scholarly journals COVID-19 preparedness at health facilities and community service points serving people living with HIV in Sierra Leone

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250236
Author(s):  
Lauren E. Parmley ◽  
Kieran Hartsough ◽  
Oliver Eleeza ◽  
Akopon Bertin ◽  
Bockarie Sesay ◽  
...  
Keyword(s):  
Service Delivery ◽  
Sierra Leone ◽  
Community Service ◽  
Health Facilities ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Health Crisis ◽  
Hiv Services ◽  
Trained Staff ◽  
Living With Hiv

After a decade of civil war and the 2014–2016 West African Ebola outbreak, Sierra Leone now faces the COVID-19 pandemic with a fragile health system. As was demonstrated during Ebola, preparedness is key to limiting a health crisis’ spread and impact on health systems and ensuring continued care for vulnerable populations including people living with HIV (PLHIV). To assess COVID-19 preparedness and inform interventions to ensure continuity of HIV services at health facilities (HFs) and community service points (CSPs), we conducted site readiness assessments in Freetown, the epicenter of COVID-19 in Sierra Leone. Data were collected at nine high-volume HIV HFs and seven CSPs in April 2020, a month after COVID-19 was declared a pandemic. CSPs comprised three community drop-in centers providing HIV counseling and testing services as well as HIV prevention services (e.g., condoms and lubricants) for key and priority populations and four community-based support groups serving PLHIV. At the time of assessment, CSPs did not provide antiretroviral therapy (ART) but were considered potential sites for expansion of differentiated service delivery (DSD)—a client-centered approach to HIV care—in the context of COVID-19. Overall, 5/9 HFs had trained staff on use of personal protective equipment (PPE) and prevention of COVID-19 transmission. Most had access to masks (5/9) and gloves (7/9) for management of suspected/confirmed COVID-19 cases, and 4/9 HFs had triage procedures for isolation of suspected cases. Conversely, few CSPs had access to masks (2/7) or gloves (2/7) and no staff were trained on PPE use or COVID-19 transmission. 7/9 HFs had adequate ART stock for multi-month dispensing though few had procedures for (3/9) or had trained staff in providing DSD (2/9). Among CSPs where measures were applicable, 2/4 had procedures for DSD, 1/3 had staff trained on DSD and none had adequate ART stock. Identification of gaps in COVID-19 preparedness is a critical step in providing support for infection control and modified service delivery. Findings from this assessment highlight gaps in COVID-19 preparedness measures at sites supporting PLHIV in Sierra Leone and indicate CSPs may require intensive supervision and training to ensure HIV services are uninterrupted while minimizing COVID-19 risk, especially if used as sites to scale up DSD.

scholarly journals Implementing TB preventive treatment within differentiated HIV service delivery models in global programs

2020 ◽  
Vol 10 (3) ◽  
pp. 104-110
Author(s):  
A. T. Boyd ◽  
B. Moore ◽  
M. Shah ◽  
C. Tran ◽  
H. Kirking ◽  
...  
Keyword(s):  
Service Delivery ◽  
Care Delivery ◽  
Scale Up ◽  
Preventive Treatment ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Emergency Plan ◽  
The Us ◽  
Living With Hiv ◽  
Delivery Models

Global HIV program stakeholders, including the US President’s Emergency Plan for AIDS Relief (PEPFAR), are undertaking efforts to ensure that eligible people living with HIV (PLHIV) receiving antiretroviral treatment (ART) receive a course of TB preventive treatment (TPT). In PEPFAR programming, this effort may require providing TPT not only to newly diagnosed PLHIV as part of HIV care initiation, but also to treatment-experienced PLHIV stable on ART who may not have been previously offered TPT. TPT scale-up is occurring at the same time as a trend to provide more person-centered HIV care through differentiated service delivery (DSD). In DSD, PLHIV stable on ART may receive less frequent clinical follow-up or receive care outside the traditional clinic-based model. The misalignment between traditional delivery of TPT and care delivery in innovative DSD may require adaptations to TPT delivery practices for PLHIV. Adaptations include components of planning and operationalization of TPT in DSD, such as determination of TPT eligibility and TPT initiation, and clinical management of PLHIV while on TPT. A key adaptation is alignment of timing and location for TPT and ART prescribing, monitoring, and dispensing. Conceptual examples of TPT delivery in DSD may help program managers operationalize TPT in HIV care.

