scholarly journals Adapting and Implementing a Community Program to Improve Retention in Care among Patients with HIV in Southern Haiti: “Group of 6”

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
John A. Naslund ◽  
Jodie Dionne-Odom ◽  
Cléonas Junior Destiné ◽  
Kristen M. Jogerst ◽  
Redouin Renold Sénécharles ◽  
...  
Keyword(s):  
Retention In Care ◽  
Hospital Staff ◽  
Routine Care ◽  
Hiv Care ◽  
Group Model ◽  
Community Art ◽  
Hiv Management ◽  
Retention Group ◽  
Group Members ◽  
One Year

Objective. In Mozambique, a patient-led Community ART Group model developed by Médecins Sans Frontières improved retention in care and adherence to antiretroviral therapy (ART) among persons with HIV. We describe the adaptation and implementation of this model within the HIV clinic located in the largest public hospital in Haiti’s Southern Department.Methods. Our adapted model was named Group of 6. Hospital staff enabled stable patients with HIV receiving ART to form community groups with 4–6 members to facilitate monthly ART distribution, track progress and adherence, and provide support. Implementation outcomes included recruitment success, participant retention, group completion of monthly monitoring forms, and satisfaction surveys.Results. Over one year, 80 patients from nine communities enrolled into 15 groups. Six participants left to receive HIV care elsewhere, two moved away, and one died of a non-HIV condition. Group members successfully completed monthly ART distribution and returned 85.6% of the monthly monitoring forms. Members reported that Group of 6 made their HIV management easier and hospital staff reported that it reduced their workload.Conclusions. We report successful adaptation and implementation of a validated community HIV-care model in Southern Haiti. Group of 6 can reduce barriers to ART adherence, and will be integrated as a routine care option.

scholarly journals A sub-group evaluation of the multi-month dispensing strategy for differentiated HIV care: is personalization of care guidelines warranted in Haiti?

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Canada Parrish ◽  
Anirban Basu ◽  
Paul Fishman ◽  
Jean Baptiste Koama ◽  
Ermane Robin ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Causal Effect ◽  
Care Delivery ◽  
Clinical Stage ◽  
Retention In Care ◽  
Individual Characteristics ◽  
Hiv Care ◽  
Marginal Effect ◽  
One Year ◽  
Living With Hiv

Abstract Background Differentiated care strategies are rapidly becoming the norm for HIV care delivery globally. Building upon an interest in tailoring antiretroviral therapy (ART) delivery for client-centered needs, the Ministry of Health and Population in Haiti formally endorsed multiple-month dispenses (MMD) in the 2016 national ART guidelines This study explores heterogeneity in retention in care with MMD for specific Haitian populations living with HIV and evaluates if a targeted algorithm for optimal ART prescription intervals is warranted in Haiti. Methods This study included ART-naïve individuals who started ART on or after January 1st, 2017 in Haiti. To identify subgroups in which to explore heterogeneity of retention, we implemented a double-lasso regression method to determine which individual characteristics would define the subgroups. Characteristics evaluated for potential subgroup definition included: sex, age category, WHO clinical stage, and body mass index category. We employed instrumental variable models to estimate the causal effect of increasing ART dispensing length on ART retention, by client subgroup. The outcome of interest was retention in care after one year in treatment. We then estimated the marginal effect of a 30-day increase to ART dispensing length to retention in care for each of these subgroups. Results There was evidence for heterogeneity in the effect of extending ART dispensing intervals on retention by WHO clinical stage. We observed significant improvements to retention in care at one year with a 30-day increase in ART dispense length for all subgroups defined by WHO clinical stages 1-4. The effects ranged from a 14.7% increase (95% CI: 12.4-17.0) to the likelihood of retention for people with HIV in WHO stage 1 to a 21.6% increase (95% CI: 18.7-24.5) to the likelihood of retention for those in WHO stage 3. Conclusions All the subgroups defined by WHO clinical stage experienced a benefit of extending ART intervals to retention in care at one year. Though the effect did differ slightly by WHO stage, the effects went in the same direction and were of similar magnitude. Therefore, a standardized recommendation for MMD among those living with HIV and new on ART is appropriate for Haiti treatment guidelines.

