A National Hiv Clinical Mentorship Program: Enabling Zambia to Accelerate Towards the Controlling the Hiv Epidemic

Abstract Background Although Zambia has increased the proportion of people living with HIV (PLHIV) who are on antiretroviral therapy (ART) in recent years, progress toward HIV epidemic control remains inconsistent. Some districts are still failing to meet the UNAIDS 90/90/90 targets where 90% of PLHIV should know their status, 90% of those who know their status should be receiving sustained ART, and 90% of those on ART should have documented viral load suppression (VLS) by 2020. Providing consistently excellent HIV services at all ART health facilities is critical for achieving the UNAIDS 90/90/90 targets and controlling the HIV epidemic in Zambia. Zambia Ministry of Health (MoH), in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), aimed to achieve these targets through establishing a national HIV clinical mentorship program in which government-employed mentors were assigned to specific facilities with a mandate to identify and ameliorate programmatic challenges. Methods Mentors were hired, trained and deployed to individual facilities in four provinces to mentor staff on quality HIV clinical and program management. The pre-mentorship period was July 2018–September 2018 and the post-mentorship period was July 2019–September 2019. Results Review of key programmatic indicators from the pre and post-deployment periods revealed HIV testing yield improved from 4.2–6.8% (P < 0.001) as fewer HIV tests were needed despite the number of PLHIV being identified and placed on ART increasing from 492,613 to 521,775, and VLS increased from 84.8–90.1% (p < 0.001). Conclusions Key considerations in the establishment of an HIV clinical mentorship program include having a government-led process of regular site level data review and continuous clinical mentorship underpinned by quality improvement methodology.

Download Full-text

Expanding access to HIV services during the COVID-19 pandemic—Nigeria, 2020

AIDS Research and Therapy ◽

10.1186/s12981-021-00385-5 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Andrew T. Boyd ◽

Ibrahim Jahun ◽

Emilio Dirlikov ◽

Stacie Greby ◽

Solomon Odafe ◽

...

Keyword(s):

State Level ◽

Data Repository ◽

People Living With Hiv ◽

Community Based ◽

Hiv Services ◽

First Case ◽

Level Data ◽

Control And Prevention ◽

Related Service ◽

Living With Hiv

Abstract Background To accelerate progress toward the UNAIDS 90-90-90 targets, US Centers for Disease Control and Prevention Nigeria country office (CDC Nigeria) initiated an Antiretroviral Treatment (ART) Surge in 2019 to identify and link 340,000 people living with HIV/AIDS (PLHIV) to ART. Coronavirus disease 2019 (COVID-19) threatened to interrupt ART Surge progress following the detection of the first case in Nigeria in February 2020. To overcome this disruption, CDC Nigeria designed and implemented adapted ART Surge strategies during February–September 2020. Methods Adapted ART Surge strategies focused on continuing expansion of HIV services while mitigating COVID-19 transmission. Key strategies included an intensified focus on community-based, rather than facility-based, HIV case-finding; immediate initiation of newly-diagnosed PLHIV on 3-month ART starter packs (first ART dispense of 3 months of ART); expansion of ART distribution through community refill sites; and broadened access to multi-month dispensing (MMD) (3–6 months ART) among PLHIV established in care. State-level weekly data reporting through an Excel-based dashboard and individual PLHIV-level data from the Nigeria National Data Repository facilitated program monitoring. Results During February–September 2020, the reported number of PLHIV initiating ART per month increased from 11,407 to 25,560, with the proportion found in the community increasing from 59 to 75%. The percentage of newly-identified PLHIV initiating ART with a 3-month ART starter pack increased from 60 to 98%. The percentage of on-time ART refill pick-ups increased from 89 to 100%. The percentage of PLHIV established in care receiving at least 3-month MMD increased from 77 to 93%. Among PLHIV initiating ART, 6-month retention increased from 74 to 92%. Conclusions A rapid and flexible HIV program response, focused on reducing facility-based interactions while ensuring delivery of lifesaving ART, was critical in overcoming COVID-19-related service disruptions to expand access to HIV services in Nigeria during the first eight months of the pandemic. High retention on ART among PLHIV initiating treatment indicates immediate MMD in this population may be a sustainable practice. HIV program infrastructure can be leveraged and adapted to respond to the COVID-19 pandemic.

Download Full-text

The essential role of physiotherapists in providing rehabilitation services to people living with HIV in South Africa

South African Journal of Physiotherapy ◽

10.4102/sajp.v69i1.368 ◽

2013 ◽

Vol 69 (1) ◽

Cited By ~ 6

Author(s):

S. Cobbing ◽

V. Chetty ◽

J. Hanass-Hancock ◽

J. Jelsma ◽

H. Myezwa ◽

...

