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.

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 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 O1-S06.04 Modelling the effectiveness of combination prevention from a house-to-house HIV testing platform in KwaZulu Natal, South Africa

2011 ◽  
Vol 87 (Suppl 1) ◽  
pp. A36-A36 ◽  
Author(s):  
R. Alsallaq ◽  
J. Baeten ◽  
J. Hughes ◽  
L. Abu-Raddad ◽  
C. Celum ◽  
...  
Keyword(s):  
South Africa ◽  
Hiv Testing ◽  
Testing Platform ◽  
Combination Prevention ◽  
Kwazulu Natal

scholarly journals Exploring People’s Candidacy for Mobile Health–Supported HIV Testing and Care Services in Rural KwaZulu-Natal, South Africa: Qualitative Study

10.2196/15681 ◽  
2019 ◽  
Vol 21 (11) ◽  
pp. e15681 ◽  
Author(s):  
Oluwafemi Adeagbo ◽  
Carina Herbst ◽  
Ann Blandford ◽  
Rachel McKendry ◽  
Claudia Estcourt ◽  
...  
Keyword(s):  
South Africa ◽  
Health Care ◽  
Young People ◽  
Mobile Phone ◽  
Hiv Testing ◽  
Mobile Health ◽  
Clinical Care ◽  
Web Based ◽  
Care Services ◽  
Kwazulu Natal

Background The use of mobile communication technologies (mHealth: mobile health) in chronic disease management has grown significantly over the years. mHealth interventions have the potential to decentralize access to health care and make it convenient, particularly in resource-constrained settings. It is against this backdrop that we aimed to codevelop (with potential users) a new generation of mobile phone–connected HIV diagnostic tests and Web-based clinical care pathways needed for optimal delivery of decentralized HIV testing, prevention, and care in low- and middle-income countries. Objective The aim of this study was to understand ways in which an mHealth intervention could be developed to overcome barriers to existing HIV testing and care services and promote HIV self-testing and linkage to prevention and care in a poor, HIV hyperendemic community in rural KwaZulu-Natal, South Africa. Methods A total of 54 in-depth interviews and 9 focus group discussions were conducted with potential users (including health care providers) in 2 different communities. Theoretically informed by the candidacy framework, themes were identified from the interview transcripts, manually coded, and thematically analyzed. Results Participants reported barriers, such as fear of HIV identity, stigma, long waiting hours, clinic space, and health care workers’ attitudes, as major impediments to effective uptake of HIV testing and care services. People continued to reassess their candidacy for HIV testing and care services on the basis of their experiences and how they or others were treated within the health systems. Despite the few concerns raised about new technology, mobile phone–linked HIV testing was broadly acceptable to potential users (particularly men and young people) and providers because of its privacy (individual control of HIV testing over health provider–initiated testing), convenience (individual time and place of choice for HIV testing versus clinic-based testing), and time saving. Conclusions Mobile phone–connected HIV testing and Web-based clinical care and prevention pathways have the potential to support access to HIV prevention and care, particularly for young people and men. Although mHealth provides a way for individuals to test their candidacy for HIV services, the barriers that can make the service unattractive at the clinic level will also need to be addressed if potential demand is to turn into actual demand.

scholarly journals Undetectable=untransmittable (U=U) messaging increases uptake of HIV testing among men: Results from a pilot cluster randomized trial

2020 ◽  
Author(s):  
Philip Smith ◽  
Alison Buttenheim ◽  
Laura Schmucker ◽  
Linda-Gail Bekker ◽  
Harsha Thirumurthy ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Hiv Testing ◽  
Cluster Randomized Trial ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Mobile Clinic ◽  
Testing Uptake ◽  
Cluster Randomized ◽  
The Impact

AbstractHIV testing coverage in sub-Saharan Africa is lower among men than women. We investigated the impact of a peer-delivered U=U (undetectable equals untransmittable) message on men’s HIV testing uptake through a cluster randomized trial with individual mobile clinic days as unit of randomization.On standard of care (SOC) days, peer promoters’ informed men about the availability of HIV testing at the mobile clinic. On intervention days, peer promoters’ delivered U=U messages. We used logistic regression adjusting for mobile clinic location, clustering by study day, to determine the percentage of invited men who tested for HIV at the mobile clinic.Peer promoters delivered 1048 invitations over 12 days. In the SOC group, 68 (13%) of 544 men invited tested for HIV (3, 4.4% HIV-positive). In the U=U group, 112 (22%) of 504 men invited tested for HIV (7, 6.3% HIV-positive). Men in the U=U group had greater odds of testing for HIV (adjusted odds ratio=1.59, 95% CI=0.98-2.57).Tailored, peer-delivered messages that explain the benefits of HIV treatment in reducing HIV transmission can increase men’s HIV testing uptake.

