scholarly journals “We are in this together:” dyadic-level influence and decision-making among HIV serodiscordant couples in Tanzania receiving access to PrEP

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Virginia A. Fonner ◽  
Jacob Ntogwisangu ◽  
Isihaka Hamidu ◽  
Juliet Joseph ◽  
Joshua Fields ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Hiv Infections ◽  
Sexual Partners ◽  
Sub Saharan Africa ◽  
Study Participation ◽  
Serodiscordant Couples ◽  
Hiv Serodiscordant Couples ◽  
Self Testing

Abstract Background A substantial number of new HIV infections in sub-Saharan Africa occur within stable couples. Biomedical prevention (pre-exposure prophylaxis, PrEP) and treatment (antiretroviral therapy, ART) can provide benefits to sexual partners and can be used to prevent infection within HIV serodiscordant couples. However, research is typically focused on individuals, not dyads, even when the intervention may directly or indirectly impact sexual partners. Gaps remain in understanding best practices for recruitment, informed consent, and intervention implementation in studies involving HIV prevention and treatment among heterosexual serodiscordant couples. This qualitative study was undertaken to understand and describe decision-making and dyadic-level influence among members of serodiscordant couples regarding (1) participation in a dyadic-based research study involving HIV self-testing and access to PrEP, and (2) utilization of PrEP and ART. Methods This qualitative study was nested within an observational cohort study assessing the acceptability of home-based couples’ HIV self-testing and uptake of dyadic care for serodiscordant couples involving facilitated referral for HIV-positive partners and access to PrEP for HIV-negative partners. Semi-structured in-depth interviews were conducted among a subset of study participants (n = 22) as well as individuals involved in serodiscordant relationships who chose not to participate (n = 9). Interviews focused on couples’ decision-making regarding study participation and dyadic-level influence on medication use. Interviews were transcribed verbatim and translated from Kiswahili into English. Data were analyzed using thematic analysis. Results Three major themes were identified: (1) HIV as “two people’s secret” and the elevated role of partner support in serodiscordant relationships; (2) the intersectional role of HIV-status and gender on decision-making; (3) the relational benefits of PrEP, including psychosocial benefits for the couple that extend beyond prevention. Conclusions The study found that couples made joint decisions regarding study participation and uptake of HIV-related medication. Relational autonomy and dyadic-level influence should be considered within research and programs involving HIV serodiscordant couples.

scholarly journals Cost-Effectiveness of Peer-Delivered HIV Self-Tests for MSM in Uganda

2021 ◽  
Vol 9 ◽  
Author(s):  
Stephen Okoboi ◽  
Barbara Castelnuovo ◽  
Jean-Pierre Van Geertruyden ◽  
Oucul Lazarus ◽  
Lung Vu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Hiv Testing ◽  
Cost Effective ◽  
Hiv Infections ◽  
Standard Of Care ◽  
Sub Saharan Africa ◽  
High Risk Population ◽  
Self Testing ◽  
The Cost

Introduction: Distribution of HIV self-testing (HIVST) kits through MSM peer networks is a novel and effective strategy to increase HIV testing coverage in this high-risk population. No study has evaluated the cost or cost effectiveness of peer distribution of HIVST strategies among MSM in sub-Saharan Africa.Methods: From June to August 2018, we conducted a pilot study of secondary MSM peer HIVST kit distribution at The AIDS Support Organization at Entebbe and Masaka. We used an ingredients approach to estimate the cost of MSM peer HIVST kit distribution relative to standard-of-care (SOC) hotspot testing using programme expenditure data reported in US dollars. The provider perspective was used to estimate incremental cost-effective ratios per HIV infection averted using the difference in HIV annual transmission rates between MSM with HIV who knew their status and were not virologically suppressed and MSM with HIV who did not know their status.Results: We enrolled 297 participants of whom 150 received MSM peer HIVST kit distribution (intervention group) and 147 received TASO standard of care HIV testing (control group). Provider cost for the intervention was $2,276 compared with $1,827 for SOC during the 3-month study period. Overall, the intervention resulted in higher HIV positivity yield (4.9 vs. 1.4%) and averted more HIV infections per quarter (0.364 vs. 0.104) compared with SOC. The cost per person tested was higher for the intervention compared to SOC ($15.90 vs. $12.40). Importantly, the cost per new HIV diagnosis ($325 vs. $914) and cost per transmission averted ($6,253 vs. $ 17,567) were lower for the intervention approach relative to SOC. The incremental cost per HIV transmission averted by the self-testing program was $1,727. The incremental cost to providers per additional HIV-positive person identified by the intervention was $147.30.Conclusion: The intervention strategy was cost-effective, and identified more undiagnosed HIV infections than SOC hotspot testing at a cost-effectiveness threshold of US $2,129. Secondary distribution of HIVST kits through peers should further be evaluated with longer duration aimed at diagnosing 95% of all persons with HIV by 2030; the first UNAIDS 95-95-95 target.

