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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sylivia Nalubega ◽  
Joshua Kyenkya ◽  
Irene Bagaya ◽  
Sylvia Nabukenya ◽  
Nelson Ssewankambo ◽  
...  
Keyword(s):  
Retention In Care ◽  
Drop Out ◽  
Hiv Care ◽  
Mitigation Measures ◽  
Public Healthcare ◽  
Distribution Models ◽  
Community Based ◽  
Cross Sectional ◽  
Short Supply ◽  
Retention In Hiv Care

Abstract Background Retention of pregnant and breastfeeding women and their infants in HIV care still remains low in Uganda. Recent literature has shown that the effects of COVID-19 mitigation measures may increase disease burden of common illnesses including HIV, Tuberculosis, Malaria and other key public health outcomes such as maternal mortality. A research program was undertaken to locate disengaged HIV positive women on option B+ and supported them to reengage in care. A 1 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 1 year since they were last contacted. Seventeen participants were included. Data was analysed using the content analysis approach. Results 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 COVID-19 may exacerbate barriers to retention in HIV care among those who have experienced previous disengagement. 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 pandemic.

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 Retention in HIV Care among Children Aged 0-14 Years and the Associated Family and Caregiver Factors in Embu County, Kenya

2021 ◽  
Vol 11 (7) ◽  
pp. 293-302
Author(s):  
Ikiara, Eliza Kathure ◽  
Orinda, George Owino ◽  
Thigiti, Joseph Mwangi
Keyword(s):  
Retention In Care ◽  
Cross Sectional Study ◽  
Hiv Care ◽  
Hiv Positive ◽  
Hiv Status ◽  
Cross Sectional ◽  
Number Of Factors ◽  
Retention In Hiv Care ◽  
The Family ◽  
Associated Family

Background: Retention of children in HIV care is influenced by a number of factors, among them family and caregiver factors. Objective: To determine the family and caregiver factors associated with retention in care. Methods: We conducted a cross sectional study in level 4 and 5 hospitals in Embu county. Data were collected through interviews using a predesigned questionnaire. Descriptive and inferential data analysis was performed. Results: We enrolled 238 participants between January and April 2018, comprising 143 males (50.5%) and 140 females (49.5%). The median age of the participants was 12 years (IQR 5). Two thirds of the minors were in primary school (192, 67.8%). More of the children’s mothers were HIV positive compared to the fathers (257 vs 99) though a greater number of the fathers had an unknown HIV status compared to the mothers (138 vs 21). Most minors (241, 85.2%) were retained in care throughout having never missed an appointment. The number of siblings alive (aOR 0.72, 95% CI: 0.56, 0.92), siblings with HIV (aOR 0.26, 95% CI: 0.10, 0.68), a HIV positive caregiver (aOR 5.48, 95% CI: 2.44, 12.97), stigma (aOR 0.35, 95% CI: 0.15, 0.77), work duties of the caregiver (aOR 0.28, 95% CI 0.13, 0.58) and denial of HIV status by the caregiver (aOR 0.10, 95% CI 0.02, 0.47) were all associated with retention in HIV care. Conclusion: A HIV positive caregiver was most likely to ensure a child is retained in care. Stigma and denial of HIV status still hinder retention. Key words: Retention, HIV, children, caregiver.

scholarly journals Correction: Adherence towards COVID-19 mitigation measures and its associated factors among Gondar City residents: A community-based cross-sectional study in Northwest Ethiopia

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256954
Author(s):  
Zelalem Nigussie Azene ◽  
Mehari Woldemariam Merid ◽  
Atalay Goshu Muluneh ◽  
Demiss Mulatu Geberu ◽  
Getahun Molla Kassa ◽  
...  
Keyword(s):  
Associated Factors ◽  
Cross Sectional Study ◽  
Northwest Ethiopia ◽  
Mitigation Measures ◽  
Sectional Study ◽  
Community Based ◽  
Cross Sectional

scholarly journals Individual and neighborhood predictors of retention in care and viral suppression among Florida youth (aged 13–24) living with HIV in 2015

2019 ◽  
Vol 30 (11) ◽  
pp. 1095-1104
Author(s):  
Merhawi T Gebrezgi ◽  
Diana M Sheehan ◽  
Daniel E Mauck ◽  
Kristopher P Fennie ◽  
Gladys E Ibanez ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Age Groups ◽  
Retention In Care ◽  
Population Based ◽  
Hiv Care ◽  
Foreign Born ◽  
Perinatal Hiv ◽  
Retention In Hiv Care ◽  
Older Youth ◽  
Sex With Men

