scholarly journals Individual and community-level benefits of PrEP in western Kenya and South Africa: Implications for population prioritization of PrEP provision

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244761
Author(s):  
Edinah Mudimu ◽  
Kathryn Peebles ◽  
Zindoga Mukandavire ◽  
Emily Nightingale ◽  
Monisha Sharma ◽  
...  
Keyword(s):  
South Africa ◽  
Hiv Infection ◽  
Fast Track ◽  
Scale Up ◽  
Status Quo ◽  
Community Level ◽  
Voluntary Medical Male Circumcision ◽  
Western Kenya ◽  
Indirect Benefits ◽  
Over Time

Background Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV and has the potential to significantly impact the HIV epidemic. Given limited resources for HIV prevention, identifying PrEP provision strategies that maximize impact is critical. Methods We used a stochastic individual-based network model to evaluate the direct (infections prevented among PrEP users) and indirect (infections prevented among non-PrEP users as a result of PrEP) benefits of PrEP, the person-years of PrEP required to prevent one HIV infection, and the community-level impact of providing PrEP to populations defined by gender and age in western Kenya and South Africa. We examined sensitivity of results to scale-up of antiretroviral therapy (ART) and voluntary medical male circumcision (VMMC) by comparing two scenarios: maintaining current coverage (“status quo”) and rapid scale-up to meet programmatic targets (“fast-track”). Results The community-level impact of PrEP was greatest among women aged 15–24 due to high incidence, while PrEP use among men aged 15–24 yielded the highest proportion of indirect infections prevented in the community. These indirect infections prevented continue to increase over time (western Kenya: 0.4–5.5 (status quo); 0.4–4.9 (fast-track); South Africa: 0.5–1.8 (status quo); 0.5–3.0 (fast-track)) relative to direct infections prevented among PrEP users. The number of person-years of PrEP needed to prevent one HIV infection was lower (59 western Kenya and 69 in South Africa in the status quo scenario; 201 western Kenya and 87 in South Africa in the fast-track scenario) when PrEP was provided only to women compared with only to men over time horizons of up to 5 years, as the indirect benefits of providing PrEP to men accrue in later years. Conclusions Providing PrEP to women aged 15–24 prevents the greatest number of HIV infections per person-year of PrEP, but PrEP provision for young men also provides indirect benefits to women and to the community overall. This finding supports existing policies that prioritize PrEP use for young women, while also illuminating the community-level benefits of PrEP availability for men when resources permit.

scholarly journals Consent Challenges and Psychosocial Distress in the Scale-up of Voluntary Medical Male Circumcision Among Adolescents in Western Kenya

2019 ◽  
Vol 23 (12) ◽  
pp. 3460-3470 ◽  
Author(s):  
Winnie K. Luseno ◽  
Samuel H. Field ◽  
Bonita J. Iritani ◽  
Stuart Rennie ◽  
Adam Gilbertson ◽  
...  
Keyword(s):  
Male Circumcision ◽  
Scale Up ◽  
Psychosocial Distress ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Western Kenya

Impact of Disclosure over Time on the Emotional Well-Being of Children with Perinatally Acquired HIV Infection in South Africa

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Janice Buckley ◽  
Kennedy Otwombe ◽  
Celeste Joyce ◽  
Given Leshabane ◽  
Lisa Galvin ◽  
...  
Keyword(s):  
South Africa ◽  
Hiv Infection ◽  
Well Being ◽  
Perinatally Acquired ◽  
Over Time

scholarly journals Reduction in extrapulmonary tuberculosis in context of antiretroviral therapy scale-up in rural South Africa

2017 ◽  
Vol 145 (12) ◽  
pp. 2500-2509 ◽  
Author(s):  
J. C. HOOGENDOORN ◽  
L. RANOTO ◽  
N. MUDITAMBI ◽  
J. RAILTON ◽  
M. MASWANGANYI ◽  
...  
Keyword(s):  
South Africa ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Strong Association ◽  
Extrapulmonary Tuberculosis ◽  
Scale Up ◽  
Public Hospitals ◽  
Immunodeficiency Virus ◽  
Clinical Records ◽  
Record Review

