scholarly journals High HIV Positivity Rates Following Large-Scale HIV Self-Testing Implementation in Zimbabwe, 2018–2020

2021 ◽  
Vol 9 ◽  
Author(s):  
Auxilia Muchedzi ◽  
Mulamuli Mpofu ◽  
Fungai H. Mudzengerere ◽  
Moses Bateganya ◽  
Tarirai Mavimba ◽  
...  
Keyword(s):  
Large Scale ◽  
Scale Up ◽  
Age Groups ◽  
Hiv Care ◽  
Hiv Positive ◽  
Chi Square ◽  
Innovative Strategy ◽  
Mobile Testing ◽  
Self Testing ◽  
The Difference

Introduction: HIV self-testing (HIV-ST) is an innovative strategy to increase HIV case identification. This analysis shares the outcomes of HIV-ST implementation within the Zimbabwe HIV Care and Treatment (ZHCT) project for the period October 2018–March, 2020.Materials and Methods: We extracted HIV-ST data for the period October 2018 to March 2020 from the project database and assessed (1) the proportion of reactive HIV-ST results; (2) the concordance between reactive HIV-ST results against rapid confirmatory HIV tests using Determine™ and Chembio™ in parallel; and (3) the monthly contribution of HIV-ST to total HIV positive individuals identified within project. The Chi-square test was used to assess for statistical differences in HIV positivity between age groups, by sex and district; as well as the difference in HIV positivity between the HIV-ST and index and mobile testing strategies.Findings: Between October 2018 and March 2020, the ZHCT project distributed 11,983 HIV-ST kits; 11,924 (99.8%) were used and 2,616 (21.9%) were reactive. Of the reactive tests, 2,610 (99.8%) were confirmed HIV positive giving a final positivity rate of 21.9%, and a concordance rate of 99.8% between the HIV-ST results and the confirmatory tests. Proportion of reactive results differed by age-groups (p < 0.001); with the 35–49 years having the highest positivity rate of 25.5%. The contribution of HIV-ST to total new positives increased from 10% in October 2018 to 80% at the end of March 2020 (p < 0.001). Positivity rates from HIV-ST were significantly different by age-groups, sex and district (p = 0.04). Additionally, index and mobile testing had a higher positivity rate compared to HIV-ST (p < 0.001).Conclusion: The ZHCT project has successfully scaled up HIV self-testing which contributed significantly to HIV case finding. Countries should consider using the lessons to scale-up the intervention which will contribute in reaching under-served and undiagnosed populations.

scholarly journals Implementation of HIV Self-Testing to Reach Men in Rural uMkhanyakude, KwaZulu-Natal, South Africa. a DO-ART Trial Sub Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Nsika Sithole ◽  
Maryam Shahmanesh ◽  
Olivier Koole ◽  
Meighan Krows ◽  
Torin Schaafsma ◽  
...  
Keyword(s):  
South Africa ◽  
Hiv Testing ◽  
Large Scale ◽  
Hiv Care ◽  
Confirmatory Test ◽  
Hiv Positive ◽  
Advisory Boards ◽  
Self Testing ◽  
Kwazulu Natal ◽  
Study Team

Background: KwaZulu–Natal, South Africa has one of the highest HIV prevalence rates globally. Persons <35 years and men have lower rates of HIV testing. HIV self-testing (HIVST) may overcome many barriers of facility-based HIV testing in order to identify HIV positive young persons and men and link them to care. We investigated whether HIVST distribution was a feasible approach to reach men and assessed the proportion of participants who reported their HIVST results, tested positive and linked to care.Methods: Teams comprised of a nurse, clinic research assistant, and recruiters distributed HIVST kits in rural uMkhanyakude, KwaZulu-Natal from August—November 2018 with a focus on testing men. Workplaces (farms), social venues, taxi ranks, and homesteads were used as HIVST kit distribution points following community sensitisation through community advisory boards and community leaders. HIVST kits, demonstration of use, and small incentives to report testing outcomes were provided. The Department of Health provided confirmatory testing and HIV care at clinics.Results: Over 11 weeks in late 2018, we distributed 2,634 HIVST kits of which 2,113 (80%) were distributed to persons aged <35 years, 2,591 (98%) to men and 356 (14%) to first time testers. Of the HIVST distributed, 2,107 (80%) reported their results to the study team, and 157 (7%) tested positive. Of persons who tested positive, 107/130 (82%) reported having a confirmatory test of which 102/107 (95%) were positive and initiated on ART. No emergencies or social harms were reported.Conclusion: Large scale distribution of HIVST kits targeting men in rural KwaZulu-Natal is feasible and highly effective in reaching men, including those who had not previously tested for HIV. While two-thirds of persons who tested HIV positive initiated ART, additional linkage strategies are needed for those who do not link after HIVST. HIVST should be used as a tool to reach men in order to achieve 95% coverage in the UNAIDS testing and care cascade in KwaZulu-Natal.

