, and structural barriers to testing and care. This includes male-led mobilization to encourage uptake of testing and treatment, male-focused testing venues, male-only counselors, developing counseling models that are flexible and responsive to men, and strategies for adhering to clinic visits without missing work and navigating the healthcare system. By thoughtfully combining male-focused mobilization, and testing and addressing some of the barriers to male engagement with health facilities, this study hopes to add to the growing evidence base about how to reach, test, link, and maintain a hard-to-reach group such as men in HIV treatment and care services. Trial registration ClinicalTrials.gov, NCT03794245. Registered on 4 January 2019.

scholarly journals Zwakala Ndoda: a cluster and individually randomised aimed at improving testing, linkage and adherence to treatment for hard-to reach men in KwaZulu-Natal, South Africa

2019 ◽  
Author(s):  
Heidi van Rooyen ◽  
Tawanda Makusha ◽  
Phillip Joseph ◽  
Thulani Ngubane ◽  
Michal Kulich ◽  
...  
Keyword(s):  
South Africa ◽  
Viral Load ◽  
Hiv Testing ◽  
Randomised Trial ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Cluster Randomised Trial ◽  
Evidence Based ◽  
Care Services ◽  
Kwazulu Natal

Abstract Background Men in sub-Saharan Africa are less likely than women to get tested for HIV, less likely to present for treatment, less likely to be maintained in treatment, more likely to have detectable viral load, more likely to transmit HIV with unprotected intercourse, and more likely to progress to AIDS and die sooner from HIV. The ultimate objective of this research is to provide evidence-based strategies to improve HIV testing and treatment of HIV-infected men. Methods This study is being conducted in the Greater Edendale Area and Vulindlela region in KwaZulu-Natal, South Africa. It is a two-stage design of a cluster-randomised trial and an individual randomised trial to test how structural and individual-level interventions address the demand-side factors that affect HIV testing and treatment for hard-to reach, high-risk men. It combines male-focused mobilization, community-based mobile HIV Testing Services and a small incentive to determine if the strategies singly and in combination can result in more men diagnosed with HIV, and more men linked to and maintained in care with undetectable viral load. Discussion A priority for sub-Sahara Africa is developing and evaluating novel and cost-effective strategies for identifying hard-to-reach groups such as men, linking them to HIV testing and care services and maintaining them in care to the point of viral suppression. We propose a combination prevention intervention that addresses men’s individual, interpersonal, and structural barriers to testing and care. This includes male-led mobilization to encourage uptake of testing and treatment; male-focused testing venues; male-only counselors; developing counseling models that are flexible and responsive to men; and strategies for adhering to clinic visits without missing work and navigating the health care system. By thoughtfully combining male-focused mobilization, testing and addressing some of the barriers to male engagement with health facilities, this study hopes to add to the growing evidence based about how to reach, test, link and maintain a hard to reach group such as men in HIV treatment and care services.

The Bio/Necropolitics of ACTG 076: Lessons from Pregnant Women of Colour Living with HIV for Treatment for Prevention in the Twenty-first Century

Somatechnics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 233-253
Author(s):  
Eli Manning
Keyword(s):  
Hiv Transmission ◽  
Ethical Dilemmas ◽  
Hiv Treatment ◽  
First Century ◽  
Hiv Positive ◽  
Treatment As Prevention ◽  
People Living With Hiv ◽  
Hiv Positive Women ◽  
Aids Clinical Trials ◽  
Living With Hiv

Since the pharmaceutical turn, using HIV treatment to prevent transmission is increasingly common. Treatment as Prevention®, or TasP, has relied on HIV treatment to prevent HIV transmission, targeting people living with HIV. However, TasP is predicated on troublesome heterosexist, classist, and racist medical practices borrowed from various times and spaces that enact biopolitical and necropolitical relations. This paper discusses the debate surrounding the first clinical trial that used HIV treatment to prevent transmission from woman-to-foetus. The 1994 landmark AIDS Clinical Trials Group 076 study laid the groundwork for using HIV treatment to prevent HIV transmission, the essential precursor to TasP. By examining the concerns of HIV positive women of colour and other AIDS activists, we are able to understand the ethical dilemmas and practical consequences that still haunt today's game-changing uses of HIV treatment for prevention and to see how biopolitics and necropolitics persist in TasP.

