Impact of Traditional Healers on the HIV Care Cascade in Senegal, West Africa: A Longitudinal Study

Consultation with traditional healers (THs) is common among people living with HIV in sub-Saharan Africa. We conducted a prospective longitudinal study to determine the association between consultation with THs and HIV outcomes following 12 months of antiretroviral therapy (ART). HIV-infected individuals presenting for care and initiation of ART in Dakar and Ziguinchor, Senegal were eligible for enrollment. Data were collected using interviews, clinical evaluations, laboratory analyses, and chart reviews at enrollment, 6 months after ART initiation, and 12 months after ART initiation. Among the 186 participants, 35.5% consulted a TH. The most common reason for consulting a TH was “mystical” concerns (18%). Those who consulted a TH before ART initiation were more likely to present with a CD4 count < 200 cells/mm3 (44% versus 28%; P = 0.04) and WHO stage 3 or 4 disease (64% versus 46%; P = 0.03), and they were less likely to disclose their HIV status (44% versus 65%; P = 0.04). Those who consulted a TH more than 6 months after ART initiation were more likely to report poor adherence to ART (57% versus 4%; P < 0.01). The strongest predictor of virologic failure was consulting a TH more than 6 months after ART initiation (odd ratio [OR], 7.43; 95% CI, 1.22–45.24). The strongest predictors of mortality were consulting a TH before ART initiation (OR, 3.53; 95% CI, 1.25–9.94) and baseline CD4 count < 200 cells/mm3 (OR, 3.15; 95% CI, 1.12–8.89). Our findings reveal multiple opportunities to strengthen the HIV care cascade through partnerships between THs and biomedical providers. Future studies to evaluate the impact of these strategies on HIV outcomes are warranted.

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Barriers and Facilitators Affecting the HIV Care Cascade for Migrant People Living with HIV in Organization for Economic Co-Operation and Development Countries: A Systematic Mixed Studies Review

AIDS Patient Care and STDs ◽

10.1089/apc.2021.0079 ◽

2021 ◽

Vol 35 (8) ◽

pp. 288-307

Author(s):

Anish K. Arora ◽

David Ortiz-Paredes ◽

Kim Engler ◽

David Lessard ◽

Kedar K.V. Mate ◽

...

Keyword(s):

Barriers And Facilitators ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Cascade ◽

Care Cascade ◽

Mixed Studies Review ◽

Living With Hiv ◽

Migrant People ◽

Systematic Mixed Studies Review

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The Benefits of Immediate ART

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325958219831714 ◽

2019 ◽

Vol 18 ◽

pp. 232595821983171 ◽

Cited By ~ 2

Author(s):

Yan Zhao ◽

Jennifer M. McGoogan ◽

Zunyou Wu

Keyword(s):

World Health ◽

Hiv Care ◽

Hiv Diagnosis ◽

Hiv Care Cascade ◽

Art Initiation ◽

Care Cascade ◽

Nations Programme ◽

United Nations Programme ◽

Health Organization ◽

Treat All

The benefits of “early” antiretroviral therapy (ART; ie, initiation when CD4 ≥500 cells/mm3) are now well accepted as reflected in the removal of the CD4-based eligibility from new ART guidelines by the World Health Organization (WHO). However, neither the “treat-all” strategy recommendations presented in the guidelines nor the HIV care cascade goals in the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets adequately address the issue of ART timing. Our recent study on “immediate” ART (ie, ≤30 days after HIV diagnosis) adds important evidence demonstrating the real and meaningful benefits of rapid ART initiation even among those who have CD4 ≥500 cells/mm3. We call on WHO and UNAIDS to consider this research and encourage a shift from the treat-all strategy to an “immediately-treat-all” strategy, and from a slow, fragmented, complicated, multistep HIV care cascade to a fast, easy, and simple cascade with effectiveness measures that incorporate the important aspect of time.

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Estimating the HIV undiagnosed population in Catalonia, Spain: descriptive and comparative data analysis to identify differences in MSM stratified by migrant and Spanish-born population

BMJ Open ◽

10.1136/bmjopen-2017-018533 ◽

2018 ◽

Vol 8 (2) ◽

pp. e018533 ◽

Cited By ~ 8

Author(s):

Juliana Maria Reyes-Urueña ◽

Colin N J Campbell ◽

Núria Vives ◽

Anna Esteve ◽

Juan Ambrosioni ◽

...