scholarly journals Characteristics and impacts ofSystematic review nutritional programmes to address undernutrition of adults living with HIV in sub-Saharan Africa: a systematic review of evidence

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e047205
Author(s):  
Fisaha Haile Tesfay ◽  
Sara Javanparast ◽  
Hailay Gesesew ◽  
Lillian Mwanri ◽  
Anna Ziersch
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Nutritional Recovery ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Nutritional Outcomes

ObjectivesAlthough some studies have identified various challenges affecting nutritional programmes to effectively tackle undernutrition among people living with HIV, evidence about the characteristics and impacts of these programmes on weight-related nutritional outcomes varies based on country contexts, specific programme goals and the implementation processes. This systematic review sought to synthesise evidence on the characteristics and impact of nutritional programmes on weight-related nutritional outcomes of people living with HIV in sub-Saharan Africa.DesignSystematic review.Data sourcesWe searched for primary studies published in the following databases: Web of Science, Medline, Scopus, ScienceDirect, ProQuest and Google Scholar, supplemented by checking reference lists of included papers.Eligibility criteriaStudies published from 2005 to 10 July 2020 and reporting on the weight-related nutritional outcomes of undernourished people enrolled in nutritional programmes in HIV care in sub-Saharan Africa were included.Data extraction and synthesisData were extracted using a data extraction proforma. Weight-related nutritional outcomes of people living with HIV before and after enrolment in a nutritional programme were compared and narratively synthesised.ResultsSixteen studies assessing the impact of nutritional programmes in HIV care on weight-related nutritional outcomes were included. Of these, 13 examined nutritional programmes implemented in health facilities and the remaining three were delivered outside of health facilities. Nutritional recovery (defined differently in the studies) ranged from 13.1% to 67.9%. Overall programme failure rate, which included default after enrolment in a nutritional programme or non-response, ranged from 37.6% to 48.0%. More specifically, non-response to a nutritional programme ranged from 21.0% to 67.4% and default from the programme ranged from 19.0% to 70.6%. Key sociodemographic, clinical and nutritional characteristics that affect nutritional recovery, non-response and default were also identified.Conclusions and recommendationsNutritional programmes in HIV care have led to some improvements in weight-related nutritional outcomes among people living with HIV. However, the programmes were characterised by a high magnitude of default and non-response. To improve desired weight-related nutritional outcomes of people living with HIV, a holistic approach that addresses longer-term determinants of undernutrition is needed.PROSPERO registration numberCRD42020196827.

scholarly journals Quantifying clinic transfers among people living with HIV in the Western Cape, South Africa: a retrospective spatial analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e055712
Author(s):  
Ana Lucia Espinosa Dice ◽  
Angela M Bengtson ◽  
Kevin M Mwenda ◽  
Christopher J Colvin ◽  
Mark N Lurie
Keyword(s):  
South Africa ◽  
Spatial Analysis ◽  
Health Facilities ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Western Cape ◽  
Western Cape Province ◽  
Care Clinic ◽  
Living With Hiv ◽  
Over Time

ObjectivesFor persons living with HIV (PLWH) in long-term care, clinic transfers are common and influence sustained engagement in HIV care, as they are associated with significant time out-of-care, low CD4 count, and unsuppressed viral load on re-entry. Despite the geospatial nature of clinic transfers, there exist limited data on the geospatial trends of clinic transfers to guide intervention development. In this study, we investigate the geospatial characteristics and trends of clinic transfers among PLWH on antiretroviral therapy (ART) in the Western Cape Province of South Africa.DesignRetrospective spatial analysis.SettingPLWH who initiated ART treatment between 2012 and 2016 in South Africa’s Western Cape Province were followed from ART initiation to their last visit prior to 2017. Deidentified electronic medical records from all public clinical, pharmacy, and laboratory visits in the Western Cape were linked across space and time using a unique patient identifier number.Participants4176 ART initiators in South Africa (68% women).MethodsWe defined a clinic transfer as any switch between health facilities that occurred on different days and measured the distance between facilities using geodesic distance. We constructed network flow maps to evaluate geospatial trends in clinic transfers over time, both for individuals’ first transfer and overall.ResultsTwo-thirds of ART initiators transferred health facilities at least once during follow-up. Median distance between all clinic transfer origins and destinations among participants was 8.6 km. Participant transfers were heavily clustered around Cape Town. There was a positive association between time on ART and clinic transfer distance, both among participants’ first transfers and overall.ConclusionThis study is among the first to examine geospatial trends in clinic transfers over time among PLWH. Our results make clear that clinic transfers are common and can cluster in urban areas, necessitating better integrated health information systems and HIV care.