scholarly journals COVID-19 may Exacerbate the Clinical, Structural and Psychological Barriers to Retention in Care Among Women Living with HIV in Rural and Peri-Urban Settings in Uganda

2020 ◽  
Author(s):  
Sylivia Nalubega ◽  
Joshua Kyenkya ◽  
Irene Bagaya ◽  
Sylvia Nabukenya ◽  
Nelson Ssewankambo ◽  
...  
Keyword(s):  
Close Contact ◽  
Retention In Care ◽  
Drop Out ◽  
Hiv Care ◽  
Public Healthcare ◽  
Distribution Models ◽  
Community Based ◽  
Cross Sectional ◽  
Short Supply ◽  
One Year

Abstract Background: Retention of pregnant and breastfeeding women and their infants in HIV care still remains low in Uganda yet it is critical in achieving elimination of mother to child transmission of HIV. A research program was undertaken to locate disengaged HIV positive women on Option B+ and supported them to reengage in care. A one year follow up done following the tracing revealed that some women still disengaged from care. We aimed to establish the barriers to and facilitators for reengagement in care among previously traced women on option B+, and how these could have been impacted by the COVID-19 pandemic. Methods: This was a cross sectional qualitative study using individual interviews conducted in June and July, 2020, a period when the COVID-19 response measures such as lockdown and restrictions on transport were being observed in Uganda. Study participants were drawn from nine peri-urban and rural public healthcare facilities. Purposive sampling was used to select women still engaged in and those who disengaged from care approximately after one year since they were last contacted. Data was analysed using the content analysis approach. Results: Seventeen participants were included. Women reported various barriers that affected their reengagement and retention in care during the COVID-19 pandemic. These included structural barriers such as transport difficulties and financial constraints; clinical barriers which included unsupportive healthcare workers, short supply of drugs, clinic delays, lack of privacy and medicine side effects; and psychosocial barriers such as perceived or experienced stigma and non-disclosure of HIV sero-status. Supportive structures such as family, community-based medicine distribution models, and a friendly healthcare environment were key facilitators to retention in care among this group. The COVID-19 pandemic was reported to exacerbate the barriers to retention in care. Conclusions: Women previously at risk of disengagement may have more chances of dropping out from care during the COVID-19. We recommend community-based models such as drop out centres, peer facilitated distribution and community outreaches as alternative measures for access to ART during the COVID-19 and other pandemics that spread through close contact.

scholarly journals Evaluation of a community-based HIV test and start program in a conflict affected rural area of Yambio County, South Sudan

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254331
Author(s):  
Cecilia Ferreyra ◽  
Laura Moretó-Planas ◽  
Fara Wagbo Temessadouno ◽  
Beatriz Alonso ◽  
Buai Tut ◽  
...  
Keyword(s):  
South Sudan ◽  
Retention In Care ◽  
Virological Suppression ◽  
Hiv Care ◽  
Program Outcomes ◽  
Community Art ◽  
Art Initiation ◽  
Hiv Test ◽  
Hiv Counselling And Testing

Background Antiretroviral therapy (ART) coverage in South Sudan is around 10%. Access to HIV care in settings with low ART coverage or conflict affected is still low; innovative strategies are needed to increase access and ensure continuation of ART during instability. A pilot HIV test and start project was implemented in a conflict-affected area of South Sudan. In a retrospective analysis, we determined the feasibility and outcomes of this intervention. Methods Programme data from July 2015 to June 2018 was analysed. The project involved five mobile teams offering HIV counselling and testing (HCT) and same day ART initiation at community level. Baseline and follow-up information on clinical, immunological and viral load (VL) was routinely recorded, as well as treatment outcomes. A semi-qualitative study was conducted to assess acceptability of the program among beneficiaries and community members. Results By June 2018, 14824 people received counselling and testing for HIV and 498 (3.4%) tested positive. Out of those 395 (79.3%) started ART. A total of 72 ART patients were organized in 26 Community ART Groups (CAGs) and contingency plan was activated 9 times for 101 patients. Kaplan-Meier estimated retention in care (RIC) at 12 and 18 months was 80.6% [95% CI: 75.9–84.5%] and 69.9% [95% CI: 64.4–74.8%] respectively. RIC was significantly higher at 18 months in patients under community ART groups (CAGs) (90.9% versus 63.4% p<0.001) when compared to patients on regular follow up. VL suppression at 12 months was 90.3% and overall virological suppression reached 91.2%. A total of 279 persons were interviewed about the MSF program perception and acceptance: 98% had heard about the programme and 84% found it beneficial for the community, 98% accepted to be tested and only 4% found disadvantages to the programme. Conclusions Our study shows that HCT and early ART initiation in conflict affected populations can be provided with good program outcomes. RIC and virological suppression are comparable with facility-based HIV programs and to those in stable contexts. This model could be extrapolated to other similar contexts with low access to ART and where security situation is a concern.

