scholarly journals Low Engagement in HIV Services and Progress through the Treatment Cascade among Key Populations Living with HIV in Mozambique: Alarming Gaps in Knowledge of Status

2020 ◽  
Author(s):  
Makini Boothe ◽  
Isabel Sathane ◽  
Cynthia Semá Baltazar ◽  
Noela Chicuecue ◽  
Roberta Horth ◽  
...  
Keyword(s):  
Linkage To Care ◽  
Population Group ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
Key Populations ◽  
Hiv Status ◽  
Treatment Cascade ◽  
Key Population ◽  
Hiv Test ◽  
Hiv Treatment Cascade

Abstract Background. Mozambique has a generalized HIV epidemic of 13.5% among the general population. Early modeling exercises estimate that key populations (KPs) and their partners account for about one third of all new infections due to their sexual and drug use behaviors. The Fast Track Targets monitor key indicators along the treatment cascade. Methods. We conducted a secondary data analysis of HIV-positive participants in the first Bio-behavioral Surveillance (BBS) surveys in Mozambique in order to assess HIV service uptake and progress though the HIV treatment cascade among men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID). Unweighted pooled estimates were calculated for each key population group. Results. Among HIV-positive MSM, 63.2% of participants had ever received an HIV test, 8.8% were aware of their status, 6.1% reported having been linked to care, while 3.5% initiated ART and were currently on treatment. Of the HIV-infected FSW participants, 76.5% reported a previous HIV test and 22.4% were previously aware of their status. Linkage to care was reported by 20.1%, while 12.7% reported having initiated ART and 11.8% reported being on treatment at the time of the survey. Among HIV-infected PWID participants, 79.9% had previously received an HIV test, 63.2% were aware of their HIV status, and 49.0% reported being linked to care for their HIV infection. ART initiation was reported by 42.7% of participants, while 29.4% were on ART at the time of the survey. All key population groups fell below the global targets of the HIV treatment cascade. Conclusion. Among the three high risk populations in Mozambique, losses occurred throughout critical areas of service uptake with the most alarming breakpoint occurring at knowledge of HIV status. Special attention should be given to increasing HIV testing and linkage to ART treatment. Future surveys will provide the opportunity to monitor improvements across the cascade and should include viral load testing to guarantee a more complete picture of the treatment cascade.

scholarly journals Low Engagement in HIV Services and Progress through the Treatment Cascade among Key Populations Living with HIV in Mozambique: Alarming Gaps in Knowledge of Status

2020 ◽  
Author(s):  
Makini Boothe ◽  
Isabel Sathane ◽  
Cynthia Semá Baltazar ◽  
Noela Chicuecue ◽  
Roberta Horth ◽  
...  
Keyword(s):  
Sex Workers ◽  
Linkage To Care ◽  
Population Group ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
Key Populations ◽  
Hiv Status ◽  
Treatment Cascade ◽  
Hiv Test ◽  
Living With Hiv

Abstract Background: Mozambique has a generalized HIV epidemic of 13.5% among the general population. Early modeling exercises in Mozambique estimate that key populations (KPs), defined as men who have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID), along with their partners account for about one third of all new infections. There is limited data describing the engagement of KP living with HIV in testing, care and treatment services. Methods: We conducted a secondary data analysis of HIV-positive participants in the first Bio-behavioral Surveillance (BBS) surveys in Mozambique conducted 2011-2014 in order to assess service uptake and progress though the HIV treatment cascade among MSM, FSW, and PWID. Unweighted pooled estimates were calculated for each key population group. Results: Among HIV-positive MSM, 63.2% of participants had ever received an HIV test, 8.8% were aware of their status, 6.1% reported having been linked to care, while 3.5% initiated ART and were currently on treatment. Of the HIV-infected FSW participants, 76.5% reported a previous HIV test and 22.4% were previously aware of their status. Linkage to care was reported by 20.1%, while 12.7% reported having initiated ART and 11.8% reported being on treatment at the time of the survey. Among HIV-infected PWID participants, 79.9% had previously received an HIV test, 63.2% were aware of their HIV status, and 49.0% reported being linked to care for their HIV infection. ART initiation was reported by 42.7% of participants, while 29.4% were on ART at the time of the survey. Conclusion: Among the three high risk populations in Mozambique, losses occurred throughout critical areas of service uptake with the most alarming breakpoint occurring at knowledge of HIV status. Special attention should be given to increasing HIV testing and linkage to ART treatment. Future surveys will provide the opportunity to monitor improvements across the cascade in line with global targets and should include viral load testing to guarantee a more complete picture of the treatment cascade.

