Antiretroviral Treatment Services Research Articles

ADHERENCE DETERMINANT ANALYSIS OF PLHIV ON ARV (ANTIRETROVIRAL) THERAPY IN SITUBONDO DISTRICT

Background: Human Immunodeficiency Virus (HIV) infection causes Acquired Immune Deficiency Syndrome (AIDS), a collection of symptoms arising from the deteriorating immunity. The number of people living with HIV worldwide continues to increase year-by-year. Those infected with HIV need antiretroviral (ARV) therapy to suppress the amount of HIV in the body. Purpose: This study aimed to investigate the determinants of adherence in people living with HIV/AIDS (PLHIV) undergoing ARV therapy in Situbondo Regency. Methods: This study employed a quantitative analytic observational approach with a cross-sectional design. Data analysis involved both descriptive and multivariate analysis. The population for this study consisted of 328 individuals, from which 212 were selected as samples, all being PLHIV on ART as of April 2022, sourced from ARV treatment services in Situbondo district. Results: The research analysis was based on predisposing factors, measured using three indicators: work, knowledge, and belief in ARVs. Supporting aspects were measured by two factors: ownership of health insurance and adherence counselling. Reinforcing factors were measured using two indicators: family support and stigma in the community. Conclusion: The study concluded that predisposing and reinforcing factors significantly influenced PLHIV adherence to antiretroviral therapy. However, supporting factors did not show a significant influence on adherence in PLHIV undergoing antiretroviral therapy in the Situbondo District.

Mortality Among Children Aged

Globally, children aged <5 years, including those living with HIV who are not receiving antiretroviral treatment (ART), experience disproportionately high mortality. Global mortality among children living with HIV aged <5 years receiving ART is not well described. This report compares mortality and related clinical measures among infants aged <1 year and children aged 1-4 years living with HIV with those among older persons aged 5-14, 15-49, and ≥50 years living with HIV receiving ART services at all clinical sites supported by the U.S. President's Emergency Plan for AIDS Relief. During October 2020-September 2022, an average of 11,980 infants aged <1 year and 105,510 children aged 1-4 years were receiving ART each quarter; among these infants and children receiving ART, 586 (4.9%) and 2,684 (2.5%), respectively, were reported to have died annually. These proportions of infants and children who died ranged from four to nine times higher in infants aged <1 year, and two to five times higher in children aged 1-4 years, than the proportions of older persons aged ≥5 years receiving ART. Compared with persons aged ≥5 years living with HIV, the proportions of children aged <5 years living with HIV who experienced interruptions in treatment were also higher, and the proportions who had a documented HIV viral load result or a suppressed viral load were lower. Prioritizing and optimizing HIV and general health services for children aged <5 years living with HIV receiving ART, including those recommended in the WHO STOP AIDS Package, might help address these disproportionately poorer outcomes.

Loss to Follow-up and Death Among Individuals With Newly Diagnosed Human Immunodeficiency Virus Receiving Dolutegravir-Based First-Line Antiretroviral Treatment in Eastern Ethiopia: Implications for 95% United Nations Targets.

Loss to follow-up (LTFU) and death are unfavorable outcomes of human immunodeficiency virus (HIV) treatment. This study aimed to identify the predictors of LTFU and death among individuals with newly diagnosed HIV receiving dolutegravir (DTG)-based first-line antiretroviral treatment (ART) in eastern Ethiopia. A multisite prospective cohort study was carried out between October 2020 and July 2022. New case patients who started ART were enrolled consecutively and then followed up for the next 6 months. A structured questionnaire and checklists were used to collect data. HIV viral load was determined using the Abbott RealTime HIV-1 assay. Bivariable and multivariable logistic regression models were used to identify baseline factors associated with the outcomes. A total of 235 people with newly diagnosed HIV were enrolled; 16.6% (95% confidence interval, 12.3%-21.9%) were lost to follow-up, and 5.9% (3.5%-9.8%) died within 6 months of follow-up. Baseline World Health Organization clinical stage I (adjusted odds ratio, 3.93 [95% confidence interval, 1.34-11.57]), low viral load (3.67 [1.09-12.36]), and body weight (1.04 [1.01-1.07]) were predictors of LTFU, whereas nonfunctional status (10.02 [1.9-51.3]) was the only factor associated with death. LTFU and death rates among patients with DTG were relatively high, accounting for roughly a quarter of the attrition of people with newly diagnosed HIV from ART care and services. Thus, targeted interventions are required to reduce LTFU and death among individuals with HIV on ART. Further investigation is necessary to evaluate the long-term effects of DTG-based regimens on LTFU and its impact on HIV mortality rates, and qualitative research, specifically tracing LTFU, is recommended.

