Water Filter Provision and Home-Based Filter Reinforcement Reduce Diarrhea in Kenyan HIV-Infected Adults and Their Household Members

Recurrent skin and soft tissue infections (SSTI) caused by Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA) or Methicillin-Sensitive Staphylococcus aureus (CA-MSSA) present treatment challenges. This community-based trial examined the effectiveness of an evidence-based intervention (CDC Guidelines, topical decolonization, surface decontamination) to reduce SSTI recurrence, mitigate household contamination/transmission, and improve patient-reported outcomes. Participants (n = 186) were individuals with confirmed MRSA(+)/MSSA(+) SSTIs and their household members. During home visits; Community Health Workers/Promotoras provided hygiene instructions; a five-day supply of nasal mupirocin; chlorhexidine for body cleansing; and household disinfecting wipes (Experimental; EXP) or Usual Care Control (UC CON) pamphlets. Primary outcome was six-month SSTI recurrence from electronic health records (EHR). Home visits (months 0; 3) and telephone assessments (months 0; 1; 6) collected self-report data. Index patients and participating household members provided surveillance culture swabs. Secondary outcomes included household surface contamination; household member colonization and transmission; quality of life; and satisfaction with care. There were no significant differences in SSTI recurrence between EXP and UC in the intent-to-treat cohort (n = 186) or the enrolled cohort (n = 119). EXP participants showed reduced but non-significant colonization rates. EXP and UC did not differ in household member transmission, contaminated surfaces, or patient-reported outcomes. This intervention did not reduce clinician-reported MRSA/MSSA SSTI recurrence. Taken together with other recent studies that employed more intensive decolonization protocols, it is possible that a promotora-delivered intervention instructing treatment for a longer or repetitive duration may be effective and should be examined by future studies.

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Non-disclosure of tuberculosis diagnosis by patients to their household members in south western Uganda

10.1101/622597 ◽

2019 ◽

Author(s):

Miria Nyangoma ◽

Francis Bajunirwe ◽

Daniel Atwine

Keyword(s):

Cross Sectional Study ◽

Adult Patients ◽

High Rate ◽

Negative Effects ◽

Cross Sectional ◽

Logistic Regression Models ◽

Household Level ◽

Home Based ◽

Household Members ◽

Western Uganda

ABSTRACTBackgroundTuberculosis (TB) non-disclosure by adult patients to all household members is a setback to TB control efforts. It reduces the likelihood that household contacts will seek early TB screening, initiation on preventive or curative treatment, but also hinders the implementation of infection controls and home-based directly observed treatment. Therefore, this study aimed at determining the level of TB non-disclosure, its predictors and effects of disclosure to household members on adult patients at a large regional referral hospital in south-western Uganda.MethodsCross-sectional study. Questionnaires administered to collect patients’ sociodemographic and their TB disclosure data. Non-disclosure was considered if a patient did not reveal their TB diagnosis to all household members within 2 weeks post-treatment initiation. Univariate and multivariate logistic regression models were fitted for predictors of non-disclosure.ResultsEnrolled 62 patients, 74% males, mean age of 32 years, and median of five people per household. Non-disclosure rate was 30.6%. Post-disclosure experiences were positive in 98.3% of patients, while negative experiences suggestive of severe stigma occurred in 24.6% of patients. Being female (OR 6.5, 95% CI: 1.42-29.28) and belonging to Muslim faith (OR 12.4, 95% CI: 1.42-109.05) predicted TB non-disclosure to household members.ConclusionsThere is a high rate of TB non-disclosure to household members by adult patients in rural Uganda, with the highest vulnerability seen among female and Muslim patients. Interventions enhancing TB disclosure at household level while minimizing negative effects of stigma should be developed and prioritized.

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HOSENG trial – Effect of the provision of oral self-testing for absent and refusing individuals during a door-to-door HIV testing campaign on testing coverage: protocol of a cluster randomized clinical trial in rural Lesotho

10.21203/rs.2.211/v3 ◽

2019 ◽

Author(s):

Alain Amstutz ◽

Thabo Ishmael Lejone ◽

Lefu Khesa ◽

Josephine Muhairwe ◽

Bienvenu Lengo Nsakala ◽

...