scholarly journals Low engagement in HIV services and progress through the treatment cascade among key populations living with HIV in Mozambique: alarming gaps in knowledge of status

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Makini A. S. Boothe ◽  
Isabel Sathane ◽  
Cynthia Semá Baltazar ◽  
Noela Chicuecue ◽  
Roberta Horth ◽  
...  
Keyword(s):  
Sex Workers ◽  
Linkage To Care ◽  
Population Group ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
Key Populations ◽  
Hiv Status ◽  
Treatment Cascade ◽  
Hiv Test ◽  
Living With Hiv

Abstract Background Mozambique has a generalized HIV epidemic of 13.5% among the general population. Early modeling exercises in Mozambique estimate that key populations (KP), defined as men who have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID), along with their partners account for about one third of all new infections. There is limited data describing the engagement of KP living with HIV in testing, care and treatment services. Methods We conducted a secondary data analysis of HIV-positive participants in the first Bio-behavioral Surveillance (BBS) surveys in Mozambique conducted 2011–2014 in order to assess service uptake and progress though the HIV treatment cascade among MSM, FSW, and PWID. Unweighted pooled estimates were calculated for each key population group. Results Among HIV-positive MSM, 63.2% of participants had ever received an HIV test, 8.8% were aware of their status, 6.1% reported having been linked to care, while 3.5% initiated ART and were currently on treatment. Of the HIV-infected FSW participants, 76.5% reported a previous HIV test and 22.4% were previously aware of their status. Linkage to care was reported by 20.1%, while 12.7% reported having initiated ART and 11.8% reported being on treatment at the time of the survey. Among HIV-infected PWID participants, 79.9% had previously received an HIV test, 63.2% were aware of their HIV status, and 49.0% reported being linked to care for their HIV infection. ART initiation was reported by 42.7% of participants, while 29.4% were on ART at the time of the survey. Conclusion Among the three high risk populations in Mozambique, losses occurred throughout critical areas of service uptake with the most alarming breakpoint occurring at knowledge of HIV status. Special attention should be given to increasing HIV testing and linkage to ART treatment. Future surveys will provide the opportunity to monitor improvements across the cascade in line with global targets and should include viral load testing to guarantee a more complete picture of the treatment cascade.

scholarly journals Low Engagement in HIV Services and Progress through the Treatment Cascade among Key Populations Living with HIV in Mozambique: Alarming Gaps in Knowledge of Status

2020 ◽  
Author(s):  
Makini Boothe ◽  
Isabel Sathane ◽  
Cynthia Semá Baltazar ◽  
Noela Chicuecue ◽  
Roberta Horth ◽  
...  
Keyword(s):  
Sex Workers ◽  
Linkage To Care ◽  
Population Group ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
Key Populations ◽  
Hiv Status ◽  
Treatment Cascade ◽  
Hiv Test ◽  
Living With Hiv