scholarly journals ‘Too old to test?’: A life course approach to HIV-related risk and self-testing among midlife-older adults in Malawi

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cheryl Johnson ◽  
Moses Kumwenda ◽  
Jamilah Meghji ◽  
Augustine T. Choko ◽  
Mackwellings Phiri ◽  
...  
Keyword(s):  
Older Adults ◽  
Life Course ◽  
Hiv Testing ◽  
Sexual Risk ◽  
Age Groups ◽  
Sub Saharan Africa ◽  
Treatment As Prevention ◽  
Sexual Risk Taking ◽  
Rural And Urban ◽  
Self Testing

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.

scholarly journals Sociodemographic and lifestyle correlates of exclusive breastfeeding practices among mothers on antiretroviral therapy in the Eastern Cape, South Africa

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Daniel Ter Goon ◽  
Anthony Idowu Ajayi ◽  
Oladele Vincent Adeniyi
Keyword(s):  
South Africa ◽  
Antiretroviral Therapy ◽  
Exclusive Breastfeeding ◽  
Hiv Transmission ◽  
Cross Sectional Study ◽  
Sub Saharan Africa ◽  
Eastern Cape ◽  
Cross Sectional ◽  
Factors Associated ◽  
Breastfeeding Practice

Abstract Background Exclusive breastfeeding (EBF) is associated with a reduction of postnatal HIV transmission and optimal infant growth. Given that the factors influencing exclusive breastfeeding are multi-factorial and context-specific, we examined the prevalence and factors associated with exclusive breastfeeding practice in the first 6 months among mothers on antiretroviral therapy in the Eastern Cape, South Africa. Methods This was a cross-sectional study conducted between January to May 2018, on 469 parturient women enlisted in the prevention of mother-to-child HIV transmission cohort study in the Eastern Cape. Mothers were asked to recall whether they breastfed their infant exclusively with breast milk from birth and if so, to state how long they did. We collected relevant sociodemographic, lifestyle, and maternal information by interview. Bivariate and multivariable logistic regression analyses were fitted to determine the sociodemographic and lifestyle factors associated with exclusive breastfeeding practice. Results The prevalence of six-month exclusive breastfeeding, measured since birth, was 32.0%. E Exclusive breastfeeding’s prevalence was significantly higher among married women (36.8%), unemployed women (36.6%), non-smokers (32.7%), and those who never drank alcohol (37.0%). Unemployed women (adjusted odds ratio [AOR] 1.66, 95% Confidence Interval [CI] 1.08–2.56) and those with grade 12 or less level of education (AOR 2.76, 95% CI 1.02–7.49) had a higher likelihood of practising EBF for 6 months since birth while mothers who consumed alcohol (AOR 0.54, 95% CI 0.34–0.85) were less likely to practice EBF for 6 months. Conclusions The prevalence of six-month exclusive breastfeeding in the study, although comparable with sub-Saharan Africa and worldwide prevalence, remains suboptimal. Advocacy campaigns on EBF must target alcohol cessation and the creation of a favourable workplace environment for lactating mothers.

scholarly journals The role of contraception in preventing HIV-positive births: global estimates and projections

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jennifer Sherwood ◽  
Elise Lankiewicz ◽  
Beirne Roose-Snyder ◽  
Bergen Cooper ◽  
Austin Jones ◽  
...  
Keyword(s):  
South Africa ◽  
Hiv Infections ◽  
Review Literature ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Treatment Coverage ◽  
Contraception Use ◽  
Unintended Births ◽  
Mother To Child ◽  
Method Mix