Keyword(s):

Hiv Testing ◽

Health Facility ◽

World Health ◽

Eligibility Criteria ◽

High Coverage ◽

Home Based ◽

Self Testing ◽

Household Members ◽

Cluster Randomized ◽

Testing Coverage

Abstract BACKGROUND HIV testing coverage remains below the targeted 90% despite efforts and resources invested. Home-based HIV testing is a key approach endorsed by the World Health Organization (WHO), especially to reach individuals who might not seek testing otherwise. Although acceptance of test-ing during such campaigns is high, coverage remains low due to absent household members. This cluster-randomized trial aims to assess increase in testing coverage using oral HIV self-testing (HIVST) among individuals who are absent or decline testing during home-based HIV testing. METHODS The HOSENG (HOme-based SElf-testiNG) trial is a cluster-randomized, parallel group, superiority trial in two districts of Lesotho, Southern Africa. Clusters are stratified by district, village size, and village access to the nearest health facility. Cluster eligibility criteria include: village is in catchment area of one of the study facilities, village authority provides consent, and village has a registered, capable and consenting village health worker (VHW). In intervention clusters, HIV self-tests are provided for eligible household members who are absent or decline HIV testing in presence of the campaign team. In control clusters, standard of care for absent and refusing individuals applies, i.e. referral to health facility. The primary outcome is HIV testing coverage among individuals 12 years and older within 120 days after enrolment. Secondary objectives include HIV testing coverage among other age groups, and uptake of the different testing modalities. Statistical analyses will be conducted and reported in line with CONSORT guidelines. HOSENG trial is linked to VIBRA (Village-Based Refill of ART) trial. Together, they constitute the GET ON (GETting tOwards Ninety) research project. DISCUSSION The HOSENG trial tests if oral HIVST may be an add-on during door-to-door testing campaigns towards achieving optimal testing coverage. The provision of oral self-test kits, followed up by VHWs, requires little additional human resources, finances and logistics. If cost-effective, this approach will inform home-based HIV testing policies not only in Lesotho, but in similar high-prevalence settings. TRIAL REGISTRATION This trial has been registered at clinicaltrials.gov (NCT03598686) on July 25, 2018. More information under www.getonproject.wordpress.com.

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Comparative Effectiveness Study of Home-Based Interventions to Prevent CA-MRSA Infection Recurrence

10.1101/2020.07.15.20154393 ◽

2020 ◽

Author(s):

Jonathan N. Tobin ◽

Suzanne Hower ◽

Brianna M. D’Orazio ◽

María Pardos de la Gándara ◽

Teresa H. Evering ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Health Workers ◽

Home Visits ◽

Self Report ◽

Household Member ◽

Surveillance Culture ◽

Home Based ◽

Patient Reported ◽

Household Members ◽

Data Surveillance

BACKGROUNDRecurrent skin and soft tissue infections (SSTI) caused by Community-Associated Methicillin-Resistant (CA-MRSA) or Methicillin-Sensitive Staphylococcus aureus (CA-MSSA) present treatment challenges.OBJECTIVESCan an evidence-based intervention (CDC Guidelines, topical decolonization, surface decontamination) reduce SSTI recurrence, mitigate household contamination and transmission, and improve patient-reported outcomes?DESIGNRandomized trialSETTINGCommunity settingsPARTICIPANTSParticipants (n=186) with confirmed MRSA(+)/MSSA(+) SSTIs and household members.INTERVENTIONCommunity Health Workers/Promotoras conducted home visits and provided participants with instructions, a five-day supply of mupirocin for nasal application, chlorhexidine for body cleansing, and disinfecting wipes for household cleaning (EXP) versus Usual Care (UC).MEASUREMENTSPrimary outcome was six-month SSTI recurrence recorded in electronic health records (EHR). Home visits (months 0/3) and telephone assessments (months 0/1/6) collected self-report data. Surveillance culture swabs (nares, axilla, groin) were obtained from index patients and participating household members. Secondary outcomes included household surface contamination, household member colonization and transmission, quality of life and satisfaction with care.RESULTSAmong patients with SSTIs (n=421), 44.2% were MRSA(+)/MSSA(+); an intent-to-treat analyses (n=186) demonstrated no significant differences in SSTI recurrence (OR: 1.4, 95% CI: 0.51-3.5). Among the enrolled cohort (n=119), there were no significant SSTI recurrence effects (OR=1.14, 95% CI=0.35-3.6). EXP participants showed reduced but non-significant colonization rates. There were no differential reductions in household member transmission or in reductions in proportions of households with ≥1 contaminated surface. Mupirocin resistance did not increase. No significant improvements for patient-reported outcomes were seen.LIMITATIONSA lower-than-predicted six-month recurrence rate may have limited the ability to detect effects.CONCLUSIONThis intervention did not reduce clinician-reported MRSA/MSSA SSTI recurrence. No differences were observed for household members decolonization or household surfaces decontamination.

