scholarly journals A realist evaluation of the continuum of HIV services for men who have sex with men

2021 ◽  
Author(s):  
Willy Dunbar ◽  
Aline Labat ◽  
Nathalie Maulet ◽  
Yves Coppieters
Keyword(s):  
Community Support ◽  
Realist Evaluation ◽  
Service Delivery Model ◽  
Loss To Follow Up ◽  
Hiv Services ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Underlying Mechanisms ◽  
The Continuum

Abstract Men who have Sex with Men (MSM) represent the risk group that are disproportionately most affected by human immunodeficiency virus (HIV), yet are understudied in intervention research. This realist evaluation assessed the continuum of HIV services for MSM in Haiti. Guided by the Context-Mechanisms-Outcomes configuration, first, aninitial program theory (IPT) was developed based on reviews, observations and discussions. Second, the IPT was tested using a mixed-method explanatory study. Third, we refined the IPT by eliciting the underlying mechanisms. The results showed that the current service delivery model is suboptimal in engaging and retaining MSM, resulting in loss to follow-up and failure to fully realize the health benefits of antiretroviral. However, the mechanisms through which linkages across the continuum can be improved are: self-acceptance, sense of community support and sense of comprehensive and tailored HIV services. Our evaluation highlighted the importance of taking a comprehensive approach to improve the continuum.

scholarly journals A realist evaluation of the continuum of HIV services for men who have sex with men

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Willy Dunbar ◽  
Marie Colette Alcide Jean-Pierre ◽  
Jacky S. Pétion ◽  
Aline Labat ◽  
Nathalie Maulet ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Community Support ◽  
Retention In Care ◽  
Realist Evaluation ◽  
Cross Sectional ◽  
Loss To Follow Up ◽  
Hiv Services ◽  
Services Delivery ◽  
Sex With Men ◽  
The Continuum

Abstract Background Men who have Sex with Men (MSM) represent the risk group that are disproportionately most affected by the human immunodeficiency virus (HIV) and continue to drop-off from the steps of the continuum of HIV services that have been adopted to overcome poor engagement and retention in care. This realist evaluation aimed at: (1) describing the evaluation carried out in Haiti aiming to ascertain why, how and under which circumstances MSM are linked and retained along the continuum, (2) assessing the outcomes of this approach and (3) exploring the motivators and facilitators for the HIV continuum of services through mechanisms and pathways. Methods Guided by a realist approach, first, an initial program theory (IPT) was developed based on literature and frameworks review, participant observations and discussions with stakeholders. Then, the IPT was tested using a mixed method explanatory study: a quantitative phase to build the continuum from a cross-sectional analysis, and a qualitative phase to explore the motivators and facilitators related to proper linkages along the continuum. Finally, the IPT was refined by eliciting the mechanisms and pathways for outcomes improvement. Results The results showed that the current service delivery model is suboptimal in identifying, engaging, linking and retaining MSM, resulting in loss to follow-up at every step of the continuum and failure to fully realize the health and prevention benefits of antiretroviral. However, the mechanisms through which linkages across the continuum can be improved are: self-acceptance, sense of community support and sense of comprehensive and tailored HIV services. These mechanisms are based on 10 different pathways: self-esteem, awareness and pride, perception of HIV risk, pcceptance and HIV status, addressing community stigma, strengthening of MSM organizations and community networks, societal acceptation and tolerance, stigma reduction training for healthcare providers, engagement of peers as educators and navigators and, adapted services delivery through drug dispensing points and mobile technology and financial assistance. Conclusions The study findings show that engagement, adherence and retention to the continuum of HIV service for MSM are affected by a multi-layer of factors, thus highlighting the importance of taking a comprehensive approach to improve the program.

scholarly journals A realist evaluation of the continuum of HIV services for men who have sex with men

2021 ◽  
Author(s):  
Willy Dunbar ◽  
Marie Colette Alcide Jean Pierre ◽  
Jacky S Pétion ◽  
Aline Labat ◽  
Nathalie Maulet ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Community Support ◽  
Retention In Care ◽  
Realist Evaluation ◽  
Cross Sectional ◽  
Loss To Follow Up ◽  
Hiv Services ◽  
Services Delivery ◽  
Sex With Men ◽  
The Continuum

