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

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.

Exploring Barriers and Facilitators of Adherence to Artemisinin-Based Combination Therapies for the Treatment of Uncomplicated Malaria in Children in Freetown, Sierra Leone

Medication adherence is an essential step in the malaria treatment cascade. We conducted a qualitative study embedded within a randomized controlled trial comparing the adherence to the recommended dosing of two artemisinin-based combination therapies (ACT) to treat uncomplicated malaria in Freetown, Sierra Leone. This study explored the circumstances and factors that influenced caregiver adherence to the ACT prescribed for their child in the trial. In-depth interviews were conducted with 49 caregivers; all interviews were recorded, transcribed, and translated. Transcripts were coded and aggregated into themes, applying a thematic content approach. We identified four key factors that influenced optimal treatment adherence: (1) health system influences, (2) health services, (3) caregivers’ experiences with malaria illness and treatment, and (4) medication characteristics. Specifically, caregivers reported confidence in the health system as facilities were well maintained and care was free. They also felt that health workers provided quality care, leading them to trust the health workers and believe the test results. Ease of medication administration and perceived risk of side effects coupled with caregivers’ prior experience treating malaria influenced how medications were administered. To ensure ACTs achieve maximum effectiveness, consideration of these contextual factors and further development of child-friendly antimalarials are needed.

Impact and Equality of Expanding Pre-Exposure Prophylaxis (PrEP) for Men who have Sex with Men in Los Angeles County

ABSTRACTBackgroundRacial and ethnic minority men who have sex with men (MSM) are disproportionately affected by HIV/AIDS in Los Angeles County (LAC), an important epicenter in the battle to end HIV.ObjectiveTo examine tradeoffs between effectiveness and equality of PrEP allocation strategies among different racial and ethnic groups of MSM in LAC.Design, Setting, and PopulationWe developed a microsimulation model of HIV among MSM in LAC using county epidemic surveillance and survey data to capture demographic trends and subgroup-specific partnership patterns, disease progression, patterns of PrEP use, and patterns for viral suppression.InterventionWe simulated interventions where an additional 3000, 6000, or 9000 PrEP prescriptions are provided annually in addition to current levels, following different allocation scenarios to each racial/ethnic group (Black, Hispanic, or White).MeasurementsWe estimated cumulative infections averted and measures of equality, after 15 years (2021-2035), relative to base case (no intervention).ResultsOf the policies evaluated, targeting PrEP preferentially to Black individuals would result in the largest reductions in incidence and disparities. This outcome was robust to different partnership preference assumptions, though the magnitude of impact differs.LimitationsWe limit analysis to MSM, who bear the majority of HIV/AIDS burden in LAC. We do not consider transmission via injection drug use or mother-to-child transmission, nor do we capture individual network transmission effects. We assume no improvements in the prevention-diagnosis-treatment cascade besides increased PrEP use.ConclusionsWe find there is little trade-off between effectiveness and equality of outcome when choosing groups to target for PrEP in LAC – by focusing on MSM with the highest HIV incidence (Black), we can reduce both overall infections and racial/ethnic disparities.

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

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.