Keyword(s):

Hiv Transmission ◽

Retention In Care ◽

Hiv And Aids ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Cascade ◽

Care Cascade ◽

Undiagnosed Hiv ◽

Sex With Men ◽

Living With Hiv

ObjectiveUndiagnosed HIV continues to be a hindrance to efforts aimed at reducing incidence of HIV. The objective of this study was to provide an estimate of the HIV undiagnosed population in Catalonia and compare the HIV care cascade with this step included between high-risk populations.MethodsTo estimate HIV incidence, time between infection and diagnosis and the undiagnosed population stratified by CD4 count, we used the ECDC HIV Modelling Tool V.1.2.2. This model uses data on new HIV and AIDS diagnoses from the Catalan HIV/AIDS surveillance system from 2001 to 2013. Data used to estimate the proportion of people enrolled, on ART and virally suppressed in the HIV care cascade were derived from the PISCIS cohort.ResultsThe total number of people living with HIV (PLHIV) in Catalonia in 2013 was 34 729 (32 740 to 36 827), with 12.3% (11.8 to 18.1) of whom were undiagnosed. By 2013, there were 8458 (8101 to 9079) Spanish-born men who have sex with men (MSM) and 2538 (2334 to 2918) migrant MSM living with HIV in Catalonia. A greater proportion of migrant MSM than local MSM was undiagnosed (32% vs 22%). In the subsequent steps of the HIV care cascade, migrants MSM experience greater losses than the Spanish-born MSM: in retention in care (74% vs 55%), in the proportion on combination antiretroviral treatment (70% vs 50%) and virally suppressed (65% vs 46%).ConclusionsBy the end of 2013, there were an estimated 34 729 PLHIV in Catalonia, of whom 4271 were still undiagnosed. This study shows that the Catalan epidemic of HIV has continued to expand with the key group sustaining HIV transmission being MSM living with undiagnosed HIV.

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Changes in liver stiffness after ART initiation in HIV-infected Nigerian adults with and without chronic HBV

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz145 ◽

2019 ◽

Vol 74 (7) ◽

pp. 2003-2008

Author(s):

Jennifer L Grant ◽

Patricia Agaba ◽

Placid Ugoagwu ◽

Auwal Muazu ◽

Jonathan Okpokwu ◽

...

Keyword(s):

Liver Disease ◽

Liver Stiffness ◽

Sub Saharan Africa ◽

University Teaching ◽

Hiv Care ◽

Inverse Association ◽

Prospective Longitudinal Study ◽

Factors Associated ◽

Art Initiation ◽

Prospective Longitudinal

Abstract Background There are limited data from sub-Saharan Africa on long-term liver fibrosis changes in HIV- and HIV/HBV-infected individuals. Objectives To assess the effects of ART on liver stiffness measurement (LSM) using transient elastography (TE) in HIV- and HIV/HBV-infected Nigerian adults and examine factors associated with fibrosis regression. Methods We included ART-naive HIV- and HIV/HBV-infected adults (≥18 years) enrolled in a prospective, longitudinal study of liver disease between July 2011 and February 2015 at Jos University Teaching Hospital HIV Care and Treatment Centre in Nigeria. Patients initiated ART and had TE at baseline and follow-up (year 3). LSM cut-offs for Metavir scores were 5.9, 7.6 and 9.4 kPa for moderate fibrosis, advanced fibrosis and cirrhosis, respectively. We used multivariable regression to identify factors associated with TE (≥1 Metavir) stage decline. Results A total of 106 HIV- and 71 HIV/HBV-infected patients [70.5% female and median age = 34 years (IQR = 29–42 years)] were studied. Baseline LSM and median LSM decline were significantly higher in HIV/HBV- versus HIV-infected patients; 41% of HIV/HBV-infected patients regressed ≥1 Metavir stage versus 17% of HIV-infected patients (P < 0.01); LSM scores at year 3 were not significantly different between HIV- and HIV/HBV-infected patients. In multivariable analyses, patients with baseline CD4+ T cells ≥200 (versus <200) cells/mm3 and lower BMIs were more likely to experience LSM stage decline. Conclusions HBV coinfection does not attenuate LSM declines in HIV-infected patients after ART initiation despite being a risk factor for more advanced liver disease prior to therapy. The inverse association between BMI and TE stage decline needs further investigation.