scholarly journals Formative research to inform the development of a peer-led HIV self-testing intervention to improve HIV testing uptake and linkage to HIV care among adolescents, young people and adult men in Kasensero fishing community, Rakai, Uganda: a qualitative study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Joseph K. B. Matovu ◽  
Aminah Nambuusi ◽  
Scovia Nakabirye ◽  
Rhoda K. Wanyenze ◽  
David Serwadda
Keyword(s):  
Young People ◽  
Hiv Testing ◽  
Hiv Care ◽  
Hiv Positive ◽  
Fishing Community ◽  
Adult Men ◽  
Self Testing ◽  
Testing Uptake ◽  
Hiv Testing Services ◽  
Linkage To Hiv Care

Abstract Background Despite efforts to improve HIV testing and linkage to HIV care among adolescents, young people and adult men, uptake rates remain below global targets. We conducted formative research to generate data necessary to inform the design of a peer-led HIV self-testing (HIVST) intervention intended to improve HIV testing uptake and linkage to HIV care in Kasensero fishing community in rural Uganda. Methods This qualitative study was conducted in three study communities in Kasensero fishing community in Rakai district, Uganda, in May 2019. Six single-sex focus group discussions (FGDs) comprising 7–8 participants were conducted with adolescents and young people (15–24 years) and adult men (25+ years). We collected data on people’s perceptions about peer-led HIVST; potential acceptability of a peer-led HIVST intervention and suggestions on how to improve linkage to HIV care after a positive HIVST result. Peer-led HIVST was defined as an approach where trained lay people distribute HIVST kits to other people in the community. FGDs were audio-recorded with permission from the participants, transcribed verbatim and analysed manually following a thematic framework approach. Results Forty-seven participants (31 men and 16 women) participated in the FGDs. Across communities and age-groups, most participants mentioned that peer-led HIVST would be generally acceptable to people in the fishing community but people will need support in performing the test due to fear of performing the test wrongly or failing to cope with HIV-positive results. Most participants felt that peer-led HIVST would bring HIV testing services closer to the community “because [the peer-leader] could be my immediate neighbour”, making it easier for people to obtain the kits at any time of their convenience. To improve linkage to HIV care, participants felt that the use of peer-leaders to deliver the initial ART dose to self-tested HIV-positive individuals would be more preferable to the use of community-based ART groups or home-based ART initiation. Conclusion Our study shows that peer-led HIVST is potentially acceptable in the fishing community. These findings suggest that this approach can improve uptake of HIV testing and linkage to HIV care services among populations that are usually missed through conventional HIV testing services.

Comparision of histologic distribution of RCC in young and older patients: Results from the SEER database.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 419-419 ◽  
Author(s):  
Michael R. Daugherty ◽  
Stephen Blakely ◽  
Oleg Shapiro ◽  
Gennady Bratslavsky
Keyword(s):  
Renal Cell ◽  
Clear Cell ◽  
Collecting Duct ◽  
Cell Cancer ◽  
Age Groups ◽  
Genetic Mutations ◽  
Chi Square ◽  
Younger Patients ◽  
The Difference ◽  
Chi Square Analysis