Abstract BackgroundMen who have Sex with Men (MSM) represent the risk group that are disproportionately most affected by the human immunodeficiency virus (HIV) and continue to drop-off from the steps of the continuum of HIV services that have been adopted to overcome poor engagement and retention in care. This realist evaluation aimed at: 1) describing the evaluation carried out in Haiti aiming to ascertain why, how and under which circumstances MSM are linked and retained along the continuum, 2) assessing the outcomes of this approach and 3) exploring the motivators and facilitators for the HIV continuum of services through mechanisms and pathways. MethodsGuided by a realist approach, first, an initial program theory (IPT) was developed based on literature and frameworks review, participant observations and discussions with stakeholders. Then, the IPT was tested using a mixed method explanatory study: a quantitative phase to build the continuum from a cross-sectional analysis, and a qualitative phase to explore the motivators and facilitators related to proper linkages along the continuum. Finally, the IPT was refined by eliciting the mechanisms and pathways for outcomes improvement.ResultsThe results showed that the current service delivery model is suboptimal in identifying, engaging, linking and retaining MSM, resulting in loss to follow-up at every step of the continuum and failure to fully realize the health and prevention benefits of antiretroviral. However, the mechanisms through which linkages across the continuum can be improved are: self-acceptance, sense of community support and sense of comprehensive and tailored HIV services. These mechanisms are based on 10 different pathways: self-esteem, awareness and pride, perception of HIV risk, pcceptance and HIV status, addressing community stigma, strengthening of MSM organizations and community networks, societal acceptation and tolerance, stigma reduction training for healthcare providers, engagement of peers as educators and navigators and, adapted services delivery through drug dispensing points and mobile technology and financial assistance.ConclusionsThe study findings show that engagement, adherence and retention to the continuum of HIV service for MSM are affected by a multi-layer of factors, thus highlighting the importance of taking a comprehensive approach to improve the program.

scholarly journals Loss to follow-up in a cohort of HIV-negative men who have sex with men: Project Horizonte

2017 ◽  
Vol 51 (0) ◽  
Author(s):  
Ana Paula Silva ◽  
Marília Greco ◽  
Maria Arlene Fausto ◽  
Mariângela Carneiro
Keyword(s):  
Loss To Follow Up ◽  
Sex With Men ◽  
Hiv Negative

Public health counselling following an HIV diagnosis among men who have sex with men: tensions between individual needs and health protection mandates

2020 ◽  
pp. 174498712093296
Author(s):  
Lauren Orser ◽  
Patrick O'Byrne
Keyword(s):  
Public Health ◽  
Human Immunodeficiency Virus ◽  
Qualitative Interviews ◽  
Primary Objective ◽  
Public Health Nurses ◽  
Hiv Diagnosis ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Health Counselling

Background In Ontario, provincial regulations stipulate that public health units must complete post-test counselling with all persons newly diagnosed with human immunodeficiency virus. Public health nurses conduct this follow-up and are responsible for ensuring appropriate surveillance and management of human immunodeficiency virus with the primary objective of reducing ongoing human immunodeficiency virus transmission in their health jurisdiction. To date, little research has explored the effectiveness of this mandatory public health counselling from the perspective of patients – the majority of whom are men who have sex with men. Aims To address gaps in public health nursing practice, a pilot study was conducted with men who have sex with men in Ottawa to explore their attitudes and experiences of receiving mandatory human immunodeficiency virus follow-up after their diagnosis. Methods Qualitative interviews were conducted and interpreted using thematic analysis. Results This analysis revealed a contrariety between the needs of individuals and of public health units, with patients' perceiving their personal wishes to be secondary to public health mandates – and led patients to simultaneously want to evade, and be assisted by, public health nurses. Conclusions Public health units and nurses should consider adopting a more patient-centered approach to HIV case management, which incorporates patients’ experiences of receiving an HIV diagnosis.

scholarly journals Risk factors for loss to follow-up in human immunodeficiency virus care in the Greater Accra Regional Hospital in Ghana: a retrospective cohort study

2019 ◽  
Vol 11 (6) ◽  
pp. 605-612
Author(s):  
Jerry S Sifa ◽  
Stephen Manortey ◽  
Sharon Talboys ◽  
Gloria A Ansa ◽  
Ekua E Houphouet
Keyword(s):  
Human Immunodeficiency Virus ◽  
Immune Deficiency Syndrome ◽  
Disease Status ◽  
Control Programme ◽  
Regional Hospital ◽  
Loss To Follow Up ◽  
Factors Associated ◽  
Persons Living With Hiv ◽  
Immunodeficiency Virus