Youth aged 13‒24 are less likely to be retained in HIV care and be virally suppressed than older age groups. This study aimed to assess predictors of retention in HIV care and viral suppression among a population-based cohort of youth (N = 2872) diagnosed with HIV between 1993 and 2014 in Florida. We used generalized estimating equations to estimate prevalence ratios (PRs). Retention in care was defined as evidence of engagement in care (at least one laboratory test, physician visit, or antiretroviral therapy prescription refill), two or more times, at least three months apart during 2015. Viral suppression was defined as having evidence of a viral load <200 copies/ml among those in care during 2015. Among the 2872 youth, 65.4% were retained in care, and among those in care, 65.0% were virally suppressed. Older youth (18‒24 years old) and non-Hispanic Blacks (NHBs) were less likely to be retained in care, whereas those men who have sex with men, perinatal HIV transmission, living in low socioeconomic neighborhoods, and those diagnosed with AIDS before 2016 were more likely to be retained in care. Those diagnosed with AIDS before 2016 and NHBs were less likely to be virally suppressed, whereas those men who have sex with men and foreign-born persons were more likely to be virally suppressed. Results suggest the need for targeted retention and viral suppression interventions for NHB youth and older youth (18‒24 years-age).

scholarly journals Retention in HIV Care Among Participants in the Patient-Centered HIV Care Model: A Collaboration Between Community-Based Pharmacists and Primary Medical Providers

2019 ◽  
Vol 33 (2) ◽  
pp. 58-66 ◽  
Author(s):  
Kathy K. Byrd ◽  
Felicia Hardnett ◽  
Patrick G. Clay ◽  
Ambrose Delpino ◽  
Ron Hazen ◽  
...  
Keyword(s):  
Hiv Care ◽  
Medical Providers ◽  
Care Model ◽  
Patient Centered ◽  
Community Based ◽  
Retention In Hiv Care

scholarly journals 1770. The Association of Unmet Needs With Subsequent Retention in Care and HIV Suppression Among Hospitalized Patients With HIV Who Are Out of Care

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S65-S66
Author(s):  
Dima Dandachi ◽  
Sarah May ◽  
Jessica Davila ◽  
Jeffrey Cully ◽  
K Rivet Amico ◽  
...  
Keyword(s):  
Viral Load ◽  
Dental Care ◽  
Unmet Needs ◽  
Unmet Need ◽  
Retention In Care ◽  
Hospitalized Patients ◽  
Hiv Care ◽  
Medical Needs ◽  
Retention In Hiv Care ◽  
Housing Needs

Abstract Background Unmet needs among hospitalized patients with HIV may prevent engagement in HIV care leading to worse clinical outcomes. Our aim was to examine the role of unmet subsistence needs (e.g., housing, transportation, food) and medical needs (e.g., mental health, substance abuse treatment) as barriers for retention in HIV care and viral load (VL) suppression. Methods We utilized data from the Mentor Approach for Promoting Patients’ Self-Care intervention study, the enrolled hospitalized HIV-patients at a large publicly funded hospital between 2010 and 2013, who were out-of-care. We examined the effect of unmet needs on retention in HIV care (attended HIV appointments within 0–30 days and 30–180 days) and viral load suppression, 6 months after discharge. Results A total of 417 participants were enrolled, 78% reported having ≥1 unmet need at baseline, most commonly dental care (55%), financial (43%), or housing needs (34%). Participants with unmet needs at baseline, compared with those with no needs, were more likely to be African American, have an existing HIV diagnosis, and be uninsured. Among participants who completed a baseline and 3-month survey (n = 320), 45% reported a need for dental care, 42% reported financial needs, and 32% reported housing needs that were unmet at either time point (Figure 1). Having a dental care need at baseline that was met was significantly associated with higher odds of VL improvements at 6-month follow-up (OR: 2.2; 95% CI: 1.04–4.50, P = 0.03) and higher odds for retention in care (OR: 2.06; 95% CI: 1.05–4.07, P = 0.04). An unmet need for transportation was associated with lower odds of retention in care (OR: 0.5; 95% CI: 0.34–0.94, P = 0.03), even after adjusting for other factors. Compared with participants with no need, those who reported ≥3 unmet subsistence needs were less likely to demonstrate viral load improvement (OR: 0.51; 95% CI: 0.28–0.92; P = 0.03) and to be retained in care (OR: 0.52; 95% CI: 0.28–0.95; P = 0.03). Conclusion An important and novel finding in our study is that the number of unmet subsistence needs had a significant effect on retention in care and VL suppression. Broader access to programs that can assist in meeting subsistence needs among hospitalized patients could have significant individual and public health benefits. Disclosures All authors: No reported disclosures.