419 Background: Renal cell cancer (RCC) incidence is relatively low in younger patients, encompassing 3-5% of all RCC tumors. These tumors tend to be due to hereditary syndromes and genetic mutations that predispose to cancer development. Patients with hereditary renal cancer (HRC) are at a higher risk of multiple tumors and bilateral disease. We hypothesize that there is a difference in histologic distribution in the younger patients and that the younger distribution contains more aggressive histologic subtypes. Methods: SEER 18-registries database was queried for all patients ≥20 years old that were surgically treated for renal cell carcinoma between the years 2001 and 2008. Patients with unknown race, grade, stage, or histology were excluded from the study. Histologies selected were clear cell, papillary, chromophobe, sarcomatoid, and collecting duct. Three cohorts were created with the ages 20-44, 45-64, and ≥65 year olds that contained 3,926, 19,661, and 16,323 patients respectively. Chi-square analysis was used to compare the histologic distributions between the cohorts. Results: There was no difference in the incidence of clear cell RCC between the three cohorts (p = 0.63). The histology distribution was not different in the 45-64 year olds compared to those ≥65 (p = 0.47). The non-clear cell histologies were different between the 3 age groups (p < 0.001). There were a larger percentage of patients in the younger patients that had chromophobe tumors compared to all non-clear cell histologies (p< 0.001). Conclusions: The difference in the non-clear cell histologic distribution between the groups is most likely due to genetic mutations predisposing these patients to chromophobe RCC. There has been limited data on HRCs, due in large part to its low incidence. Although the HRCs are known to have a most common histology, it is likely that this information is incomplete, as younger patients have undiagnosed genetic mutations that led to development of chromophobe tumors. [Table: see text]

scholarly journals Ethical issues in the use of SMS messaging in HIV care and treatment in low- and middle-income countries: case examples from Mozambique

2017 ◽  
Vol 25 (4) ◽  
pp. 423-427 ◽  
Author(s):  
Ezequiel B Ossemane ◽  
Troy D Moon ◽  
Martin C Were ◽  
Elizabeth Heitman
Keyword(s):  
Large Scale ◽  
Ethical Issues ◽  
Scale Up ◽  
Hiv Care ◽  
Ethical Framework ◽  
Middle Income ◽  
Middle Income Countries ◽  
Retention In Hiv Care ◽  
Care And Treatment ◽  
Low And Middle Income

Abstract The introduction of mobile communication technologies in health care in low- and middle-income countries offers an opportunity for increased efficiencies in provision of care, improved utilization of scarce resources, reductions in workload, and increased reach of services to a larger target population. Short message service (SMS) technologies offer promise, with several large-scale SMS-based implementations already under way. Still largely lacking in the research literature are evaluations of specific ethical issues that arise when SMS programs are implemented and studied in resource-limited settings. In this paper, we examine the ethical issues raised by the deployment of SMS messaging to support patient retention in HIV care and treatment and in the research conducted to evaluate that deployment. We use case studies that are based in Mozambique and ground our discussion in the ethical framework for international research proposed by Emanuel et al., highlighting ethical considerations needed to guide the design and implementation of future SMS-based interventions. Such guidance is increasingly needed in countries such as Mozambique, where the local capacity for ethical study design and oversight is still limited and the scale-up and study of mHealth initiatives are still driven predominantly by international collaborators. These issues can be complex and will need ongoing attention on a case-by-case basis to ensure that appropriate protections are in place, while simultaneously maximizing the potential benefit of new mHealth technologies.

scholarly journals Accessing antiretroviral therapy for children: Caregivers' voices

2016 ◽  
Vol 21 ◽  
pp. 331-338
Author(s):  
Margaret Williams ◽  
Dalena R.M. Van Rooyen ◽  
Esmeralda J. Ricks
Keyword(s):  
Antiretroviral Therapy ◽  
Tertiary Care ◽  
Scale Up ◽  
Target Population ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Hiv Positive ◽  
Eastern Cape ◽  
Care Facilities ◽  
Sub Saharan

