scholarly journals The Shinyanga Patient: A Patient’s Journey through HIV Treatment Cascade in Rural Tanzania

2021 ◽  
Vol 18 (16) ◽  
pp. 8418
Author(s):  
Nwanneka E. Okere ◽  
Veryeh Sambu ◽  
Yudas Ndungile ◽  
Eric van Praag ◽  
Sabine Hermans ◽  
...  
Keyword(s):  
Control Program ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Load Testing ◽  
Hiv Viral Load ◽  
Treatment Cascade ◽  
For Profit ◽  
Rural Tanzania ◽  
Hiv Test ◽  
Hiv Treatment Cascade

The 2016–2017 Tanzania HIV Impact Survey (THIS) reported the accomplishments towards the 90-90-90 global HIV targets at 61-94-87, affirming the need to focus on the first 90 (i.e., getting 90% of people living with HIV (PLHIV) tested). We conducted a patient-pathway analysis to understand the gap observed, by assessing the alignment between where PLHIV seek healthcare and where HIV services are available in the Shinyanga region, Tanzania. We used existing and publicly available data from the National AIDS Control program, national surveys, registries, and relevant national reports. Region-wide, the majority (n = 458/722, 64%) of THIS respondents accessed their last HIV test at public sector facilities. There were 65.9%, 45.1%, and 74.1% who could also access antiretroviral therapy (ART), CD4 testing, and HIV viral load testing at the location of their last HIV test, respectively. In 2019, the viral suppression rate estimated among PLHIV on ART in the Shinyanga region was 91.5%. PLHIV access HIV testing mostly in public health facilities; our research shows that synergies can be achieved to improve access to services further down the cascade in this sector. Furthermore, effective engagement with the private sector (not-for-profit and for-profit) will help to achieve the last mile toward ending the HIV epidemic.

Overview of Factors Associated with HIV Viral Load Suppression in Transgender Women

2020 ◽  
Author(s):  
Zil G Goldstein
Keyword(s):  
Viral Load ◽  
Transgender Women ◽  
Hiv Treatment ◽  
Viral Load Suppression ◽  
Hiv Viral Load ◽  
Treatment Cascade ◽  
Factors Associated ◽  
The World ◽  
Hiv Treatment Cascade ◽  
Almost All

Abstract Background Transgender women face a significantly higher HIV burden than their cisgender counterparts around the world with worse treatment outcomes in almost all categories. Content A mini-review of the available literature discussing HIV risk and factors associated with HIV viral load suppression in transgender women. Summary This review discusses the disparities transgender women face that contribute to both of these factors including race as well as social determinants of health and how they affect the HIV treatment cascade in this population.

scholarly journals The HIV treatment cascade in people living with HIV in Iran in 2014: Mixed-method study to measure losses and reasons

2019 ◽  
Vol 30 (13) ◽  
pp. 1257-1264 ◽  
Author(s):  
Nima Ghalehkhani ◽  
Behnam Farhoudi ◽  
Mohammad Mehdi Gouya ◽  
Hamid Sharifi ◽  
SeyedAhmad SeyedAlinaghi ◽  
...  
Keyword(s):  
Cell Count ◽  
Hiv Treatment ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Treatment Cascade ◽  
Cascade Analysis ◽  
Hiv Treatment Cascade ◽  
Living With Hiv ◽  
Cd4 Cell

The study assessed the HIV treatment cascade of people living with HIV (PLWH) in Iran and the reasons for gaps in HIV services in 2014. We did the cascade analysis using the WHO HIV test–treat–retain cascade analysis tool (2014). To measure the gaps, we checked the records for all PLWH reported to the national HIV surveillance till September 2014 to define how many were alive, linked to HIV care, assessed for CD4 cell count, started antiretroviral therapy (ART), and reported to be alive up to five years after ART. To assess the reasons for gaps in the cascade, we ran desk review, four focus group discussions and 51 in-depth interviews with key informants including PLWH. Spectrum model estimated 75,700 PLWH in Iran, of whom only 22,647 people (%30) were diagnosed. Of those who were diagnosed with HIV, 16,266 people (%72) had enrolled in HIV care. About 13% of all PLWH were retained in HIV care and only 9% (6745 people) had ever been tested for CD4 cell count. Only 8% (6018 people) of all PLWH had received ART by September 2014. We found the biggest gap in the HIV treatment cascade to be HIV diagnosis as only 30% of PLWH have been diagnosed. Innovative strategies to improve HIV testing, particularly those that work best for key populations, are critical to reach the 90–90-90 targets.

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.

Early stages of HIV treatment cascade in people living with HIV in Saint-Petersburg, Russia

AIDS Care ◽  
2018 ◽  
Vol 30 (7) ◽  
pp. 857-862 ◽  
Author(s):  
M. V. Vetrova ◽  
O. V. Aleksandrova ◽  
A. E. Paschenko ◽  
S. E. Toropov ◽  
V. V. Rassokhin ◽  
...  
Keyword(s):  
Hiv Treatment ◽  
People Living With Hiv ◽  
Treatment Cascade ◽  
Saint Petersburg ◽  
Early Stages ◽  
Hiv Treatment Cascade ◽  
Living With Hiv

scholarly journals Problematizing transitions in relation to correctional centres for people living with HIV: Unpacking the taken for granted.