scholarly journals Stigma and discrimination: barriers to the utilisation of a nutritional program in HIV care services in the Tigray region, Ethiopia.

2020 ◽  
Author(s):  
Fisaha Tesfay ◽  
Sara Javanparast ◽  
Lillian Mwanri ◽  
Anna Ziersch
Keyword(s):  
Family Members ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Hiv Services ◽  
Tigray Region ◽  
Stigma And Discrimination ◽  
Hiv Status Disclosure ◽  
Living With Hiv ◽  
Status Disclosure

Abstract Background: In Ethiopia, stigmatising attitudes towards people living with HIV have reduced over time due to improved HIV knowledge and the expansion of services. However, HIV stigma and discrimination remain a key challenge and have negative impacts on access to and utilisation of HIV services including nutritional programs. A small number of studies have examined the experience of stigma related to nutritional programs, but this is limited. This study explored HIV status disclosure and experience of stigma related to a nutritional program in HIV care settings in Ethiopia and impacts on nutritional program utilisation. Methods: As part of a larger study, qualitative in-depth interviews were conducted with 20 adults living with HIV, 15 caregivers of children living with HIV and 13 program staff working in the nutritional program in three hospitals in the Tigray region of Ethiopia. Framework thematic analysis using NVivo was employed to analyse the data. Results: The study found varying levels of positive HIV status disclosure, depending on who the target of disclosure was. Disclosing to family members was reported to be less problematic by most participants. Despite reported benefits of the nutritional program in terms of improving weight and overall health status, adults and caregivers of children living with HIV revealed experiences of stigma and discrimination that were amplified by enrolment to the nutritional program. This was due to: a) transporting, consuming and disposing of the nutritional support itself, which is associated with HIV in the broader community; b) required increased frequency of visits to HIV services for those enrolled in the nutritional program and associated. Conclusion: There was evidence of concerns about HIV-related stigma and discrimination among individuals enrolled in this program and their family members, which in turn negatively affected the utilisation of the nutritional program. Stigma and discrimination are a source of health inequity and undermine access to the nutritional program. Nutritional programs in HIV care should include strategies to take these concerns into account by mainstreaming stigma prevention and mitigation activities. Further research should be done to identify innovative ways of facilitating social inclusion to mitigate stigma and improve utilisation.

scholarly journals Barriers to HIV service utilisation by people living with HIV in two provinces of Zimbabwe: Results from 2016 baseline assessment

2018 ◽  
Vol 19 (1) ◽  
Author(s):  
Taurayi A. Tafuma ◽  
Nyikadzino Mahachi ◽  
Chengetai Dziwa ◽  
Tafara Moga ◽  
Paul Baloyi ◽  
...  
Keyword(s):  
Health Workers ◽  
Waiting Times ◽  
Male Involvement ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Service Utilisation ◽  
Access To Health Services ◽  
Related Factors ◽  
Hiv Services ◽  
Living With Hiv

