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

IntroductionFemale sex workers (FSWs) are a known high-risk group that are at increased risk of HIV transmission due to exposure to multiple sexual partners and inability to negotiate safe sex attributed to challenging economic circumstances. Previous systematic reviews have examined the effectiveness of HIV interventions prioritising FSWs and have shown that targeted interventions improve access to HIV prevention and treatment services. Interventions that increase FSWs’ uptake of services are well documented; however, evidence on specific interventions aimed at improving FSWs’ continuity in HIV care along the treatment cascade is lacking. This systematic review aims to document the performance of community-based interventions along the HIV treatment cascade.Methods and analysisWe will use a sensitive search strategy for electronic bibliographic databases, bibliographies of included articles and grey literature sources. In addition, the Joint United Nations Programme on HIV/AIDS and the WHO websites, peer-reviewed conference papers and grey literature sources will be searched for additional reports of sex work programmes. We will include randomised controlled trials, cross-sectional surveys and cohort interventions where community-based HIV services were provided to FSWs and measure the performance of the HIV intervention on one or more cascade stages. We will conduct a systematic review of studies published from 2004 to present within the sub-Saharan Africa region. We will report quantitative study outcomes of HIV testing and diagnosis, linkage to care, initiation on antiretroviral therapy and viral suppression. We will analyse the data using the random-effects meta-analysis method, and funnel plots will be used to assess the publication bias.Ethics and disseminationThis systematic review will not require ethical approval; we will publish data from manuscripts. The results of this study will be disseminated in peer-reviewed journals and conference presentations.PROSPERO registration numberCRD42020157623.

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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

10.21203/rs.3.rs-28468/v1 ◽

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.

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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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073709 ◽

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.

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