scholarly journals Living conditions, HIV and gender affirmation care pathways of transgender people living with HIV in France: a nationwide, comprehensive, cross-sectional, community-based research protocol (ANRS Trans&HIV)

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052691
Author(s):  
Marion Mora ◽  
Giovanna Rincon ◽  
Michel Bourrelly ◽  
Gwenaëlle Maradan ◽  
Anaenza Freire Maresca ◽  
...  
Keyword(s):  
Medical Care ◽  
Living Conditions ◽  
Hiv Care ◽  
Care Pathways ◽  
Community Based ◽  
Cross Sectional ◽  
Transgender People ◽  
Community Based Research ◽  
Gender Affirmation ◽  
And Gender

IntroductionTransgender identity is poorly accepted in France, and data on living conditions and the daily difficulties transgender people encounter are scarce. This lack of data reinforces their invisibility in social life, contributes to their stigmatisation and probably increases the burden of HIV infection, especially for HIV-positive transgender people (TRHIV). The main objective of the community-based research study ANRS Trans&HIV is to identify personal and social situations of vulnerability in TRHIV, the obstacles they encounter in terms of access to and retention in medical care, and their gender affirmation and HIV care needs.Methods and analysisANRS Trans&HIV is a national, comprehensive, cross-sectional survey of all TRHIV currently being followed in HIV care units in France. TRHIV women are exclusively included in the quantitative component, and TRHIV men in the qualitative component. Data are collected by community-based interviewers and will be analysed to explore patient care pathways and living conditions in the TRHIV population with regard to gender affirmation and HIV. Data collection began in October 2020 and should be completed in December 2021. The statistical analyses techniques used will be adapted to each of the study’s objectives and to the type of data collected (cross-sectional (questionnaires) and retrospective (biographical trajectory)). The study’s results will provide a greater understanding of TRHIV health needs in order to suggest possible national recommendations for comprehensive HIV and gender affirmation medical care.Ethics and disseminationANRS Trans&HIV was approved by Inserm’s Ethical Evaluation Committee (no 20-694 on 12 May 2020) and is registered with the National Commission on Informatics and Liberty under number 2518030720. Potential participants are informed about the study through an information note provided by their attending HIV physician. All results published in peer-reviewed journals will be disseminated to the HIV transgender community, institutional stakeholders and healthcare providers.Trial registration numberNCT04849767.

scholarly journals Strategies for retention of heterosexual men in HIV care in sub-Saharan Africa: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246471
Author(s):  
Sylvia Kusemererwa ◽  
Dickens Akena ◽  
Damalie Nakanjako ◽  
Joanita Kigozi ◽  
Regina Nanyunja ◽  
...  
Keyword(s):  
Sub Saharan Africa ◽  
Hiv Care ◽  
Heterosexual Men ◽  
Inclusion Criteria ◽  
Community Based ◽  
Art Programs ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Retention In Hiv Care ◽  
Sub Saharan

Expansion of Antiretroviral Therapy (ART) programs in sub-Saharan Africa (SSA) has increased the number of people accessing treatment. However, the number of males accessing and being retained along the human immunodeficiency virus (HIV) care cascade is significantly below the UNAIDS target. Male gender has been associated with poor retention in HIV care programs, and little is known about strategies that reduce attrition of men in ART programs. This review aimed to summarize any studies on strategies to improve retention of heterosexual males in HIV care in SSA. An electronic search was conducted through Ovid® for three databases (MEDLINE®, Embase and Global Health). Studies reporting interventions aimed at improving retention among heterosexual men along the HIV care cascade were reviewed. The inclusion criteria included randomized-controlled trials (RCTs), prospective or retrospective cohort studies that studied adult males (≥15years of age), conducted in SSA and published between January 2005 and April 2019 with an update from 2019 to 2020. The search returned 1958 articles, and 14 studies from eight countries met the inclusion criteria were presented using the PRISMA guidelines. A narrative synthesis was conducted. Six studies explored community-based adherence support groups while three compared use of facility versus community-based delivery models. Three studies measured the effect of national identity cards, disclosure of HIV status, six-monthly clinic visits and distance from the health center. Four studies measured risk of attrition from care using hazard ratios ranging from 1.2–1.8, four studies documented attrition proportions at an average of 40.0% and two studies an average rate of attrition of 43.4/1000PYs. Most (62%) included studies were retrospective cohorts, subject to risk of allocation and outcome assessment bias. A pooled analysis was not performed because of heterogeneity of studies and outcome definitions. No studies have explored heterosexual male- centered interventions in HIV care. However, in included studies that explored retention in both males and females, there were high rates of attrition in males. More male-centered interventions need to be studied preferably in RCTs. Registry number: PROSPERO2020 CRD42020142923 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020142923.

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