Abstract Background. Mozambique has a generalized HIV epidemic of 13.5% among the general population. Early modeling exercises in Mozambique estimate that key populations (KP), defined as men who have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID), along with their partners account for about one third of all new infections. There is limited data describing the engagement of KP living with HIV in testing, care and treatment services. Methods. We conducted a secondary data analysis of HIV-positive participants in the first Bio-behavioral Surveillance (BBS) surveys in Mozambique conducted 2011-2014 in order to assess service uptake and progress though the HIV treatment cascade among MSM, FSW, and PWID. Unweighted pooled estimates were calculated for each key population group.Results. Among HIV-positive MSM, 63.2% of participants had ever received an HIV test, 8.8% were aware of their status, 6.1% reported having been linked to care, while 3.5% initiated ART and were currently on treatment. Of the HIV-infected FSW participants, 76.5% reported a previous HIV test and 22.4% were previously aware of their status. Linkage to care was reported by 20.1%, while 12.7% reported having initiated ART and 11.8% reported being on treatment at the time of the survey. Among HIV-infected PWID participants, 79.9% had previously received an HIV test, 63.2% were aware of their HIV status, and 49.0% reported being linked to care for their HIV infection. ART initiation was reported by 42.7% of participants, while 29.4% were on ART at the time of the survey. Conclusion. Among the three high risk populations in Mozambique, losses occurred throughout critical areas of service uptake with the most alarming breakpoint occurring at knowledge of HIV status. Special attention should be given to increasing HIV testing and linkage to ART treatment. Future surveys will provide the opportunity to monitor improvements across the cascade in line with global targets and should include viral load testing to guarantee a more complete picture of the treatment cascade.

scholarly journals Low Engagement in HIV Services and Progress through the Treatment Cascade among Key Populations Living with HIV in Mozambique: Alarming Gaps in Knowledge of Status

2020 ◽  
Author(s):  
Makini Boothe ◽  
Isabel Sathane ◽  
Cynthia Semá Baltazar ◽  
Noela Chicuecue ◽  
Roberta Horth ◽  
...  
Keyword(s):  
Sex Workers ◽  
Linkage To Care ◽  
Population Group ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
Key Populations ◽  
Hiv Status ◽  
Treatment Cascade ◽  
Hiv Test ◽  
Living With Hiv

Abstract Background. Mozambique has a generalized HIV epidemic of 13.5% among the general population. Early modeling exercises in Mozambique estimate that key populations (KP), defined as men who have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID), along with their partners account for about one third of all new infections. There is limited data describing the engagement of KP living with HIV in testing, care and treatment services. Methods. We conducted a secondary data analysis of HIV-positive participants in the first Bio-behavioral Surveillance (BBS) surveys in Mozambique conducted 2011-2014 in order to assess service uptake and progress though the HIV treatment cascade among MSM, FSW, and PWID. Unweighted pooled estimates were calculated for each key population group.Results. Among HIV-positive MSM, 63.2% of participants had ever received an HIV test, 8.8% were aware of their status, 6.1% reported having been linked to care, while 3.5% initiated ART and were currently on treatment. Of the HIV-infected FSW participants, 76.5% reported a previous HIV test and 22.4% were previously aware of their status. Linkage to care was reported by 20.1%, while 12.7% reported having initiated ART and 11.8% reported being on treatment at the time of the survey. Among HIV-infected PWID participants, 79.9% had previously received an HIV test, 63.2% were aware of their HIV status, and 49.0% reported being linked to care for their HIV infection. ART initiation was reported by 42.7% of participants, while 29.4% were on ART at the time of the survey. Conclusion. Among the three high risk populations in Mozambique, losses occurred throughout critical areas of service uptake with the most alarming breakpoint occurring at knowledge of HIV status. Special attention should be given to increasing HIV testing and linkage to ART treatment. Future surveys will provide the opportunity to monitor improvements across the cascade in line with global targets and should include viral load testing to guarantee a more complete picture of the treatment cascade.

scholarly journals Low Engagement in HIV Services and Progress through the Treatment Cascade among Key Populations Living with HIV in Mozambique: Alarming Gaps in Knowledge of Status