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Conformity and communal decision-making: First-tester effects on acceptance of home-based HIV counseling and testing in Uganda

10.7287/peerj.preprints.27006v2 ◽

2018 ◽

Author(s):

Mari Armstrong-Hough ◽

Amanda J Meyer ◽

Achilles Katamba ◽

J. Lucian Davis

Keyword(s):

Decision Making ◽

Hiv Testing ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

First Person ◽

Home Based ◽

Group Members ◽

Household Members ◽

Individual Decisions

Background: Individuals’ observation of how group members ahead of them behave can profoundly shape their perceptions, judgements, and subsequent behaviors. Moreover, social influence theories from the sociology of networks suggest that individuals’ social status and social network position determine the scope of their influence on other group members. We set out to examine the role of conformity and communal decision-making in shaping individual decisions to test for HIV during home-based TB contact investigation in Kampala, Uganda. Methods: We analyzed the HIV testing decisions of individuals who were offered free, optional, home-based HIV testing during a home visit by community health workers. We used generalized estimating equations (GEE) to estimate how the testing decision made by the first individual in a household offered testing influenced the subsequent testing decisions of other household members. Results: Community health workers visited 55 households with two or more eligible household members and offered 160 individuals HIV testing. Seventy-five (47%) declined the test. Individuals in households where the first person invited declined HIV testing had four times the risk of declining themselves (RR: 3.96, 95% CI: 1.7-9.0, p=0.001) compared to individuals in households where the first person invited agreed to HIV testing, controlling for individual age and gender. Conclusions: The decision of the first individual offered HIV testing seems to influence the decisions of subsequent household members when they are also offered testing. Even when results are confidential, individual decisions may be shaped by the testing behavior of the first household member offered the test.

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Conformity and communal decision-making: First-tester effects on acceptance of home-based HIV counseling and testing in Uganda

10.7287/peerj.preprints.27006 ◽

2018 ◽

Author(s):

Mari Armstrong-Hough ◽

Amanda J Meyer ◽

Achilles Katamba ◽

J. Lucian Davis

Keyword(s):

Decision Making ◽

Hiv Testing ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

First Person ◽

Home Based ◽

Group Members ◽

Household Members ◽

Individual Decisions

Background: Individuals’ observation of how group members ahead of them behave can profoundly shape their perceptions, judgements, and subsequent behaviors. Moreover, social influence theories from the sociology of networks suggest that individuals’ social status and social network position determine the scope of their influence on other group members. We set out to examine the role of conformity and communal decision-making in shaping individual decisions to test for HIV during home-based TB contact investigation in Kampala, Uganda. Methods: We analyzed the HIV testing decisions of individuals who were offered free, optional, home-based HIV testing during a home visit by community health workers. We used generalized estimating equations (GEE) to estimate how the testing decision made by the first individual in a household offered testing influenced the subsequent testing decisions of other household members. Results: Community health workers visited 55 households with two or more eligible household members and offered 160 individuals HIV testing. Seventy-five (47%) declined the test. Individuals in households where the first person invited declined HIV testing had four times the risk of declining themselves (RR: 3.96, 95% CI: 1.7-9.0, p=0.001) compared to individuals in households where the first person invited agreed to HIV testing, controlling for individual age and gender. Conclusions: The decision of the first individual offered HIV testing seems to influence the decisions of subsequent household members when they are also offered testing. Even when results are confidential, individual decisions may be shaped by the testing behavior of the first household member offered the test.

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Conformity and communal decision-making: First-tester effects on acceptance of home-based HIV counseling and testing in Uganda

10.7287/peerj.preprints.27006v1 ◽

2018 ◽

Author(s):

Mari Armstrong-Hough ◽

Amanda J Meyer ◽

Achilles Katamba ◽

J. Lucian Davis

Keyword(s):

Decision Making ◽

Hiv Testing ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

First Person ◽

Home Based ◽

Group Members ◽

Household Members ◽

Individual Decisions

Background: Individuals’ observation of how group members ahead of them behave can profoundly shape their perceptions, judgements, and subsequent behaviors. Moreover, social influence theories from the sociology of networks suggest that individuals’ social status and social network position determine the scope of their influence on other group members. We set out to examine the role of conformity and communal decision-making in shaping individual decisions to test for HIV during home-based TB contact investigation in Kampala, Uganda. Methods: We analyzed the HIV testing decisions of individuals who were offered free, optional, home-based HIV testing during a home visit by community health workers. We used to generalized estimating equations (GEE) to estimate how the testing decision made by the first individual in a household offered testing influenced the subsequent testing decisions of other household members. Results: Community health workers visited 55 households with two or more eligible household members and offered 160 individuals HIV testing. Seventy-five (47%) declined the test. Individuals in households where the first person invited declined HIV testing had four times the risk of declining themselves (RR: 3.96, 95% CI: 1.7-9.0, p=0.001) compared to individuals in households where the first person invited agreed to HIV testing, controlling for individual age and gender. Conclusions: The decision of the first individual offered HIV testing seems to influence the decisions of subsequent household members when they are also offered testing. Even when results are confidential, individual decisions may be shaped by the testing behavior of the first household member offered the test.