Despite efforts to scale up access to antiretroviral therapy (ART), particularly at primary health care (PHC) facilities, antiretroviral therapy (ART) continues to be out of reach formany human immunodeficiency virus (HIV)-positive children in sub-Saharan Africa. In resource limited settings decentralisation of ART is required to scale up access to essential medication. Traditionally, paediatric HIV care has been provided in tertiary care facilities which have better human and material resources, but limited accessibility in terms of distance for caregivers of HIV-positive children. The focus of this article is on the experiences of caregivers whilst accessing ART for HIV-positive children at PHC (decentralised care) facilities in Nelson Mandela Bay (NMB) in the Eastern Cape, South Africa. A qualitative, explorative, descriptive and contextual research design was used. The target population comprised caregivers of HIV-positive children. Data were collected by means of indepth individual interviews, which were thematically analysed. Guba's model was usedto ensure trustworthiness. Barriers to accessing ART at PHC clinics for HIV-positive children included personal issues, negative experiences, lack of support and finance, stigma and discrimination. The researchers recommend standardised programmes be developed and implemented in PHC clinics to assist in providing treatment, care and support for HIV positive children.

scholarly journals Causes of Hospitalization and Predictors of Mortality among Adult HIV Positive Patients at the Benue State University Teaching Hospital, Makurdi

2020 ◽  
pp. 88-97
Author(s):  
Patrick Ojojarumi Echekwube ◽  
Emmanuel Uzodimma Iwuozo ◽  
Helen Sagay
Keyword(s):  
Substance Use ◽  
Pulmonary Tuberculosis ◽  
Short Duration ◽  
Opportunistic Infections ◽  
Scale Up ◽  
University Teaching ◽  
Hiv Care ◽  
Hiv Positive ◽  
Predictors Of Mortality ◽  
Male Sex

Introduction: HIV/AIDS is one of the leading causes of morbidity and mortality worldwide. In Africa, opportunistic infections are the leading causes of morbidity among HIV patients and there is need to establish the causes of morbidity and/or mortality among the patients in our environment. Methods: This was a retrospective study in which the case files of adult HIV positive patients admitted from January 2018 to December 2018 were retrieved. Their socio-demographic profile, HIV stage at admission, outcomes and other relevant information were extracted. The Center for Disease Control staging for HIV was used for the study. Results: A total of 94 patients were enrolled into the study. At admission, most of the patients, 57(61%) were in CDC Stage B while the remaining patients were in stage C. Pulmonary tuberculosis was responsible for most of the admissions. The total number of deaths were 27 giving a mortality ratio of 28.7%; 9 (33%) of them were in stage B and the remaining 18 (67%) were in stage C. The predictors of mortality were male sex, short duration of admission, substance use and referral from non-specialist centres. Conclusion: The major disease cause of morbidity among PLHIV in Makurdi is Pulmonary Tuberculosis. Male sex, substance use, referral from non-specialist centres and short duration of admission were significant predictors of mortality. All stakeholders involved in HIV care should intensify efforts at early HIV diagnosis, scale up HAART where necessary and implement task shifting at non-specialist centres to improve treatment outcomes.

Anisometropia in the 5th and 6th school years

2020 ◽  
Vol 30 (Supplement_2) ◽  
Author(s):  
A F Nunes ◽  
A S Nunes ◽  
P Monteiro ◽  
C R Martins ◽  
H Forte
Keyword(s):  
Binocular Vision ◽  
Rural Areas ◽  
Urban Areas ◽  
Basic Education ◽  
Age Groups ◽  
Separate Analysis ◽  
Chi Square ◽  
Screening Programs ◽  
The Difference ◽  
Urban And Rural Areas