scholarly journals Exploring People’s Candidacy for Mobile Health–Supported HIV Testing and Care Services in Rural KwaZulu-Natal, South Africa: Qualitative Study (Preprint)

2019 ◽  
Author(s):  
Oluwafemi Adeagbo ◽  
Carina Herbst ◽  
Ann Blandford ◽  
Rachel McKendry ◽  
Claudia Estcourt ◽  
...  
Keyword(s):  
South Africa ◽  
Health Care ◽  
Young People ◽  
Mobile Phone ◽  
Hiv Testing ◽  
Mobile Health ◽  
Clinical Care ◽  
Web Based ◽  
Care Services ◽  
Kwazulu Natal

BACKGROUND The use of mobile communication technologies (mHealth: mobile health) in chronic disease management has grown significantly over the years. mHealth interventions have the potential to decentralize access to health care and make it convenient, particularly in resource-constrained settings. It is against this backdrop that we aimed to codevelop (with potential users) a new generation of mobile phone–connected HIV diagnostic tests and Web-based clinical care pathways needed for optimal delivery of decentralized HIV testing, prevention, and care in low- and middle-income countries. OBJECTIVE The aim of this study was to understand ways in which an mHealth intervention could be developed to overcome barriers to existing HIV testing and care services and promote HIV self-testing and linkage to prevention and care in a poor, HIV hyperendemic community in rural KwaZulu-Natal, South Africa. METHODS A total of 54 in-depth interviews and 9 focus group discussions were conducted with potential users (including health care providers) in 2 different communities. Theoretically informed by the candidacy framework, themes were identified from the interview transcripts, manually coded, and thematically analyzed. RESULTS Participants reported barriers, such as fear of HIV identity, stigma, long waiting hours, clinic space, and health care workers’ attitudes, as major impediments to effective uptake of HIV testing and care services. People continued to reassess their candidacy for HIV testing and care services on the basis of their experiences and how they or others were treated within the health systems. Despite the few concerns raised about new technology, mobile phone–linked HIV testing was broadly acceptable to potential users (particularly men and young people) and providers because of its privacy (individual control of HIV testing over health provider–initiated testing), convenience (individual time and place of choice for HIV testing versus clinic-based testing), and time saving. CONCLUSIONS Mobile phone–connected HIV testing and Web-based clinical care and prevention pathways have the potential to support access to HIV prevention and care, particularly for young people and men. Although mHealth provides a way for individuals to test their candidacy for HIV services, the barriers that can make the service unattractive at the clinic level will also need to be addressed if potential demand is to turn into actual demand.

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 Engaging the ‘Missing Men’ in the HIV Treatment Cascade: Creating a Tailored Intervention to Improve Men’s Uptake of HIV Care Services in Rural South Africa: A Study Protocol

2021 ◽  
Vol 18 (7) ◽  
pp. 3709
Author(s):  
Oluwafemi Adeagbo ◽  
Kammila Naidoo
Keyword(s):  
South Africa ◽  
Health Outcomes ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Treatment Cascade ◽  
Hiv Care Cascade ◽  
Care Services ◽  
The Social ◽  
Hiv Treatment Cascade ◽  
Male Specific

Men, especially young men, have been consistently missing from the HIV care cascade, leading to poor health outcomes in men and ongoing transmission of HIV in young women in South Africa. Although these men may not be missing for the same reasons across the cascade and may need different interventions, early work has shown similar trends in men’s low uptake of HIV care services and suggested that the social costs of testing and accessing care are extremely high for men, particularly in South Africa. Interventions and data collection have hitherto, by and large, focused on men in relation to HIV prevention in women and have not approached the problem through the male lens. Using the participatory method, the overall aim of this study is to improve health outcomes in men and women through formative work to co-create male-specific interventions in an HIV-hyper endemic setting in rural KwaZulu-Natal, South Africa.

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