2021 ◽  
Vol 3 (2) ◽  
pp. 47-63
Author(s):  
Morgan Wadams
Keyword(s):  
Healthcare Providers ◽  
Hiv Treatment ◽  
Knowledge Generation ◽  
Hiv Care ◽  
Correctional Facilities ◽  
People Living With Hiv ◽  
Treatment Cascade ◽  
Hiv Treatment Cascade ◽  
Care Practices ◽  
Living With Hiv

Transitions into and out of correctional facilities for people living with HIV are a pivotal point in the HIV treatment cascade where adherence metrics are significantly affected. In this paper I use Alvesson and Sandberg’s problematization method of literature analysis to critique and understand the taken-for-granted assumptions underpinning how knowledge is generated within the intersecting fields of HIV, transitions, and corrections. Utilizing problematization, two assumptions underpinning knowledge generation are identified: the linearity of the HIV care continuum model and the tendency to create and perpetuate spatially segregating metaphors of transitions inside versus outside correctional facilities for people living with HIV. These assumptions are discussed in the context of how they shape dominant ways of thinking and practicing in the field. An alternative way to understand transitions for people living with HIV is proposed along with recommendations to guide the HIV care practices of nurses and other healthcare providers.

scholarly journals Engaging the ‘Missing Men’ in the HIV Treatment Cascade: Creating a Tailored Intervention to Improve Men’s Uptake of HIV Care Services in Rural South Africa: A Study Protocol

2021 ◽  
Vol 18 (7) ◽  
pp. 3709
Author(s):  
Oluwafemi Adeagbo ◽  
Kammila Naidoo
Keyword(s):  
South Africa ◽  
Health Outcomes ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Treatment Cascade ◽  
Hiv Care Cascade ◽  
Care Services ◽  
The Social ◽  
Hiv Treatment Cascade ◽  
Male Specific

Men, especially young men, have been consistently missing from the HIV care cascade, leading to poor health outcomes in men and ongoing transmission of HIV in young women in South Africa. Although these men may not be missing for the same reasons across the cascade and may need different interventions, early work has shown similar trends in men’s low uptake of HIV care services and suggested that the social costs of testing and accessing care are extremely high for men, particularly in South Africa. Interventions and data collection have hitherto, by and large, focused on men in relation to HIV prevention in women and have not approached the problem through the male lens. Using the participatory method, the overall aim of this study is to improve health outcomes in men and women through formative work to co-create male-specific interventions in an HIV-hyper endemic setting in rural KwaZulu-Natal, South Africa.

A model to predict adherence to antiretroviral therapy among people living with HIV

2021 ◽  
pp. sextrans-2021-055222
Author(s):  
Hui Chen ◽  
Rusi Long ◽  
Tian Hu ◽  
Yaqi Chen ◽  
Rongxi Wang ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Treatment ◽  
Poor Adherence ◽  
People Living With Hiv ◽  
Art Adherence ◽  
Snowball Sampling ◽  
Hiv Viral Load ◽  
Temporal Validation ◽  
Suboptimal Adherence ◽  
Living With Hiv

ObjectivesSuboptimal adherence to antiretroviral therapy (ART) dramatically hampers the achievement of the UNAIDS HIV treatment targets. This study aimed to develop a theory-informed predictive model for ART adherence based on data from Chinese.MethodsA cross-sectional study was conducted in Shenzhen, China, in December 2020. Participants were recruited through snowball sampling, completing a survey that included sociodemographic characteristics, HIV clinical information, Information-Motivation-Behavioural Skills (IMB) constructs and adherence to ART. CD4 counts and HIV viral load were extracted from medical records. A model to predict ART adherence was developed from a multivariable logistic regression with significant predictors selected by Least Absolute Shrinkage and Selection Operator (LASSO) regression. To evaluate the performance of the model, we tested the discriminatory capacity using the concordance index (C-index) and calibration accuracy using the Hosmer and Lemeshow test.ResultsThe average age of the 651 people living with HIV (PLHIV) in the training group was 34.1±8.4 years, with 20.1% reporting suboptimal adherence. The mean age of the 276 PLHIV in the validation group was 33.9±8.2 years, and the prevalence of poor adherence was 22.1%. The suboptimal adherence model incorporates five predictors: education level, alcohol use, side effects, objective abilities and self-efficacy. Constructed by those predictors, the model showed a C-index of 0.739 (95% CI 0.703 to 0.772) in internal validation, which was confirmed be 0.717 via bootstrapping validation and remained modest in temporal validation (C-index 0.676). The calibration capacity was acceptable both in the training and in the validation groups (p>0.05).ConclusionsOur model accurately estimates ART adherence behaviours. The prediction tool can help identify individuals at greater risk for poor adherence and guide tailored interventions to optimise adherence.

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