2020 ◽  
Author(s):  
Makini Boothe ◽  
Isabel Sathane ◽  
Cynthia Semá Baltazar ◽  
Noela Chicuecue ◽  
Roberta Horth ◽  
...  
Keyword(s):  
Sex Workers ◽  
Linkage To Care ◽  
Population Group ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
Key Populations ◽  
Hiv Status ◽  
Treatment Cascade ◽  
Hiv Test ◽  
Living With Hiv

Abstract Background. Mozambique has a generalized HIV epidemic of 13.5% among the general population. Early modeling exercises in Mozambique estimate that key populations (KP), defined as men who have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID), along with their partners account for about one third of all new infections. There is limited data describing the engagement of KP living with HIV in testing, care and treatment services.Methods. We conducted a secondary data analysis of HIV-positive participants in the first Bio-behavioral Surveillance (BBS) surveys in Mozambique conducted 2011-2014 in order to assess service uptake and progress though the HIV treatment cascade among MSM, FSW, and PWID. Unweighted pooled estimates were calculated for each key population group.Results. Among HIV-positive MSM, 63.2% of participants had ever received an HIV test, 8.8% were aware of their status, 6.1% reported having been linked to care, while 3.5% initiated ART and were currently on treatment. Of the HIV-infected FSW participants, 76.5% reported a previous HIV test and 22.4% were previously aware of their status. Linkage to care was reported by 20.1%, while 12.7% reported having initiated ART and 11.8% reported being on treatment at the time of the survey. Among HIV-infected PWID participants, 79.9% had previously received an HIV test, 63.2% were aware of their HIV status, and 49.0% reported being linked to care for their HIV infection. ART initiation was reported by 42.7% of participants, while 29.4% were on ART at the time of the survey.Conclusion. Among the three high risk populations in Mozambique, losses occurred throughout critical areas of service uptake with the most alarming breakpoint occurring at knowledge of HIV status. Special attention should be given to increasing HIV testing and linkage to ART treatment. Future surveys will provide the opportunity to monitor improvements across the cascade in line with global targets and should include viral load testing to guarantee a more complete picture of the treatment cascade.

scholarly journals HIV treatment cascade among people who inject drugs in Ukraine

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244572
Author(s):  
Yana Sazonova ◽  
Roksolana Kulchynska ◽  
Yuliia Sereda ◽  
Marianna Azarskova ◽  
Yulia Novak ◽  
...  
Keyword(s):  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Scale Up ◽  
Linkage To Care ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
Hiv Status ◽  
Opioid Agonist ◽  
Treatment Cascade ◽  
Hiv Treatment Cascade

The HIV treatment cascade is an effective tool to track progress and gaps in the HIV response among key populations. People who inject drugs (PWID) remain the most affected key population in Ukraine with HIV prevalence of 22% in 2015. We performed secondary analysis of the 2017 Integrated Bio-Behavioral Surveillance (IBBS) survey data to construct the HIV treatment cascade for PWID and identify correlates of each indicator achievement. The biggest gap in the cascade was found in the first “90”, HIV status awareness: only 58% [95% CI: 56%-61%] of HIV-positive PWID reported being aware of their HIV-positive status. Almost 70% [67%-72%] of all HIV-infected PWID who were aware of their status reported that they currently received antiretroviral therapy (ART). Almost three quarters (74% [71%-77%]) of all HIV-infected PWID on ART were virally suppressed. Access to harm reduction services in the past 12 months and lifetime receipt of opioid agonist treatment (OAT) had the strongest association with HIV status awareness. Additionally, OAT patients who were aware of HIV-positive status had 1.7 [1.2–2.3] times the odds of receiving ART. Being on ART for the last 6 months or longer increased odds to be virally suppressed; in contrast, missed recent doses of ART significantly decreased the odds of suppression. The HIV treatment cascade analysis for PWID in Ukraine revealed substantial gaps at each step and identified factors contributing to achievement of the outcomes. More intensive harm reduction outreach along with targeted case finding could help to fill the HIV awareness gap among PWID in Ukraine. Scale up of OAT and community-level linkage to care and ART adherence interventions are viable strategies to improve ART coverage and viral suppression among PWID.