scholarly journals Bijou: Engaging Young MSM in HIV Care Using a Mobile Health Strategy

2021 ◽  
Vol 20 ◽  
pp. 232595822110308
Author(s):  
Tiffany Chenneville ◽  
Hunter Drake ◽  
Kemesha Gabbidon ◽  
Carina Rodriguez ◽  
Lisa Hightow-Weidman
Keyword(s):  
Health Literacy ◽  
Self Efficacy ◽  
Retention In Care ◽  
Knowledge Retention ◽  
Hiv Care ◽  
Ehealth Literacy ◽  
Literacy Engagement ◽  
Southeastern Us ◽  
Post Test ◽  
Living With Hiv

Young men who have sex with men (YMSM) living with HIV experience challenges with retention in care, which negatively affects viral suppression. To address this, researchers piloted Bijou, a program designed to provide health education through electronically delivered behavior and risk reduction modules. Participants were 29 YMSM aged 19-24 living with HIV from the southeastern US. Participants completed pre, post, and 3-month follow-up (3MFU) surveys assessing knowledge, intervention acceptability, satisfaction, self-efficacy, ehealth literacy, and usability. Findings revealed significant improvement in knowledge and e-health literacy from pre-test to post-test but lost significance at 3MFU. Self-efficacy scores did not show significant differences from pre-test to post-test or 3MFU. Participants who completed all modules considered Bijou usable and acceptable; however, many did not complete the program. Findings suggest a need for adaptations to promote knowledge retention, e-health literacy, engagement over time, and research with a larger, more representative sample.

scholarly journals 1042. The Attitude of Patients With HIV about Telehealth for Their HIV Care

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S550-S551
Author(s):  
Dima Dandachi ◽  
Bich Dang ◽  
Thomas Giordano Giordano
Keyword(s):  
Hiv Transmission ◽  
Personal Information ◽  
Critical Role ◽  
Retention In Care ◽  
Hiv Care ◽  
Structural Factors ◽  
Personal Factors ◽  
Response Distribution ◽  
Related Factors ◽  
Clinic Visits

Abstract Background The world is facing a pandemic of SARS-CoV-2 that disrupted our healthcare system and the way we deliver healthcare. For people with HIV (PWH), the ability to be retained in care plays a critical role in improving health outcomes and in preventing HIV transmission. Several definitions exist for retention in care, but they are centered around outpatient clinic visits. It is now more important than ever to understand PWH’s attitudes about using telemedicine for HIV care instead of face-to face clinic visits. Methods We administered a one-time survey to PWH presenting to an outpatient HIV center in Houston, Texas, from February–June 2018. The survey items were used to assess PWH’s attitudes towards and concerns for telehealth and explanatory variables. Results 371 participants completed the survey; median age was 51, 36% were female, and 63% African-American. Overall, 57% of respondents were more likely to use telehealth for their HIV care if available, as compared to one-on-one in-person care, and 37% would use telehealth frequently or always as an alternative to clinic visits. Participants reported many benefits including ability to fit better their schedule, decreasing travel time, and privacy but expressed concerns about the ability to effective communication and examination and the safety of personal information. Factors associated with likelihood of using telehealth include personal factors (US-born, men who have sex with men, higher educational attainment, higher HIV-related stigma perception), HIV-related factors (long standing HIV), and structural factors (having difficulty attending clinic visits, not knowing about or not having the necessary technology). There was no association between participants with uncontrolled HIV, medication adherence, and likelihood of using telehealth. Survey items and response distribution Conclusion Telehealth programs for PWH can improve retention in care. A modification of the definition for retention in care, incorporating telehealth, should be considered. Availability and confidence using various telehealth technologies need to be addressed to increase acceptability and usage of telehealth among PWH. Disclosures All Authors: No reported disclosures

scholarly journals Salud y Orgullo Mexicano: Development of a Culturally Specific Transnational Linkage and Retention in Care Intervention for Mexican Men Who Have Sex with Men Living with HIV in Chicago