Abstract Introduction Anisometropia is characterized by a refractive inter ocular difference greater than 1.00 dioptre (D). It is the main cause of amblyopia and loss of binocular vision. Its prevalence depends on several factors, being different values in different geographical areas of the world and in different age groups. Objectives To estimate the frequency of anisometropia in children of the 2nd cycle of Basic Education. Methodology A total of 519 children attending the 5th and 6th school years, from Covilhã schools, from urban and rural areas, aged between 9 and 14 years (10.8 ± 0.8 years) were enrolled in the study. The refractive error was measured with a paediatric auto refractometer (Plusoptix), without cycloplegic and in binocular conditions. Anisometropia was defined as the inter ocular difference in spherical equivalent or cylindrical, greater than 1.00 D and a separate analysis for values greater than 2.00 D. Results The sample was symmetrically divided into genders (50.9% Male), between school grade (53% 5th year) and higher in urban areas (70.1%). The prevalence of anisometropia with cut-off points of 1.00 D and 2.00 D was 12.3% and 5.0%, respectively. There was a higher prevalence among males, in rural areas and in 6th grade. The Chi-square test (□2) shows that the difference is statistically significant only between years of schooling, with a higher prevalence in the 6th grade (p = 0.001). Conclusion There was a slightly higher prevalence of spherical and cylindrical anisometropia (5% and 12.3%) than is reported in the literature (rates between 4.4% and 9.4%). The 6th school year presented rates significantly higher than the 5th year, which points out that anisometropia increases with age, as was also advocated by other authors. Visual screening programs in adolescence for the detection of anisometropia are fundamental, since their timely correction allows to safeguard the binocular vision.

scholarly journals Quality of care for tuberculosis and HIV in the private health sector: a cross-sectional, standardised patient study in South Africa

2021 ◽  
Vol 6 (5) ◽  
pp. e005250
Author(s):  
Jody Boffa ◽  
Sizulu Moyo ◽  
Jeremiah Chikovore ◽  
Angela Salomon ◽  
Benjamin Daniels ◽  
...  
Keyword(s):  
South Africa ◽  
Cape Town ◽  
Hiv Care ◽  
Hiv Positive ◽  
Hiv Status ◽  
Clinical Practices ◽  
History Of ◽  
Knowledge And Practice ◽  
The Difference

BackgroundSouth Africa has high burdens of tuberculosis (TB) and TB-HIV, yet the quality of patient care in the private sector is unknown. We describe quality of TB and TB-HIV care among private general practitioners (GPs) in two South African cities using standardised patients (SPs).MethodsSixteen SPs presented one of three cases during unannounced visits to private GPs in selected high-TB burden communities in Durban and Cape Town: case 1, typical TB symptoms, HIV-positive; case 2, TB-specified laboratory report, HIV-negative and case 3, history of incomplete TB treatment, HIV-positive. Clinical practices were recorded in standardised exit interviews. Ideal management was defined as relevant testing or public sector referral for any reason. The difference between knowledge and practice (know-do gap) was assessed through case 1 vignettes among 25% of GPs. Factors associated with ideal management were assessed using bivariate logistic regression.Results511 SP visits were completed with 212 GPs. Respectively, TB and HIV were ideally managed in 43% (95% CI 36% to 50%) and 41% (95% CI 34% to 48%) of case 1, 85% (95% CI 78% to 90%) and 61% (95% CI 73% to 86%) of case 2 and 69% (95% CI 61% to 76%) and 80% (95% CI 52% to 68%) of case 3 presentations. HIV status was queried in 35% (95% CI 31% to 39%) of visits, least with case 1 (24%, 95% CI 18% to 30%). The difference between knowledge and practice was 80% versus 43% for TB and 55% versus 37% for HIV, resulting in know-do gaps of 37% (95% CI 19% to 55%) and 18% (95% CI −1% to 38%), respectively. Ideal TB management was associated with longer visit time (OR=1.1, 95% CI 1.1 to 1.2), female GPs (3.2, 95% CI 2.0 to 5.1), basic symptom inquiry (2.0, 95% CI 1.7 to 2.3), HIV-status inquiry (OR=11.2, 95% CI 6.4 to 19.6), fewer medications dispensed (OR=0.6, 95% CI 0.5 to 0.7) and Cape Town (OR=2.2, 95% CI 1.5 to 3.1). Similar associations were observed for HIV.ConclusionsPrivate providers ideally managed TB more often when a diagnosis or history of TB was implied or provided. Management of HIV in the context of TB was less than optimal.

scholarly journals Psychotherapy can be effective in prolonging periods free of depression in early senescent