Assessment of Health-Related Quality of Life Using EQ-5D-5L Tool With Indian Tariffs Among Reproductive Age Group Women Living With HIV in India

ObjectiveIndia is witnessing declining HIV prevalence because of dedicated efforts by the government. The highly active antiretroviral therapy has improved life span of people living with HIV but bearing many side effects. Women living with HIV (WLHIV) in reproductive age group have additional burden of pregnancy-related issues. This study aimed to estimate the health utility score among WLHIV in India, particularly in context of their contraceptive use, during pregnancy and postpartum period. MethodsA primary cross-sectional study was conducted among 195 WLHIV availing antiretroviral treatment services at public health facilities of Mumbai. The EQ-5D-5L interview-based questionnaire in local language and Indian value set was used to estimate health-related quality of life (QOL) reported as mean (± SD) utility and visual analog scale (VAS) scores. The relationship between utility values and VAS scores was assessed. ResultsThe WLHIV with mean age of 31.6 (6.4) years were on antiretroviral medication for nearly 7 years, and 63% had CD4+ cell count > 500 cells/mm3. Response of “11111,” that is, in full health state, was reported by 66.7%. The mean utility and VAS scores were 0.976 (± 0.0519) and 82.21 (± 15.77). Reduced health-related QOL scores were associated with pain and discomfort dimension. Utility scores among contraceptive users (0.986 [± 0.029]) was higher than nonusers (0.976 [± 0.028]). Currently pregnant WLHIV had least utility score (0.959 [± 0.088]). ConclusionsWLHIV had better QOL while using contraceptives more so when they were sterilized. Pregnancy reduces the QOL. This emphasizes the need to promote effective contraceptive methods among WLHIV and prevent unintended pregnancies.

Client satisfaction with antiretroviral treatment services in South Ethiopian public health facilities: an institution-based cross-sectional survey

ABSTRACT Background HIV/AIDS remains the leading cause of morbidity and mortality worldwide. Moreover, sub-Saharan countries, including Ethiopia, are highly affected by HIV/AIDS pandemic. Ethiopia’s government has been working on a comprehensive HIV care and treatment programme, including antiretroviral therapy. However, evaluating client satisfaction with antiretroviral treatment services is not well studied. Objectives This study aimed to assess client satisfaction and associated factors with antiretroviral treatment services provided at public health facilities of Wolaita zone, South Ethiopia. Methods A facility-based cross-sectional study involved 605 randomly selected clients using ART services from six public health facilities in Southern Ethiopia. A multivariate regression model was used to see an association between independent variables and the outcome variable. The odds ratio with 95% CI was computed to determine the presence and strength of the association. Results Four hundred twenty-eight (70.7%) clients were satisfied with an overall antiretroviral treatment service, which included significant variations ranging from 21.1% to 90.0% among health facilities. Sex [AOR = 1.91; 95% CI = 1.10–3.29], employment [AOR = 13.04; 95% CI = 4.34–39.22], clients’ perception of the availability of prescribed laboratory services [AOR = 2.56; 95% CI = 1.42–4.63], availability of prescribed drugs [AOR = 6.26; 95% CI = 3.40–11.52] and cleanliness of toilet in the facility [AOR = 2.83; 95% CI = 1.56–5.14] were factors associated with client satisfaction with antiretroviral treatment services. Conclusion The overall client satisfaction with antiretroviral treatment service was lower than the national target of 85%, with a marked difference among facilities. Sex, occupational status, availability of comprehensive laboratory services, standard drugs, and cleanliness toilets in the facility were factors associated with client satisfaction with antiretroviral treatment services. Sex-sensitive services needed to address and sustained availability of laboratory services and medicine recommended.

The impact of war on HIV/AIDS service provision: In rural health facilities of Tigray, northern Ethiopia, a cross-sectional study.

HIV/AIDS remained among the common public health problems in developing country. Despite the extensive delivery of ART and improved coverage of the service access, still, man-made problems like war have negatively influenced the utilization of antiretroviral treatment services. The war in Tigray Region in the northern Ethiopia broke out in November 2020 and thereby has brought about an extreme damage on most of the infrastructure in Tigray, including the health institutions. The purpose of this study is, therefore, to assess and report the trend of HIV service provision across the war affected rural health facilities in Tigray. The study was conducted in 33 rural health facilities during the active war in Tigray. A facility based retrospective cross-sectional study design was conducted among health facilities from July 03 to August 05, 2021. A total of 33 health facilities from 25 rural districts were included in the HIV service delivery assessment. A total of 3274 and 3298 HIV patients were seen during pre-war period in September and October 2020, respectively. The number of follow-up patients during the war period in January remained to be only 847(25%) which is significantly reduced with a P value<0.001. A similar trend was observed during the subsequent months until May. The trend of follow-up patients on ART significantly declined from 1940 in September (pre-war) to 331(16.6%) in May (during the war). This study also revealed a 95.5% reduction of laboratory service provision to HIV/AIDS patients during the war in January and with similar trends thereafter (P<0.001). The war has led to a significant decline of HIV service provision in the rural health facilities and most part of the region during the first eight months of active war in Tigray.