2021 ◽  
Author(s):  
Amy K. Johnson ◽  
Román Buenrostro ◽  
Gilberto Soberanis ◽  
Banita McCarn ◽  
Bridget Magner ◽  
...  
Keyword(s):  
Intervention Mapping ◽  
Retention In Care ◽  
Hiv Care ◽  
Individual Level ◽  
Expert Advisory ◽  
Mapping Process ◽  
Sex With Men ◽  
Peer Navigation ◽  
Living With Hiv ◽  
Mexican Men

AbstractThis manuscript documents the development of an innovative individual-level peer navigation intervention “Salud y Orgullo Mexicano” (SOM) designed to increase linkage and retention to HIV care for Mexican men who have sex with men (MSM) in Chicago, Illinois. The intervention was developed via a modified intervention mapping process. Elements of two existing interventions were combined and refined with input from the Mexican MSM community, including informant interviews, an expert advisory board, and a design team. A manualized transnational intervention was developed via intervention mapping. A peer health navigation intervention “SOM” was created using intervention mapping and input from the focus community. Next steps include implementing and evaluating the intervention to determine acceptability and efficacy.

scholarly journals Impact of a child -friendly clinic on retention of HIV-infected children in care: an intervention study

1970 ◽  
Vol 44 (4) ◽  
pp. 175-179
Author(s):  
OR Ugwu
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Retention Rate ◽  
Retention In Care ◽  
Hiv Care ◽  
Satisfaction Survey ◽  
Loss To Follow Up ◽  
Child Friendly ◽  
Children In Care ◽  
The Impact

Background: Certain researchers have reported that a child-friendly clinic may improve patient/caregiver satisfaction at clinic attendance. This could serve as an innovation for reducing loss-to-follow up and increasing retention in care.Aim: To assess the impact of making the clinic more child-friendly on clinic experience, retention in care and loss-to-follow up of HIV -infected children.Method: The study was carried out in three phases. Phase one was a satisfaction survey to find out the patient/caregivers’ satisfaction of the clinic environment and services provided using a selfadministered questionnaire. Phase two was the creation of the childfriendly environment and phase three was a post-provision of child-friendly clinic satisfaction survey. The loss-to-follow up rate (failure to return to clinic ≥3months after the last scheduled clinic appointment in a child not known to be dead or transferred out of the facility) and retention rate (remaining alive and receiving highly active antiretroviral therapy) were also determined before and after setting up the childfriendly clinic.Results: There were 146 respondents before the study and 206 respondents after the intervention. The retention rate increased from 62.5% to 82% (p=0.02), while the loss-to-follow up rate dropped from 27.7% to 7.0% (p=0.00).Conclusion: Making the clinic area child-friendly can impact greatly on HIV care by improving patient satisfaction and retention of HIVinfected children in care and reducing loss-to-follow up.Key words: HIV, child-friendly environment, retention in care, loss to follow-up.

scholarly journals Performance and Outcomes of Routine Viral Load Testing in People Living with HIV Newly Initiating ART in the Integrated HIV Care Program in Myanmar between January 2016 and December 2017

2020 ◽  
Vol 5 (3) ◽  
pp. 140
Author(s):  
Sai Soe Thu Ya ◽  
Anthony D. Harries ◽  
Khin Thet Wai ◽  
Nang Thu Thu Kyaw ◽  
Thet Ko Aung ◽  
...  
Keyword(s):  
Viral Load ◽  
Virologic Failure ◽  
Secondary Data ◽  
Care Program ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Second Line ◽  
Load Testing ◽  
One Year ◽  
Living With Hiv