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Effect and cost of two successive home visits to increase HIV testing coverage: a prospective study in Lesotho, Southern Africa

BMC Public Health ◽

10.1186/s12889-019-7784-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Niklaus Daniel Labhardt ◽

Isaac Ringera ◽

Thabo Ishmael Lejone ◽

Alain Amstutz ◽

Thomas Klimkait ◽

...

Keyword(s):

Hiv Testing ◽

Urban Areas ◽

Home Visits ◽

Sub Saharan Africa ◽

Hiv Status ◽

Home Based ◽

Household Members ◽

Catch Up ◽

First Time ◽

Testing Coverage

Abstract Background Home-based HIV testing and counselling (HB-HTC) is frequently used to increase awareness of HIV status in sub-Saharan Africa. Whereas acceptance of HB-HTC is usually high, testing coverage may remain low due to household members being absent during the home visits. This study assessed whether two consecutive visits, one during the week, one on the weekend, increase coverage. Methods The study was a predefined nested-study of the CASCADE-trial protocol and conducted in 62 randomly selected villages and 17 urban areas in Butha-Buthe district, Lesotho. HB-HTC teams visited each village/urban area twice: first during a weekday, followed by a weekend visit to catch-up for household members absent during the week. Primary outcome was HTC coverage after first and second visit. Coverage was defined as all individuals who knew their HIV status out of all household members (present and absent). Results HB-HTC teams visited 6665 households with 18,286 household members. At first visit, 69.2 and 75.4% of household members were encountered in rural and urban households respectively (p < 0.001) and acceptance for testing was 88.5% in rural and 79.5% in urban areas (p < 0.001), resulting in a coverage of 61.8 and 61.5%, respectively. After catch-up visit, the HTC coverage increased to 71.9% in rural and 69.4% in urban areas. The number of first time testers was higher at the second visit (47% versus 35%, p < 0.001). Direct cost per person tested and per person tested HIV positive were lower during weekdays (10.50 and 335 USD) than during weekends (20 and 1056 USD). Conclusions A catch-up visit on weekends increased the proportion of persons knowing their HIV status from 62 to 71% and reached more first-time testers. However, cost per person tested during catch-up visits was nearly twice the cost during first visit. Trial registration NCT02692027 (prospectively registered on February 21, 2016).

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HOSENG trial – Effect of the provision of oral self-testing for absent and refusing individuals during a door-to-door HIV testing campaign on testing coverage: protocol of a cluster randomized clinical trial in rural Lesotho

10.21203/rs.2.211/v2 ◽

2019 ◽

Author(s):

Alain Amstutz ◽

Thabo Ishmael Lejone ◽

Lefu Khesa ◽

Josephine Muhairwe ◽

Bienvenu Lengo Nsakala ◽

...

Keyword(s):

Hiv Testing ◽

Health Facility ◽

World Health ◽

Eligibility Criteria ◽

High Coverage ◽

Home Based ◽

Self Testing ◽

Household Members ◽

Cluster Randomized ◽

Testing Coverage

Abstract BACKGROUND HIV testing coverage remains below the targeted 90% despite efforts and resources invested. Home-based HIV testing is a key approach endorsed by the World Health Organization (WHO), especially to reach individuals who might not seek testing otherwise. Although acceptance of test-ing during such campaigns is high, coverage remains low due to absent household members. This cluster-randomized trial aims to assess increase in testing coverage using oral HIV self-testing (HIVST) among individuals who are absent or decline testing during home-based HIV testing. METHODS The HOSENG (HOme-based SElf-testiNG) trial is a cluster-randomized, parallel group, superiority trial in two districts of Lesotho, Southern Africa. Clusters are stratified by district, village size, and village access to the nearest health facility. Cluster eligibility criteria include: village is in catchment area of one of the study facilities, village authority provides consent, and village has a registered, capable and consenting village health worker (VHW). In intervention clusters, HIV self-tests are provided for eligible household members who are absent or decline HIV testing in presence of the campaign team. In control clusters, standard of care for absent and refusing individuals applies, i.e. referral to health facility. The primary outcome is HIV testing coverage among individuals 12 years and older within 120 days after enrolment. Secondary objectives include HIV testing coverage among other age groups, and uptake of the different testing modalities. Statistical analyses will be conducted and reported in line with CONSORT guidelines. HOSENG trial is linked to VIBRA (Vil-lage-Based Refill of ART) trial. Together, they constitute the GET ON (GETting tOwards Ninety) research project. DISCUSSION The HOSENG trial tests if oral HIVST may be an add-on during door-to-door testing campaigns towards achieving optimal testing coverage. The provision of oral self-test kits, followed up by VHWs, requires little additional human resources, finances and logistics. If cost-effective, this approach will inform home-based HIV testing policies not only in Lesotho, but in similar high-prevalence settings. TRIAL REGISTRATION This trial has been registered at clinicaltrials.gov (NCT03598686) on July 25, 2018. More information under www.getonproject.wordpress.com.

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