SUMMARYScale-up of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection has reduced the incidence of pulmonary tuberculosis (PTB) in South Africa. Despite the strong association of HIV infection with extrapulmonary tuberculosis (EPTB), the effect of ART on the epidemiology of EPTB remains undocumented. We conducted a retrospective record review of patients initiated on treatment for EPTB in 2009 (ART coverage <5%) and 2013 (ART coverage 41%) at four public hospitals in rural Mopani District, South Africa. Data were obtained from TB registers and patients’ clinical records. There was a 13% decrease in overall number of TB cases, which was similar for cases registered as EPTB (n = 399 in 2009 vs. 336 in 2013; P < 0·01) and for PTB (1031 vs. 896; P < 0·01). Among EPTB cases, the proportion of miliary TB and disseminated TB decreased significantly (both P < 0·01), TB meningitis and TB of bones increased significantly (P < 0·01 and P = 0·02, respectively) and TB pleural effusion and lymphadenopathy remained the same. This study shows a reduction of EPTB cases that is similar to that of PTB in the context of the ART scale-up. The changing profile of EPTB warrants attention of healthcare workers.

scholarly journals The cost effectiveness and optimal configuration of HIV self-test distribution in South Africa: a model analysis

2021 ◽  
Vol 6 (Suppl 4) ◽  
pp. e005598
Author(s):  
Lise Jamieson ◽  
Leigh F Johnson ◽  
Katleho Matsimela ◽  
Linda Alinafe Sande ◽  
Marc d'Elbée ◽  
...  
Keyword(s):  
South Africa ◽  
Cost Effectiveness ◽  
Scale Up ◽  
Cost Effective ◽  
Health Impact ◽  
Status Quo ◽  
Fractional Factorial ◽  
Self Testing ◽  
Life Years ◽  
The Impact

BackgroundHIV self-testing (HIVST) has been shown to be acceptable, feasible and effective in increasing HIV testing uptake. Novel testing strategies are critical to achieving the UNAIDS target of 95% HIV-positive diagnosis by 2025 in South Africa and globally.MethodsWe modelled the impact of six HIVST kit distribution modalities (community fixed-point, taxi ranks, workplace, partners of primary healthcare (PHC) antiretroviral therapy (ART) patients), partners of pregnant women, primary PHC distribution) in South Africa over 20 years (2020–2039), using data collected alongside the Self-Testing AfRica Initiative. We modelled two annual distribution scenarios: (A) 1 million HIVST kits (current) or (B) up to 6.7 million kits. Incremental economic costs (2019 US$) were estimated from the provider perspective; assumptions on uptake and screening positivity were based on surveys of a subset of kit recipients and modelled using the Thembisa model. Cost-effectiveness of each distribution modality compared with the status-quo distribution configuration was estimated as cost per life year saved (estimated from life years lost due to AIDS) and optimised using a fractional factorial design.ResultsThe largest impact resulted from secondary HIVST distribution to partners of ART patients at PHC (life years saved (LYS): 119 000 (scenario A); 393 000 (scenario B)). However, it was one of the least cost-effective modalities (A: $1394/LYS; B: $4162/LYS). Workplace distribution was cost-saving ($52–$76 million) and predicted to have a moderate epidemic impact (A: 40 000 LYS; B: 156 000 LYS). An optimised scale-up to 6.7 million tests would result in an almost threefold increase in LYS compared with a scale-up of status-quo distribution (216 000 vs 75 000 LYS).ConclusionOptimisation-informed distribution has the potential to vastly improve the impact of HIVST. Using this approach, HIVST can play a key role in improving the long-term health impact of investment in HIVST.

scholarly journals Healthcare providers’ perceptions and understanding of voluntary medical male circumcision in KwaZulu-Natal, South Africa: A qualitative study

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Celenkosini T. Nxumalo ◽  
Gugu G. Mchunu
Keyword(s):  
South Africa ◽  
Male Circumcision ◽  
Healthcare Workers ◽  
Scale Up ◽  
Healthcare Providers ◽  
Structured Interview ◽  
Heterosexual Transmission ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Kwazulu Natal