Background: The emergence of antiretroviral therapy (ART) transformed HIV from a terminal illness to a chronic disease. However, limited access to health services remains one of many barriers to HIV service utilisation by people living with HIV (PLHIV) in low-resource settings. The goal of this study was to describe the barriers to HIV service utilisation in two provinces of Zimbabwe.Methods: A qualitative descriptive study was conducted with PLHIV and village health workers (VHW) in eight districts within the two provinces. Convenience sampling was used to select the participants. This sampling was limited to communities supported by health facilities with more than 500 PLHIV enrolled into HIV care and treatment. Interviews were audio-recorded and transcripts were subjected to thematic content analysis.Results: A total of 22 community focus group discussions (FGDs) were conducted. Barriers to using HIV services cited in PLHIV and VHW FGDs were similar. These were categorised as health system-related barriers, which include user fees, long waiting times, lack of confidentiality and negative attitudes by healthcare providers, and lack of consistent community-based HIV services. Community-related barriers cited were stigma and discrimination, food insecurity, distance to facilities and counterproductive messaging from religious sectors. Client-related factors reported were inadequate male involvement in HIV-related activities and defaulting after symptoms improved.Conclusion: Our assessment has indicated that there are several barriers to the utilisation of HIV services by PLHIV in the two provinces of Zimbabwe. As new strategies and programmes are being introduced in the current resource-constrained era, efforts should be made to understand the needs of the clients. If programmes are designed with an effort to address some of these challenges, there is a possibility that countries will quickly achieve the 90-90-90 targets set by The Joint United Nations Programme on HIV/AIDS.

scholarly journals Identifying the Gaps in HIV Prevention and Treatment During the COVID-19 Pandemic in Nigeria

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Archibong Edem Bassey ◽  
Lotenna Chidubem Olisaeloka ◽  
Yusuff Adebayo Adebisi
Keyword(s):  
Care Delivery ◽  
Disease Status ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Snowball Sampling ◽  
Hiv Services ◽  
Care Services ◽  
Prevention And Treatment ◽  
Living With Hiv ◽  
The Impact

Context: To manage the COVID-19 pandemic, the Nigerian government has introduced travel restrictions to reduce the spread of the virus. However, this measure has caused numerous challenges in the accessibility and availability of HIV services (testing, prevention, and treatment) for patients. This study aimed to examine the delivery of HIV care services during the COVID-19 pandemic in Nigeria by analyzing the barriers to HIV care in recent years, weighing the impact of these barriers, and bridging the existing gaps by proposing practical solutions to maintain the patients’ uninterrupted access to HIV services throughout the pandemic. Evidence Acquisition: We searched Google Scholar, PubMed, and Science Direct databases, using the following MESH headings: “HIV”, “COVID-19”, and “Nigeria”. The reviewed articles provided information on gaps and solutions for maintaining HIV services during the COVID-19 pandemic in Nigeria. The selected papers were all written in English, with no time restrictions. Also, further publications were identified from the reference lists of articles and reports via snowball sampling. Results: The collected data in 2018 revealed that 67% of people living with HIV were aware of their disease status. Based on the results, 53% of people living with HIV were on antiretroviral treatment, and 42% of people living with HIV had viral suppression, based on the global 90-90-90 HIV targets. Ten barriers and gaps were identified in different aspects of HIV care delivery (prevention, testing, and treatment), and practical solutions were proposed to provide a more effective approach for ensuring the availability and accessibility of services during pandemics. Conclusions: A unique and inter-sectoral approach is generally needed to address different barriers to the delivery of HIV care services during the COVID-19 pandemic. Also, funding of HIV care services is critical at this time. Based on the findings, HIV care services (prevention, testing, and treatment programs) cannot be postponed due to the COVID-19 outbreak, otherwise Nigeria may face a double pandemic.

Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study (Preprint)

2019 ◽  
Author(s):  
Jenevieve Opoku ◽  
Rupali K Doshi ◽  
Amanda D Castel ◽  
Ian Sorensen ◽  
Michael Horberg ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hiv Care ◽  
Disease Stage ◽  
People Living With Hiv ◽  
Hiv Disease ◽  
Persons Living With Hiv ◽  
Living With Hiv

BACKGROUND HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. OBJECTIVE The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). METHODS Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. RESULTS There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, <i>P</i>&lt;.001) but more likely to be black (82.3% vs 69.5%, <i>P</i>&lt;.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, <i>P</i>&lt;.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, <i>P</i>&lt;.001), have a CD4 &lt;200 cells/µL in 2017 (6.2% vs 4.6%, <i>P</i>&lt;.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, <i>P</i>&lt;.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). CONCLUSIONS These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.