Abstract Background Meeting the contraceptive needs of women living with HIV (WLHIV) has primary health benefits for women, in addition to being a key element to prevent mother-to-child HIV transmission. This analysis will estimate the current number of infant HIV infections prevented by contraception in the era of increased HIV treatment coverage and; 2) model the additional HIV benefits of preventing unintended births to WLHIV. Methods Secondary data analysis was conducted using publicly available data from the United Nations Programme on HIV/AIDS (UNAIDS) and Population Division, Demographic Health Surveys, and peer-review literature. National data from 70 countries, that had a UNAIDS estimate for the number of WLHIV nationally, were combined into country-level models. Models estimated the current number of infant HIV infections averted by contraception annually and potentially averted if unintended births to WLHIV were prevented. Estimates take into account pregnancy and live birth rates, contraceptive coverage, contraceptive method mix and failure rates, and HIV treatment coverage during pregnancy to prevent mother to child transmission. Results Contraception use among WLHIV prevents an estimated 43,559 new infant HIV infections annually across 70 countries. Countries with the largest number of infant infections averted by contraception included South Africa (9441), Nigeria (4195), Kenya (3508), Zimbabwe (2586), and India (2145). Preventing unintended births to WLHIV could avert an additional 43,768 new infant infections per year, with the greatest potential gains to be made in South Africa (12,036), Nigeria (2770), Uganda (2552), and the Democratic Republic of the Congo (2324). Conclusions Contraception continues to play an integral role in global HIV prevention efforts in the era of increasing HIV treatment coverage, especially in sub-Saharan Africa. Broad contraceptive availability, increased contraceptive voluntarism and method mix are key components to preventing unintended births and ending new infant HIV infections worldwide.

scholarly journals Sociodemographic and lifestyle correlates of exclusive breastfeeding practices among mothers on antiretroviral therapy in the Eastern Cape, South Africa

2021 ◽  
Author(s):  
Daniel Ter Goon ◽  
Anthony Idowu Ajayi ◽  
Oladele Vincent Adeniyi
Keyword(s):  
South Africa ◽  
Antiretroviral Therapy ◽  
Exclusive Breastfeeding ◽  
Hiv Transmission ◽  
Cross Sectional Study ◽  
Sub Saharan Africa ◽  
Eastern Cape ◽  
Cross Sectional ◽  
Factors Associated ◽  
Breastfeeding Practice

Abstract Background: Exclusive breastfeeding (EBF) is associated with a reduction of postnatal HIV transmission and optimal infant growth. Given that the factors influencing exclusive breastfeeding are multi-factorial and context-specific, we examined the prevalence and factors associated with exclusive breastfeeding practice in the first six months among mothers on antiretroviral therapy in the Eastern Cape, South Africa. Methods: This was a cross-sectional study conducted between January – May 2018 on 469 parturient women enlisted in the prevention of mother-to-child HIV transmission cohort study in the Eastern Cape. Mothers were asked to recall whether they breastfed their infant exclusively with breast milk from birth and if so, to state how long they did. We collected relevant sociodemographic, lifestyle, and maternal information by interview. Bivariate and multivariable logistic regression analyses were fitted to determine the sociodemographic and lifestyle factors associated with exclusive breastfeeding practice.Results: The prevalence of six-month exclusive breastfeeding, measured since birth, was 32.0%. EBF’s prevalence was significantly higher among married women (36.8%), unemployed women (36.6%), non-smokers (32.7%), and those who never drank alcohol (37.0%). Unemployed women [adjusted odds ratio (AOR) = 1.66, 95% Confidence Interval CI), 1.08-2.56] and those with grade 12 or less level of education (AOR =2.76, 95% CI, 1.02-7.49) had a higher likelihood of practising EBF for six months since birth while mothers who consumed alcohol (AOR = 0.54, 95% CI, 0.34-0.85) were less likely to practice EBF for six months. Conclusions: The prevalence of six-month exclusive breastfeeding in the study, although comparable with sub-Saharan Africa and worldwide prevalence, remains suboptimal. Advocacy campaigns on EBF must target alcohol cessation and the creation of a favourable workplace environment for lactating mothers.

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