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Differences between migrants and Spanish-born population through the HIV care cascade, Catalonia: an analysis using multiple data sources

Epidemiology and Infection ◽

10.1017/s0950268817000437 ◽

2017 ◽

Vol 145 (8) ◽

pp. 1670-1681 ◽

Cited By ~ 11

Author(s):

J. REYES-URUEÑA ◽

C. CAMPBELL ◽

C. HERNANDO ◽

N. VIVES ◽

C. FOLCH ◽

...

Keyword(s):

At Risk ◽

Hiv Testing ◽

Sub Saharan Africa ◽

Retention Rates ◽

Hiv Care ◽

Hiv Care Cascade ◽

Care Cascade ◽

Barriers To Access ◽

Hiv Testing Services ◽

Shared Risk

SUMMARYMigrants are considered a key group at risk for HIV infection. This study describes differences between migrants and the Spanish-born population as they progress through the HIV care cascade in Catalonia, Spain. This study found that among people reached by prevention activities, migrants had a higher number of barriers to access HIV testing services than Spanish-born people, driven primarily by shared risk factors. Between 2001 and 2013, 9829 new HIV diagnoses were reported in Catalonia, the proportion of migrants increasing from 24% in 2001 to 41% in 2013. Compared with Spanish-born people, migrants had a higher proportion of women at diagnosis (24·6% vs. 16·7%), and were younger (median age of 33 vs. 37). The most frequent at-risk population was MSM (men who have sex with men) in both migrants and Spanish-born people, (40% and 43%, respectively), although there were significant differences by region of origin. People from sub-Saharan Africa had the highest proportion of late diagnosis (63·7%). Compared with the Spanish-born population, migrants on follow-up had a lower proportion of people on antiretroviral therapy (ART) (93·7% vs. 90·8%, P < 0·001) and with viral suppression (87·2% vs. 82·9%, P < 0·001). Migrants have higher number of barriers to access HIV testing services, lower retention rates and proportions on ART as compared with Spanish-born people, these differences not being uniform between migrants from different regions.

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HIV care cascade among cisgender men who have sex with men in a key population-led community center in the Philippines

International Journal of STD & AIDS ◽

10.1177/0956462420987435 ◽

2021 ◽

pp. 095646242098743

Author(s):

Patrick C Eustaquio ◽

Steffen S Docken ◽

Katerina T Leyritana ◽

Luh Putu Lila Wulandari

Keyword(s):

The Philippines ◽

Hiv Care ◽

Sexually Transmitted ◽

Effective Strategies ◽

Hiv Care Cascade ◽

Art Initiation ◽

Care Cascade ◽

Key Population ◽

Hiv Test ◽

Sex With Men

The HIV epidemic in the Philippines is the fastest growing globally, and disproportionately affects cisgender men who have sex with men (cis-MSM) demanding effective strategies for this key population (KP) group. KP-specific and community-based (CB) interventions have improved the HIV response elsewhere, but these have yet to be evaluated locally. We analyzed the HIV care cascade outcomes in a KP-led, CB HIV test-and-treat center and determined factors that affect these by performing a retrospective study of medical records of 3137 patients diagnosed from January 2016 to March 2019 in LoveYourself in Manila, Philippines. Multivariate logistic regression was performed to determine predictors affecting the likelihood of antiretroviral therapy (ART) initiation and viral load (VL) suppression. As to UNAIDS 90–90–90 targets, LoveYourself had higher rates than national outcomes with 78% initiated ART and 84% achieved VL suppression. Such satisfactory performance is consistent with other studies exploring CB, KP-led approaches among cis-MSM. Patients who presented with WHO Stages 2–4 and those with sexually transmitted infections were less likely to initiate ART. Patients who presented with WHO Stages 2–4 and those whose ART was started late were less likely to be virally suppressed. These findings suggest the need to develop responsive interventions to reach the UNAIDS targets.

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Strategies for retention of heterosexual men in HIV care in sub-Saharan Africa: A systematic review

PLoS ONE ◽

10.1371/journal.pone.0246471 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246471

Author(s):

Sylvia Kusemererwa ◽

Dickens Akena ◽

Damalie Nakanjako ◽

Joanita Kigozi ◽

Regina Nanyunja ◽

...