Depressive Symptoms, Gender, Disclosure, and HIV Care Stage Among People Living with HIV in Cameroon

2021 ◽  
Author(s):  
Angela M. Parcesepe ◽  
Molly Remch ◽  
Anastase Dzudie ◽  
Rogers Ajeh ◽  
Denis Nash ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Living With Hiv

scholarly journals The Utilisation of Payment Models Across the HIV Continuum of Care: Systematic Review of Evidence

2021 ◽  
Author(s):  
Tiago Rua ◽  
Daniela Brandão ◽  
Vanessa Nicolau ◽  
Ana Escoval
Keyword(s):  
Positive Impact ◽  
Cost Effective ◽  
Relative Magnitude ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Continuum Of Care ◽  
Clinical Conditions ◽  
Study Designs ◽  
Living With Hiv ◽  
Payment Models

AbstractThe increasing chronicity and multimorbidities associated with people living with HIV have posed important challenges to health systems across the world. In this context, payment models hold the potential to improve care across a spectrum of clinical conditions. This study aims to systematically review the evidence of HIV performance-based payments models. Literature searches were conducted in March 2020 using multiple databases and manual searches of relevant papers. Papers were limited to any study design that considers the real-world utilisation of performance-based payment models applied to the HIV domain. A total of 23 full-text papers were included. Due to the heterogeneity of study designs, the multiple types of interventions and its implementation across distinct areas of HIV care, direct comparisons between studies were deemed unsuitable. Most evidence focused on healthcare users (83%), seeking to directly affect patients' behaviour based on principles of behavioural economics. Despite the variability between interventions, the implementation of performance-based payment models led to either a neutral or positive impact throughout the HIV care continuum. Moreover, this improvement was likely to be cost-effective or, at least, did not compromise the healthcare system’s financial sustainability. However, more research is needed to assess the durability of incentives and its appropriate relative magnitude.

scholarly journals Reducing time to differentiated service delivery for newly diagnosed people living with HIV in Kigali, Rwanda: study protocol for a pilot, unblinded, randomised controlled study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e047443
Author(s):  
Jonathan Ross ◽  
Gad Murenzi ◽  
Sarah Hill ◽  
Eric Remera ◽  
Charles Ingabire ◽  
...  
Keyword(s):  
Service Delivery ◽  
Health Centre ◽  
Albert Einstein College ◽  
Secondary Outcome ◽  
Controlled Study ◽  
People Living With Hiv ◽  
Newly Diagnosed ◽  
Differentiated Service ◽  
Viral Loads ◽  
Living With Hiv

IntroductionCurrent HIV guidelines recommend differentiated service delivery (DSD) models that allow for fewer health centre visits for clinically stable people living with HIV (PLHIV). Newly diagnosed PLHIV may require more intensive care early in their treatment course, yet frequent appointments can be burdensome to patients and health systems. Determining the optimal parameters for defining clinical stability and transitioning to less frequent appointments could decrease patient burden and health system costs. The objectives of this pilot study are to explore the feasibility and acceptability of (1) reducing the time to DSD from 12 to 6 months after antiretroviral therapy (ART) initiation,and (2) reducing the number of suppressed viral loads required to enter DSD from two to one.Methods and analysesThe present study is a pilot, unblinded trial taking place in three health facilities in Kigali, Rwanda. Current Rwandan guidelines require PLHIV to be on ART for ≥12 months with two consecutive suppressed viral loads in order to transition to less frequent appointments. We will randomise 90 participants to one of three arms: entry into DSD at 6 months after one suppressed viral load (n=30), entry into DSD at 6 months after two suppressed viral loads (n=30) or current standard of care (n=30). We will measure feasibility and acceptability of this intervention; clinical outcomes include viral suppression at 12 months (primary outcome) and appointment attendance (secondary outcome).Ethics and disseminationThis clinical trial was approved by the institutional review board of Albert Einstein College of Medicine and by the Rwanda National Ethics Committee. Findings will be disseminated through conferences and peer-reviewed publications, as well as meetings with stakeholders.Trial registration numberNCT04567693.

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