Background: There is compelling evidence that voluntary medical male circumcision (VMMC) reduces the chances of heterosexual transmission of HIV infection. Healthcare workers are among the key influencers in terms of the scale-up of VMMC as they are often involved in mobilisation for uptake. There is a paucity of qualitative research on healthcare workers’ experiences, understanding and perceptions of VMMC; particularly in the South African rural primary healthcare context. This study was conducted to examine healthcare workers perceptions and understanding of VMMC in KwaZulu-Natal, South Africa.Methods: The study employed a qualitative approach using a phenomenographic design. A purposive sample of 15 doctors, nurses and clinical associates working in 6 different rural clinics in KwaZulu-Natal, South Africa, were interviewed in English in-depth using a semi-structured interview schedule. The interviews were audio-recorded, and transcribed. The results were analysed thematically using phenomenographic data analysis procedures.Results: Categories of description in participants’ perceptions and understanding of VMMC emerged. The findings of this study revealed that healthcare workers perceptions and understanding of VMMC were predominantly influenced by the hegemonic religious and cultural norms associated with male circumcision in KwaZulu-Natal, South Africa.Conclusion: The findings of this study suggest that tailored training to address healthcare workers misperceptions and poor understanding of VMMC is necessary to ensure that they become effective custodians for VMMC implementation.

scholarly journals Provider Attitudes toward the Voluntary Medical Male Circumcision Scale-Up in Kenya, South Africa, Tanzania and Zimbabwe

PLoS ONE ◽  
2014 ◽  
Vol 9 (5) ◽  
pp. e82911 ◽  
Author(s):  
Webster Mavhu ◽  
Sasha Frade ◽  
Ann-Marie Yongho ◽  
Margaret Farrell ◽  
Karin Hatzold ◽  
...  
Keyword(s):  
South Africa ◽  
Male Circumcision ◽  
Scale Up ◽  
Voluntary Medical Male Circumcision ◽  
Provider Attitudes ◽  
Medical Male Circumcision

scholarly journals Zulu Men’s Conceptions, Understanding, and Experiences of Voluntary Medical Male Circumcision in KwaZulu-Natal, South Africa

2020 ◽  
Vol 14 (2) ◽  
pp. 155798831989243
Author(s):  
Celenkosini Thembelenkosini Nxumalo ◽  
Gugu Gladness Mchunu
Keyword(s):  
South Africa ◽  
Male Circumcision ◽  
Low Income ◽  
Cultural Beliefs ◽  
Scale Up ◽  
Rural Setting ◽  
Voluntary Medical Male Circumcision ◽  
Semistructured Interview ◽  
Medical Male Circumcision ◽  
Kwazulu Natal

Voluntary Medical Male Circumcision (VMMC) is proven to reduce transmission of HIV/AIDS. Despite concerted efforts to scale up VMMC in men aged 18–49, the number of medically circumcised men in this age group remains suboptimal. Research has shown that several individual factors hinder and promote uptake of VMMC. The nature of these factors is not clearly understood within the dimensions of religion, culture and tradition, particularly in a low-income rural setting. This study aimed to analyze Zulu men’s conceptions, understanding and experiences regarding VMMC in KwaZulu-Natal (KZN), South Africa. A qualitative phenomenographic study approach was used to collect data from 20 uncircumcised males at six different clinics that provide VMMC services. Ethical approval to collect data was obtained from the Biomedical Research Ethics Committee of the University of KZN (BREC – BE627/18). Individual in-depth face to face interviews were conducted using a semistructured interview guide. Audiotapes were used to record interviews which were transcribed verbatim and then analyzed manually. The conceptions regarding medical circumcision appeared to be related to religious and cultural beliefs surrounding circumcision and the historical traditional practice thereof. The understanding of males regarding VMMC was mainly attributed to HIV prevention; however, knowledge on the degree of partial protection appeared to be limited. An array of negative accounted in the form of complications such as poor wound healing and postoperative pain undergone by peers and other close influencers’ accounted for participants’ experiences of VMMC. Poor knowledge and negative experiences relating to VMMC could account for reasons why men choose not to undergo VMMC.

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