Keyword(s):

Sub Saharan Africa ◽

Hiv Care ◽

Heterosexual Men ◽

Inclusion Criteria ◽

Community Based ◽

Art Programs ◽

Hiv Care Cascade ◽

Care Cascade ◽

Retention In Hiv Care ◽

Sub Saharan

Expansion of Antiretroviral Therapy (ART) programs in sub-Saharan Africa (SSA) has increased the number of people accessing treatment. However, the number of males accessing and being retained along the human immunodeficiency virus (HIV) care cascade is significantly below the UNAIDS target. Male gender has been associated with poor retention in HIV care programs, and little is known about strategies that reduce attrition of men in ART programs. This review aimed to summarize any studies on strategies to improve retention of heterosexual males in HIV care in SSA. An electronic search was conducted through Ovid® for three databases (MEDLINE®, Embase and Global Health). Studies reporting interventions aimed at improving retention among heterosexual men along the HIV care cascade were reviewed. The inclusion criteria included randomized-controlled trials (RCTs), prospective or retrospective cohort studies that studied adult males (≥15years of age), conducted in SSA and published between January 2005 and April 2019 with an update from 2019 to 2020. The search returned 1958 articles, and 14 studies from eight countries met the inclusion criteria were presented using the PRISMA guidelines. A narrative synthesis was conducted. Six studies explored community-based adherence support groups while three compared use of facility versus community-based delivery models. Three studies measured the effect of national identity cards, disclosure of HIV status, six-monthly clinic visits and distance from the health center. Four studies measured risk of attrition from care using hazard ratios ranging from 1.2–1.8, four studies documented attrition proportions at an average of 40.0% and two studies an average rate of attrition of 43.4/1000PYs. Most (62%) included studies were retrospective cohorts, subject to risk of allocation and outcome assessment bias. A pooled analysis was not performed because of heterogeneity of studies and outcome definitions. No studies have explored heterosexual male- centered interventions in HIV care. However, in included studies that explored retention in both males and females, there were high rates of attrition in males. More male-centered interventions need to be studied preferably in RCTs. Registry number: PROSPERO2020 CRD42020142923 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020142923.

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How early is too early? Challenges in ART initiation and engaging in HIV care under Treat All in Rwanda—A qualitative study

PLoS ONE ◽

10.1371/journal.pone.0251645 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251645

Author(s):

Jonathan Ross ◽

Charles Ingabire ◽

Francine Umwiza ◽

Josephine Gasana ◽

Athanase Munyaneza ◽

...

Keyword(s):

Treatment Guidelines ◽

Qualitative Interviews ◽

Hiv Treatment ◽

Sub Saharan Africa ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Status ◽

Hiv Diagnosis ◽

Art Initiation ◽

Treat All

Introduction HIV treatment guidelines recommend that all people living with HIV (PLWH) initiate antiretroviral therapy (ART) as soon as possible after diagnosis (Treat All). As Treat All is more widely implemented, an increasing proportion of PLWH are likely to initiate ART when they are asymptomatic, and they may view the relative benefits and risks of ART differently than those initiating at more advanced disease stages. To date, patient perspectives of initiating care under Treat All in sub-Saharan Africa have not been well described. Methods From September 2018 to March 2019, we conducted individual, semi-structured, qualitative interviews with 37 patients receiving HIV care in two health centers in Kigali, Rwanda. Data were analyzed using a mixed deductive and inductive thematic analysis approach to describe perceived barriers to, facilitators of and acceptability of initiating and adhering to ART rapidly under Treat All. Results Of 37 participants, 27 were women and the median age was 31 years. Participants described feeling traumatized and overwhelmed by their HIV diagnosis, resulting in difficulty accepting their HIV status. Most were prescribed ART soon after diagnosis, yet fear of lifelong medication and severe side effects in the immediate period after initiating ART led to challenges adhering to therapy. Moreover, because many PLWH initiated ART while healthy, taking medications and attending appointments were visible signals of HIV status and highly stigmatizing. Nonetheless, many participants expressed enthusiasm for Treat All as a program that improved health as well as health equity. Conclusion For newly-diagnosed PLWH in Rwanda, initiating ART rapidly under Treat All presents logistical and emotional challenges despite the perceived benefits. Our findings suggest that optimizing early engagement in HIV care under Treat All requires early and ongoing intervention to reduce trauma and stigma, and promote both individual and community benefits of ART.

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