Myanmar has introduced routine viral load (VL) testing for people living with HIV (PLHIV) starting first-line antiretroviral therapy (ART). The first VL test was initially scheduled at 12-months and one year later this changed to 6-months. Using routinely collected secondary data, we assessed program performance of routine VL testing at 12-months and 6-months in PLHIV starting ART in the Integrated HIV-Care Program, Myanmar, from January 2016 to December 2017. There were 7153 PLHIV scheduled for VL testing at 12-months and 1976 scheduled for VL testing at 6-months. Among those eligible for testing, the first VL test was performed in 3476 (51%) of the 12-month cohort and 952 (50%) of the 6-month cohort. In the 12-month cohort, 10% had VL > 1000 copies/mL, 79% had repeat VL tests, 42% had repeat VL > 1000 copies/mL (virologic failure) and 85% were switched to second-line ART. In the 6-month cohort, 11% had VL > 1000 copies/mL, 83% had repeat VL tests, 26% had repeat VL > 1000 copies/mL (virologic failure) and 39% were switched to second-line ART. In conclusion, half of PLHIV initiated on ART had VL testing as scheduled at 12-months or 6-months, but fewer PLHIV in the 6-month cohort were diagnosed with virologic failure and switched to second-line ART. Programmatic implications are discussed.

scholarly journals Physical Activity on Prescription in Routine Health Care: 1-Year Follow-Up of Patients with and without Counsellor Support

2020 ◽  
Vol 17 (16) ◽  
pp. 5679
Author(s):  
Pia Andersen ◽  
Sara Holmberg ◽  
Kristofer Årestedt ◽  
Lena Lendahls ◽  
Per Nilsen
Keyword(s):  
Physical Activity ◽  
Health Care ◽  
Health Care Professionals ◽  
Routine Care ◽  
Interquartile Range ◽  
Activity Levels ◽  
Everyday Activity ◽  
Significant Difference ◽  
One Year

The effectiveness of counsellor support in addition to physical activity on prescription (PAP) from health care professionals has rarely been evaluated. This observational follow-up study investigated differences in physical activity levels and health-related quality of life (HRQoL) one year after PAP regarding patients’ use of counsellor support in addition to PAP in routine care. The study was conducted in a Swedish health care region in which all patients receiving PAP from health care professionals were offered counsellor support. Data were collected from medical records and questionnaires (baseline and follow-up). Of the 400 study participants, 37% used counsellor support. The group of counsellor users attained a higher level of physical activity one year after receiving PAP compared to the group of non-users (p < 0.001). The level of physical activity was measured by a validated index (score 3–19) calculated from weekly everyday activity and exercise training. Comparison of the change in scores between baseline and follow-up showed a significant difference between the two groups, (p < 0.001). The median difference in the PAP + C group was 2.0 (interquartile range, 7.0) and 0.0. among non-users (interquartile range, 4.0). Significant differences in HRQoL were due to positive improvements among counsellor users, with the main improvement in general health. The conclusion is that patients using counsellor support after receiving PAP from health care professionals had higher physical activity and better HRQoL one year after compared with patients who did not use this support.

The Impact of Broadband Access on Social and Economic Integration: Results from the RefugeeMobile Pilot

2019 ◽  
Author(s):  
William N Evans ◽  
Brendan Perry ◽  
Rachel Factor
Keyword(s):  
United States ◽  
Research Question ◽  
Risk Groups ◽  
The United States ◽  
Control Group ◽  
Broadband Access ◽  
Office Visits ◽  
Group Members ◽  
One Year ◽  
The Impact

Abstract The Internet is a ubiquitous feature of everyday life and an important research question is whether improving broadband access for at-risk groups such as refugees enhances social and economic outcomes. The article reports the results of the RefugeeMobile pilot where a sample of refugees to the United States were randomly assigned a smartphone (n = 82) with eight months of free service and pre-loaded apps designed to help them adjust to life in the United States, or not (n = 74). At a one-year follow-up, results indicate that assignment to treatment generates statistically significant increases in smartphone ownership and Internet access, and some measures of social integration. Results for employment and earnings were positive but statistically insignificant. Treatment-group members had fewer interactions with their case worker, a smaller fraction of in-office visits and hence a larger fraction of interactions by phone than control-group members, suggesting the pilot may have increased programme efficiency.

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