scholarly journals Pre-exposure prophylaxis for HIV-negative persons with partners living with HIV: uptake, use, and effectiveness in an open-label demonstration project in East Africa

2018 ◽  
Vol 1 ◽  
pp. 3 ◽  
Author(s):  
Renee Heffron ◽  
Kenneth Ngure ◽  
Josephine Odoyo ◽  
Nulu Bulya ◽  
Edna Tindimwebwa ◽  
...  
Keyword(s):  
Hiv Infections ◽  
Hiv Treatment ◽  
Demonstration Project ◽  
Hiv Incidence ◽  
Serodiscordant Couples ◽  
Treatment Services ◽  
Hiv Serodiscordant Couples ◽  
Exposure Prophylaxis ◽  
Living With Hiv ◽  
Hiv Negative

Background: Pre-exposure prophylaxis (PrEP) can provide high protection against HIV infection and is a recommended intervention for HIV-negative persons with substantial HIV risk.  Demonstration projects conducted in diverse settings worldwide illustrate practical examples of how PrEP can be delivered. This manuscript presents estimates of effectiveness and patterns of PrEP use within a two-year demonstration project of PrEP for HIV-negative members of heterosexual HIV serodiscordant couples in East Africa. Methods: The PrEP delivery model integrated PrEP into HIV treatment services, prioritizing PrEP use for HIV-negative partners within serodiscordant couples before and during the first 6 months after the partner living with HIV initiated antiretroviral therapy (ART).  We measured PrEP uptake through pharmacy records and adherence to PrEP through medication event monitoring system (MEMS) bottle caps and quantification of tenofovir in plasma among a random sample of participants. We estimated HIV infections prevented using a counterfactual cohort simulated from the placebo arm of a previous PrEP clinical trial. Results: We enrolled 1,010 HIV serodiscordant couples that were naïve to ART and PrEP.  Ninety-seven percent of HIV-negative partners initiated PrEP. Objective measures suggest high adherence: 71% of HIV-negative participants took ≥80% of expected doses, as recorded via MEMS, and 81% of plasma samples had tenofovir detected.  Four incident HIV infections were observed (incidence rate=0.24 per 100 person-years), a 95% reduction (95% CI 86-98%, p<0.0001) in HIV incidence, relative to estimated HIV incidence for the population in the absence of PrEP integrated into HIV treatment services.   Conclusions: PrEP uptake and adherence were high and incident HIV was rare in this PrEP demonstration project for African HIV-negative individuals whose partners were known to be living with HIV.  Delivery of PrEP to HIV-negative partners within HIV serodiscordant couples was feasible and should be prioritized for wide-scale implementation.

scholarly journals Behavioural and environmental influences on adolescent decision making in personal relationships: a qualitative multi-stakeholder exploration in Panama

2019 ◽  
Vol 35 (1) ◽  
pp. 1-14
Author(s):  
Ana B Ara�z-Ledezma ◽  
Karlijn Massar ◽  
Gerjo Kok
Keyword(s):  
Decision Making ◽  
Education System ◽  
Teenage Pregnancy ◽  
Sexuality Education ◽  
Family Relations ◽  
Hiv Infections ◽  
Well Being ◽  
Sexual Relationships ◽  
Sufficient Evidence

Abstract Adolescents in Panama face multiple challenges to their sexual health, rights and well-being such as high rates of teenage pregnancy (∼30% of all pregnancies), increased HIV infections and sexual violence. In the absence of sufficient evidence-based data and an ongoing debate in Panamanian society about how to approach adolescents’ health problems, the aim of this qualitative study was to explore the perceptions and attitudes of different societal actors, namely governmental employees, NGO employees, academics, members from religious groups, teachers and parents. We conducted in-depth interviews (N = 34) which focused on the behavioural and environmental factors considered to influence adolescents’ decision making with regard to love, friendships and family relations. Furthermore, we explored how these stakeholders viewed the role of the education system, and the potential of including social–emotional learning (SEL) in the curriculum to provide skills and capacities, which could encourage adolescents to make better decisions and improve their well-being, in general but also in the context of sexual behaviours. Analysis revealed five central themes, i.e. perceptions towards gender roles and equality, adolescents’ love (sexual) relationships, capacity needs regarding prevention of risk behaviours and the role of education, comprehensive sexuality education in schools and the potentiality of SEL in the education system. The findings of the study can enhance understanding on the views of stakeholders regarding the factors influencing adolescents’ decision making, as well as regarding the possibilities of introducing SEL in the Panamanian educational curriculum.