Keyword(s):

South Africa ◽

South African ◽

Policy Formulation ◽

People Living With Hiv ◽

Highly Active ◽

Hiv Epidemic ◽

Wide Range ◽

Living With Hiv ◽

Education Courses

Despite increased access to highly active anti-retroviral therapy (HAART) in South Africa, there remains a high risk of people living with HIV (PLHIV) developing a wide range of disabilities. Physiotherapists are trained to rehabilitate individuals with the disabilities related to HIV. Not only can South African physiotherapists play a significant role in improving the lives of PLHIV, but by responding proactively to the HIV epidemic they can reinforce the relevance and value of the profession in this country at a time when many newly qualified therapists are unable to secure employment. This paper offers recommendations that may help to fuel this response. These ideas include enhancing HIV curricula at a tertiary level, designing and attending continuing education courses on HIV and researching Southern African rehabilitation interventions for HIV at all levels of practice. furthermore, it is vital that physiotherapists are at the forefront of directing multi-disciplinary responses to the rehabilitation of PLHIV in order to influence stakeholders who are responsible for health policy formulation. it is hoped that this paper stimulates discussion and further ideas amongst physiotherapists and other health professionals in order to improve the quality and access to care available to PLHIV in South Africa.

Download Full-text

Malaria and intestinal parasite co-infection and its association with anaemia among people living with HIV in Buea, Southwest Cameroon: A community-based retrospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0245743 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245743

Author(s):

Sorelle Mekachie Sandie ◽

Irene Ule Ngole Sumbele ◽

Martin Mih Tasah ◽

Helen Kuokuo Kimbi

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Intestinal Parasites ◽

Significant Risk ◽

People Living With Hiv ◽

Viral Load Suppression ◽

Community Based ◽

Living With Hiv ◽

Hiv Negative

Background Both malaria and intestinal parasites are endemic in Cameroon, and their co-infection can be of great impact on anaemia among people living with HIV (PLWH). This community-based retrospective cohort study determined the prevalence and association of infections with anaemia in PLWH and HIV-negative individuals in Buea, Cameroon from March to August 2019. Methods The study population comprised of 190 PLWH and 216 consenting HIV-negative individuals from the Buea community. Participants were examined clinically, the collected blood sample was used for malaria parasite (MP) detection, HIV diagnosis and haemoglobin (Hb) measurement while stool samples were examined for the detection of intestinal parasites (IPs). Proportions were compared using Pearson’s Chi-square test and association of anaemia with independent variables was evaluated using logistic regression analysis. Results Out of the 406 participants, MP, IPs and MP/IP co-infection prevalences were 15.5%, 13.0% and 3.0% respectively. PLWH had a higher prevalence of MP (16.3%, P = 0.17), IPs (23.7%, P ˂ 0.001) and MP/IPs co-infection (3.7%, P = 0.04) when compared with HIV-negative participants. Similarly, PLWH had significantly lower mean haemoglobin value (11.10 ± 1.54 g/dL) than their HIV-negative counterparts (12.45 ± 2.06 g/dL). Also, PLWH co-infected with MP and IPs were observed to have a significantly lower mean haemoglobin value (10.6 ± 1.21 g/dL). PLWH had a significantly (P ˂ 0.001) higher prevalence of mild (56.8%), moderate (18.4%) and severe (1.6%) anaemia when compared with HIV-negative counterparts. The significant risk factors associated with anaemia included being febrile (P = 0.03), MP-infected only (P = 0.001), HIV-infected only (P < 0.001), having dual (P < 0.001) or triple-infections (P = 0.03). Conclusion Malaria and intestinal parasites remain public health concerns among PLWH and anaemia as a serious haematological abnormality gets exacerbated even with the viral load suppression. Hence, routine medical check-ups among PLWH are recommended.

Download Full-text

HIV Stigma Reduction Through Peer-Led Advocacy Training

AIDS Education and Prevention ◽

10.1521/aeap.2021.33.4.303 ◽

2021 ◽

Vol 33 (4) ◽

pp. 303-311

Author(s):

Susan Reif ◽

Haley Cooper ◽

Elena Wilson ◽

Gina Brown ◽

Nicole Beckwith ◽

...