2016 ◽  
Vol 15 (1) ◽  
pp. 118-122
Author(s):  
Vidya Bhagat
Keyword(s):  
Medical Science ◽  
Age Groups ◽  
Sampling Technique ◽  
Age Group ◽  
Chi Square ◽  
Significant Difference ◽  
Before And After ◽  
The Difference ◽  
To Come ◽  
Level Of Significance

Background: The Psychotherapy can be effective in prolonging periods free of depression in early senescent has been focused on the study. People refused medication agreed to come for psychotherapy are treated to get free from their depressive symptom. The main objective of the study was therefore using psychotherapy as a treatment module to stretch time free of depression. Further psycho education to give more information on depression and increase patient flexibility for the combination of anti-depressant with psychotherapy when needed.Methodology: The subjects selected for the study were 60 patients from ‘Nitte Rural Psychiatry Clinic’ Nitte Mangalore Karnataka, India. They were selected by random sampling technique. Medico-Psychological questionnaire for general neuroticism was administered to find out the extent of depression before and after psychotherapy. To find the difference between the age and depression before and after psychotherapy Carl Pearson’s Correlation coefficient method was carried out.Results: The results reveal that a non-significant difference between age groups with extent of depression in different age group of early senescent before and after psychotherapy (Chi-square=1.7913, p>0.05) at the 5 % level of significance and (Chi-square=2.4485, p>0.05) at the 5 % level of significance respectively. Further the Comparison of extent of depression before and after psychotherapy in 50-55, 56-60 age groups and as a total by Wilcoxon matched pairs test has been administered and the result reveals that significant differences between extent of depression before and after psychotherapy in 50-55yrs of age group (Z=2.5205, p<0.05) at the 5 % level of significance, 56-60yrs of age group (Z=2.2014, p<0.05) at the 5 % level of significance. It means that, the significant means that, the significance of 15.7%, 10.5%depression was decreased before and after psychotherapy respectively. A significant difference was observed between extent of depression before and after psychotherapy in 50-60yrs of age group (Z=3. 2958, p<0.05) at the 5 % level of significance. It means that, the significance of 13.0% depression was decreased after psychotherapy.Conclusion: The implication of this study was to develop insight and understanding among the clinicians that importance psychotherapy as treatment of depression.Bangladesh Journal of Medical Science Vol.15(1) 2016 p.118-122

scholarly journals Studies on Plasmodium falciparum Infection Rates among Patients Attending General Hospitals in Benue State, Nigeria

2020 ◽  
pp. 1-8
Author(s):  
O. A. Adulugba ◽  
O. Amali ◽  
F. T. Ikpa ◽  
M. M. Manyi ◽  
V. U. Obisike
Keyword(s):  
Plasmodium Falciparum ◽  
Malaria Infection ◽  
Informal Education ◽  
Age Groups ◽  
Chi Square ◽  
General Hospitals ◽  
Significant Difference ◽  
The Difference ◽  
Chi Square Analysis ◽  
Preventive Methods

Plasmodium falciparum is the most virulent and prevalent malaria parasite in Nigeria .This study aimed to determine the prevalence of malaria infection among patients at General Hospitals in Benue State. A total of 1200 patients were examined in this study.  Blood samples were collected by finger prick onto clean slides and into the round sample well of PfRDTs. Thick and thin blood films were prepared for microscopic examination. The overall prevalence of malaria infection was 34.8%. A questionnaire was used to determine some demographic factors. Prevalence of malaria in relation to residence, rural area recorded higher prevalence of 42.2% than urban area with prevalence of 23.8%. Chi square analysis showed a significant difference (p < 0.05) in prevalence in relation to residence. The Prevalence of malaria in relation to age groups, age between 6-10 and 7-15 recorded higher infection rate of 54.5% and 51.5% respectively. While, age group >46 recorded  17.5%. The female patients 36.2% were more infected than the males 33.1%.Patients that had informal education recorded higher prevalence rate of 89.2% and those that are farmers had 57.9%. Chi square analysis however showed that the difference was significant (p < 0.05). A significant difference  (P<0.05) was observed between patients that  used insecticide spray alone as malaria preventive methods (70.1%) compared to patients that used combined methods of prevention (17.2%). Malaria still remains prevalent among patients in Benue State, Nigeria.

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