Observational study of the populations accessing rapid point-of-care HIV testing in Winnipeg, Manitoba, Canada, through a retrospective chart review of site records

2017 ◽  
Vol 94 (3) ◽  
pp. 194-199 ◽  
Author(s):  
James Blain Johnston ◽  
Joss N Reimer ◽  
John L Wylie ◽  
Jared Bullard
Keyword(s):  
Viral Load ◽  
Hiv Testing ◽  
Clinical Outcomes ◽  
Point Of Care ◽  
Age Groups ◽  
Linkage To Care ◽  
Hiv Positive ◽  
Hiv Status ◽  
Viral Load Suppression ◽  
Hiv Test

ObjectivesHIV point-of-care testing (POCT) has been available in Manitoba since 2008. This study evaluated the effectiveness of POCT at identifying individuals with previously unknown HIV status, its effects on clinical outcomes and the characteristics of the populations reached.MethodsA retrospective database review was conducted for individuals who received HIV POCT from 2011 to 2014. Time to linkage to care and viral load suppression were compared between individuals who tested positive for HIV using POCT and controls identified as positive through standard screening. Testing outcomes for labouring women with undocumented HIV status accessing POCT during labour were also assessed.Results3204 individuals received POCT (1055 females (32.9%) and 2149 males (67.1%)), being the first recorded HIV test for 2205 (68.8%). Males were more likely to be targeted with POCT as their first recorded HIV test (adjusted OR (AOR) 1.40). Between the two main test sites (Main Street Project (MSP) and Nine Circles Community Health Centre), MSP tested relatively fewer males (AOR 0.79) but a higher proportion of members of all age groups over 30 years old (AOR 1.83, 2.51 and 3.64 for age groups 30–39, 40–49 and >50, respectively). There was no difference in time to linkage to care (p=0.345) or viral load suppression (p=0.405) between the POCT and standard screening cohorts. Of 215 women presenting in labour with unknown HIV status, one was identified as HIV positive.ConclusionsPOCT in Manitoba has been successful at identifying individuals with previously unknown HIV-positive status. Demographic differences between the two main testing sites support that this intervention is reaching unique populations. Given that we observed no significant difference in time to clinical outcomes, it is reasonable to continue using POCT as a targeted intervention.MeSH termsHIV infection; rapid HIV testing; vertical infectious disease transmission; community outreach; service delivery; marginalised populations.

Determinants of Gender Disparities in Scaling Up the First 90 Towards the UNAIDS 90-90-90 Targets in South Africa: Findings From the 2017 Household-based National Cross-sectional Survey

2020 ◽  
Author(s):  
Sean Jooste ◽  
Musawenkosi Mabaso ◽  
Myra Taylor ◽  
Alicia North ◽  
Yolande Shean ◽  
...  
Keyword(s):  
South Africa ◽  
Tertiary Education ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Primary Level ◽  
Treatment Cascade

Abstract Background: The first 90 of UNAIDS 90–90–90 targets to have 90% of the people living with HIV know their status is an important entry point to the HIV treatment cascade and care continuum, but evidence shows that there is a large gap between males and females in this regard. It is therefore important to understand barriers and facilitators of achieving the first 90 target. This study examined determinants of the first 90 target among females and males in order to inform strategies aimed at improving the HIV cascade in South Africa.Methods: The data used in the analysis were obtained from a 2017 household-based cross-sectional nationally representative survey conducted using a multi-stage stratified cluster random sampling design. A series of hierarchical multiple logistic regression models were fitted to identify the determinants of the first 90 target by gender.Results: Overall, 84.8% of HIV-positive individuals aged 15 years and older were aware of their HIV status. Females were significantly more aware of their HIV status compared to males (88.7% vs 78.2%, p<0.001). Both females aged 25 to 49 years [aOR=3.20 (95% CI: 1.35–7.57), p=0.008], and 50 years and older [aOR=3.19 (95% CI: 1.04–9.76), p=0.042] and males aged 25 to 49 years [aOR=3.00 (95% CI: 1.13–7.97), p=0.028], and 50 years and older [aOR=7.25 (95% CI: 2.07–25.36), p=0.002] were significantly more likely to know their HIV status compared to those aged 15 to 19 years. Males with tertiary education level were significantly more likely to be aware of their HIV positive status [aOR=75.24 (95% CI: 9.07–624.26), p<0.001] compared to those with no education or with primary level education. Females with secondary [aOR=3.28 (95% CI: 1.20–8.99), p=0.021] and matric [aOR=4.35 (95% CI: 1.54–12.37), p=0.006] educational levels were significantly more likely to be aware of their HIV positive status, compared to those with no education or with primary level education.Conclusion: Significant progress has been made with regards to reaching the UNAIDS first 90 target. In this context achieving the first 90 target is feasible but there is a need for additional interventions to reach the males especially youth including those with no education or low levels of education.