Keyword(s):

Well Being ◽

Hiv Stigma ◽

People Living With Hiv ◽

Negative Effects ◽

Advocacy Training ◽

Ongoing Training ◽

Related Stigma ◽

Training And Support ◽

Living With Hiv ◽

The U.S

HIV-related stigma is pervasive in the U.S. South and has potential negative effects on health outcomes and emotional well-being, and may act as a barrier to HIV-related advocacy among people living with HIV (PLWH). This article reports on the preliminary outcomes associated with participation in an HIV advocacy training for PLWH, LEAD, that included education and skills building for reducing HIV-related stigma. Fifty-seven PLWH at four sites in the U.S. South participated in the retreat-style training and completed a survey measuring stigma and comfort engaging in advocacy prior to and after the worshop. Participation was associated with statistically significant reduction in internalized HIV stigma and increase in comfort with participation in advocacy; however, participants reported a need for ongoing training and support to further increase comfort with advocacy participation. Although more research is needed on the LEAD Workshop, it shows promise as an option for reducing HIV-related stigma among PLWH.

Download Full-text

Leveraging a Legacy of Activism: Black Lives Matter and the Future of HIV Prevention for Black MSM

AIDS Education and Prevention ◽

10.1521/aeap.2018.30.3.208 ◽

2018 ◽

Vol 30 (3) ◽

pp. 208-212

Author(s):

Derrick D. Matthews

Keyword(s):

United States ◽

The United States ◽

Aids Education ◽

Black Msm ◽

People Living With Hiv ◽

Black Lives Matter ◽

Aids Epidemic ◽

Hiv Epidemic ◽

Sex With Men ◽

Living With Hiv

This year marks the 30th anniversary of AIDS Education and Prevention. As we approach the United Nations goal of ending the AIDS epidemic by 2030, it is a useful time to reflect on and learn from history. In the United States, no such endeavor can be successful without addressing the specific context of Black men who have sex with men. In this commentary I highlight factors that led us to a state in which Black MSM represent approximately a quarter of all people living with HIV in the United States. I also look back at the power of activism during the beginning of the HIV epidemic. Using Black Lives Matter as a contemporary framework, I highlight natural linkages between activism 30 years ago, its incarnation and relationship to public health today, and its promise as the way forward in achieving the elimination of AIDS for Black MSM by 2030.

Download Full-text

Abstract PO-103: Cancer mortality disparities among people living with HIV in the U.S.

10.1158/1538-7755.disp20-po-103 ◽

2020 ◽

Author(s):

Sabina O. Nduaguba ◽

Janai Poullard ◽

Robert L. Cook ◽

Folakemi Odedina ◽

Almut G. Winterstein

Keyword(s):

Cancer Mortality ◽

People Living With Hiv ◽

Mortality Disparities ◽

Living With Hiv ◽

The U.S

Download Full-text

Cascade of care for people living with HIV infection in Southern Brazil: results from a public health network

Cadernos de Saúde Pública ◽

10.1590/0102-311x00009718 ◽

2018 ◽

Vol 34 (12) ◽

Author(s):

Ingridt Hildegard Vogler ◽

Daniela Frizon Alfieri ◽

Heloisa Damazio Bruna Gianjacomo ◽

Elaine Regina Delicato de Almeida ◽

Edna Maria Vissoci Reiche

Keyword(s):

Public Health ◽

Viral Load ◽

Hiv Infection ◽

Retention In Care ◽

People Living With Hiv ◽

Southern Brazil ◽

Viral Load Suppression ◽

Health Network ◽

Cascade Of Care ◽

Living With Hiv

Abstract: The cascade of care for people living with HIV infection (PLHIV) describes steps in diagnosis, linkage and retention in care, as well as the provision and success of combination antiretroviral therapy (cART). The aim of this study was to evaluate the rates regarding the retention in care, on cART, and suppressed viral load for PLHIV attended at a Brazilian public health network. Data on PLHIV from 116 cities of Paraná, Southern Brazil, attended from 2012 to 2015, were retrospectively collected through the Laboratory Tests Control System (SISCEL). The number of PLHIV related to care increased about 22.5% from 2012 to 2015 (4,106 to 5,030 individuals). The proportion of PLHIV retained in care showed a trend toward stabilization around 81.7-86.9%. Every year, the use of cART increased up to 90.3% for PLHIV retained in care. Viral load suppression was achieved by 72.8% of patients on cART and 57.1% by those linked to care. Retention in care and HIV viral suppression were more likely to occur in older PLHIV than younger ones; similarly, patients living in medium-sized cities were more susceptible to these factors than in large- or small-sized cities. In conclusion, the study showed a high level of retention in care and HIV suppression on cART, as well as emphasized that current efforts for treating already-infected PLHIV remain a challenge for our health public institutions and may contribute to highlight steps for improvement of the HIV cascade of care in our population.

Download Full-text