scholarly journals Is race medically relevant? A qualitative study of physicians' attitudes about the role of race in treatment decision-making

2011 ◽  
Vol 11 (1) ◽  
Author(s):  
Shedra Amy Snipes ◽  
Sherrill L Sellers ◽  
Adebola Odunlami Tafawa ◽  
Lisa A Cooper ◽  
Julie C Fields ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Treatment Decision ◽  
Treatment Decision Making

scholarly journals The role of severity perceptions and beliefs in natural infections in Shanghai parents’ vaccine decision-making: a qualitative study

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Xiaodong Sun ◽  
Zhuoying Huang ◽  
Abram L. Wagner ◽  
Lisa A. Prosser ◽  
Erzhan Xu ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Vaccine Decision Making

scholarly journals Venues and methods to improve professional men’s access to HIV self-testing and linkage to HIV prevention or treatment: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Patience A. Muwanguzi ◽  
Esther M. Nasuuna ◽  
Florence Namimbi ◽  
Charles Peter Osingada ◽  
Tom Denis Ngabirano
Keyword(s):  
Qualitative Study ◽  
Hiv Testing ◽  
Underserved Populations ◽  
Linkage To Care ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Eligibility Criteria ◽  
Prevention Services ◽  
Self Testing ◽  
Engaging Men

Abstract Background HIV testing among men in sub-Saharan Africa is sub-optimal. Despite several strategies to improve access to underserved populations, evidence regarding engaging men in professional and formal occupations in HIV testing is limited. This study explored employed professional men’s preferences for uptake of HIV self-testing, and linkage to HIV care, or prevention services. Methods This was an explorative-descriptive qualitative study where a sample of 33 men from six Ugandan urban centres. Participants were purposively selected guided by the International Standard Classification of Occupations to participate in in-depth interviews. The data were collected using an interview guide and the sample size was determined by data saturation. Eligibility criteria included fulltime formal employment for over a year at that organization. The data were analyzed manually using thematic content analysis. Results Three categories emerged: uptake of HIV self-tests, process of HIV self-testing and linkage to post-test services. The different modes of distribution of HIV self-test kits included secondary distribution, self-tests at typically male dominated spaces, delivery to workplaces and technology-based delivery. The process of HIV self-testing may be optimized by providing collection bins, and mHealth or mobile phone applications. Linkage to further care or prevention services may be enhanced using medical insurance providers, giving incentives and tele counselling. Conclusion We recommend utilization of several channels for the uptake of HIV self-tests. These include distribution of test kits both to offices and men’s leisure and recreation ‘hot spots’, Additionally, female partners, peers and established men’s group including social media groups can play a role in improving the uptake of HIV self-testing. Mobile phones and digital technology can be applied in innovative ways for the return of test results and to strengthen linkage to care or prevention services. Partnership with medical insurers may be critical in engaging men in professional employment in HIV services.

scholarly journals The role of religion in decision-making on antenatal screening of congenital anomalies: A qualitative study amongst Muslim Turkish origin immigrants

Midwifery ◽  
2014 ◽  
Vol 30 (3) ◽  
pp. 297-302 ◽  
Author(s):  
Janneke T. Gitsels-van der Wal ◽  
Judith Manniën ◽  
Mohammed M. Ghaly ◽  
Pieternel S. Verhoeven ◽  
Eileen K. Hutton ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Congenital Anomalies ◽  
Antenatal Screening ◽  
Turkish Origin ◽  
Role Of Religion

The Implementation of PSAK 109 on Infaq Shadaqah Funds in Zakat Institutions (Study in DMC Dompet Dhuafa)

2020 ◽  
Vol 4 (2) ◽  
pp. 16
Author(s):  
Yudi Yudiana
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Critical Discourse Analysis ◽  
Goal Orientation ◽  
Processing Method ◽  
Critical Discourse ◽  
Financial Reports ◽  
Non Profit ◽  
Data Processing Method

This study aims to determine the application of infaq and alms accounting based on PSAK 109 which focuses on the presentation of financial reports on DMC organs as a network of Dompet Dhuafa amil zakat institutions in the field of disasters which mostly manages infak/sedekah funds in its operations. This research is a qualitative study of critical discourse analysis, which is a method by collecting, preparing, and analyzing data in the form of organizational financial reports so that later it can provide a clear picture of the application of infak and sedekah accounting based on PSAK 109 in the DMC organ. The data processing method uses interviews with related documents and is accompanied by one of the validity of the data, namely triangulation. The results showed errors in understanding and applying the recording method will affect the decision making strategy and goal orientation of the non-profit organization. The role of the leader is the key to success in disseminating it, as well as setting it in the form of an Operating Procedure System.

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