scholarly journals HIV Treatment Cascade Assessment of a Community-Based Test and Start Model for Key Populations in Lagos State Nigeria: Where Are the Gaps?

2018 ◽  
Vol 08 (03) ◽  
pp. 105-117
Author(s):  
Jean Njab ◽  
Sylvia Adebajo ◽  
George Eluwa ◽  
Elizabeth Shoyemi ◽  
Progress Osakwe ◽  
...  
Keyword(s):  
Hiv Treatment ◽  
Key Populations ◽  
Community Based ◽  
Treatment Cascade ◽  
Lagos State ◽  
Hiv Treatment Cascade

scholarly journals HIV treatment cascade for older adults in rural South Africa

2019 ◽  
Vol 96 (4) ◽  
pp. 271-276 ◽  
Author(s):  
Julia K Rohr ◽  
Jennifer Manne-Goehler ◽  
Francesc Xavier Gómez-Olivé ◽  
Ryan G Wagner ◽  
Molly Rosenberg ◽  
...  
Keyword(s):  
South Africa ◽  
Hiv Testing ◽  
Hiv Treatment ◽  
Self Report ◽  
Data Sources ◽  
Hiv Positive ◽  
Treatment Cascade ◽  
South Africans ◽  
Self Reports ◽  
Hiv Treatment Cascade

ObjectivesThe HIV treatment cascade is a powerful framework for understanding progress from initial diagnosis to successful treatment. Data sources for cascades vary and often are based on clinical cohorts, population cohorts linked to clinics, or self-reported information. We use both biomarkers and self-reported data from a large population-based cohort of older South Africans to establish the first HIV cascade for this growing segment of the HIV-positive population and compare results using the different data sources.MethodsData came from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) 2015 baseline survey of 5059 adults aged 40+ years. Dried blood spots (DBS) were screened for HIV, antiretroviral drugs and viral load. In-home surveys asked about HIV testing, diagnosis and antiretroviral therapy (ART) use. We calculated proportions and CIs for each stage of the cascade, conditional on attainment of the previous stage, using (1) biomarkers, (2) self-report and (3) both biomarkers and self-report, and compared with UNAIDS 90-90-90 targets.Results4560 participants had DBS results, among whom 1048 (23%) screened HIV-positive and comprised the denominator for each cascade. The biomarker cascade showed 63% (95% CI 60 to 66) on ART and 72% (95% CI 69 to 76) of those on ART with viral suppression. Self-reports underestimated testing, diagnosis and ART, with only 47% (95% CI 44 to 50) of HIV-positive individuals reporting ART use. The combined cascade indicated high HIV testing (89% (95% CI 87 to 91)), but lower knowledge of HIV-positive status (71% (95% CI 68 to 74)).ConclusionsOlder South Africans need repeated HIV testing and sustained ART to reach 90-90-90 targets. HIV cascades relying on self-reports are likely to underestimate true cascade attainment, and biomarkers provide substantial improvements to cascade estimates.

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