Abstract Background Loss of human immunodeficiency virus (HIV)-positive patients to follow-up increases HIV-related morbidity and mortality. This study identified the factors associated with loss to follow-up (LTFU) in an urban health facility in Ghana. Methods A 12-y retrospective study was conducted using routinely collected data from the National Acquired Immune Deficiency Syndrome (AIDS) Control Programme (NACP) on persons living with HIV/AIDS (PLWHA) who initiated antiretroviral therapy (ART) from 2006 to 2017 at the Greater Accra Regional Hospital. Convenience sampling was used to select the study area. All gathered data were exported to Stata 14 statistical software for analysis. Results A total of 4330 PLWHA initiated ART between January 2006 and December 2017. Of these, 1166 (26.9%) were lost to follow-up over the 12-y period. The factors associated with LTFU included being a Muslim (adjusted hazard ratio [aHR] 1.31 [95% confidence interval {CI} 1.05 to 1.65]), having CD4 <250 cells/ml (aHR 1.45 [95% CI 1.21 to 1.76]) and completing adherence counselling (aHR 1.58 [95% CI 1.31 to 1.92]). Having other sources of health care funding and disclosure of one’s disease status were found to be protective (aHR 0.74 [95% CI 0.58 to 0.94] and 0.80 [95% CI 0.65 to 0.98], respectively). Conclusions Some of the determinants of LTFU in the hospital are comparable to those found in other parts of Africa and could be addressed using existing interventions.

scholarly journals Factors Associated with Loss-to-Follow-Up during Behavioral Interventions and HIV Testing Cohort among Men Who Have Sex with Men in Nanjing, China

PLoS ONE ◽  
2015 ◽  
Vol 10 (1) ◽  
pp. e115691 ◽  
Author(s):  
Weiming Tang ◽  
Xiping Huan ◽  
Ye Zhang ◽  
Tanmay Mahapatra ◽  
Jianjun Li ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Behavioral Interventions ◽  
Loss To Follow Up ◽  
Factors Associated ◽  
Sex With Men

scholarly journals The extent of loss to follow among patients initiated on antiretroviral treatment, Pakistan 2017-2018: a retrospective cross-sectional study

2019 ◽  
Author(s):  
Saima Iqbal Paracha ◽  
Fahad Hafeez ◽  
Hammad Habib ◽  
Aashifa Yaqoob ◽  
Raazia Fatima ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cross Sectional Study ◽  
Control Programme ◽  
Sociodemographic Characteristics ◽  
Sectional Study ◽  
Cross Sectional ◽  
Loss To Follow Up ◽  
Immunodeficiency Virus ◽  
Lost To Follow Up

Abstract Background The HIV epidemic in Pakistan is concentrated in key populations and is one of the fastest growing epidemics in South Asia. Over the years the number of people infected with the human immunodeficiency virus initiated on antiretroviral therapy has gradually increased. The effectiveness of the treatment programmes depends on retention in care and treatment adherence. The aim of the study is to the explore the sociodemographic characteristics and magnitude of loss to follow-up in patients initiated on ART in three provinces of Pakistan.Methods A retrospective cross-sectional study was conducted in the National AIDS Control Programme. Case-based data (n=5,215) of 16 treatment centres for all patients initiated on anti-retroviral therapy from 1 st January 2017 to 31 st December 2018 was extracted from the national management information system. Loss to follow-up was defined as a patient who has not visited/attended the ART clinic for >180 days (6 months) and has not been reported dead or transferred out to another ART clinic. Descriptive statistics were applied to study the sociodemographic characteristics and level of lost to follow up in patients initiated on treatment.Results Of the 5,215 patients, 3,097 (59.4%) were aged between 15-49 years. About 4,069 (78%) were male. Around 1,686 (34.3%) of the patients on ART were defined as lost to follow up. Age, gender, and patients with undisclosed identity were identified as the key characteristics of patients lost to follow-up. A greater proportion of the patients were lost to follow-up within the first year of initiation of treatment.Conclusions The loss to follow in the study is high. Efforts need to be focussed on linking people infected with human immunodeficiency virus to treatment, retaining them in care, and increasing patient time on treatment. Patient tracing mechanisms should be strengthened.

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