Analysis Factors Affecting the Utilization of Antiretroviral Treatment Services in HIV Patients in Ambon City Puskesmas

Analysis Factors Affecting the Utilization of Antiretroviral Treatment Services in HIV Patients in Ambon City Puskesmas

Reaching transgender populations in Zambia for HIV prevention and linkage to treatment using community-based service delivery.

IntroductionTransgender and gender‐diverse communities in Zambia are highly vulnerable and experience healthcare differently than cisgender persons. The University of Maryland, Baltimore (UMB) supports projects in Zambia to improve HIV case‐finding, linkage and antiretroviral treatment (ART) for Zambia's transgender community. We describe programme strategies and outcomes for HIV prevention, testing and ART linkage among transgender communities.MethodsUMB utilizes a differentiated service delivery model whereby community health workers (CHWs) recruited from key populations (KPs) reach community members through a peer‐to‐peer approach, with the support of local transgender civil society organizations (CSOs) and community gatekeepers. Peer CHWs are trained and certified as HIV testers and psychosocial counsellors to offer counselling with HIV testing and prevention services in identified safe spaces. HIV‐negative people at risk of HIV infection are offered pre‐exposure prophylaxis (PrEP), while those who test positive for HIV are linked to ART services. CHWs collect data using the standardized facility and community tools and a dedicated DHIS2 database system. We conducted a descriptive analysis examining HIV testing and prevention outcomes using proportions and comparisons by time period and geographic strata.ResultsFrom October 2020 to June 2021, across Eastern, Lusaka, Western and Southern Provinces, 1860 transgender persons were reached with HIV prevention messages and services. Of these, 424 (23%) were tested for HIV and 78 (18%) tested positive. Of the 346 HIV‐negative persons, 268 (78%) eligible transgender individuals were initiated on PrEP. ART linkage was 97%, with 76 out of the 78 transgender individuals living with HIV initiating treatment. Programme strategies that supported testing and linkage included peer CHWs, social network strategy testing, same‐day ART initiation and local KP CSO support. Challenges included non‐transgender‐friendly environments, stigma and discrimination, the high transiency of the transgender community and the non‐availability of transgender‐specific health services, such as hormonal therapy.ConclusionsPeer KP CHWs were able to reach many members of the transgender community, providing safe HIV testing, PrEP services and linkage to care. Focusing on community gatekeepers and CSOs to disburse health messages and employ welcoming strategies supported high linkage to both PrEP and ART for transgender people in Zambia.

Group antenatal care for improving retention of adolescent and young pregnant women living with HIV in Kenya

BackgroundPregnant and breastfeeding adolescents and young women living with HIV (AYWLH) have lower retention in prevention of mother-to-child transmission (PMTCT) services compared to older women.MethodsWe evaluated a differentiated service model for pregnant and postnatal AYWLH at seven health facilities in western Kenya aimed at improving retention in antiretroviral treatment (ART) services. All pregnant AYWLH < 25 years presenting for antenatal care (ANC) were invited to participate in group ANC visits including self-care and peer-led support sessions conducted by health facility nurses per national guidelines. ART register data were used to assess loss to follow-up (LTFU) among newly-enrolled pregnant adolescent (< 20 years) and young women (20–24 years) living with HIV starting ART in the pre-period (January-December 2016) and post-period (during implementation; December 2017-January 2019). Poisson regression models compared LTFU incidence rate ratios (IRR) in the first six months after PMTCT enrollment and risk ratios compared uptake of six week testing for HIV-exposed infants (HEI) between the pre- and post-periods.ResultsIn the pre-period, 223 (63.2%) of 353 pregnant AYWLH newly enrolled in ANC had ART data, while 320 (71.1%) of 450 in the post-period had ART data (p = 0.02). A higher proportion of women in the post-period (62.8%) had known HIV-positive status at first ANC visit compared to 49.3% in the pre-period (p < 0.001). Among pregnant AYWLH < 20 years, the incidence rate of LTFU in the first six months after enrollment in ANC services declined from 2.36 per 100 person months (95%CI 1.06–5.25) in the pre-period to 1.41 per 100 person months (95%CI 0.53–3.77) in the post-period. In both univariable and multivariable analysis, AYWLH < 20 years in the post-period were almost 40% less likely to be LTFU compared to the pre-period, although this finding did not meet the threshold for statistical significance (adjusted incidence rate ratio 0.62, 95%CI 0.38–1.01, p = 0.057). Testing for HEI was 10% higher overall in the post-period (adjusted risk ratio 1.10, 95%CI 1.01–1.21, p = 0.04).ConclusionsInterventions are urgently needed to improve outcomes among pregnant and postnatal AYWLH. We observed a trend towards increased retention among pregnant adolescents during our intervention and a statistically significant increase in uptake of six week HEI testing.

The secret life of young adolescents living with HIV in northern Mozambique - a mixed methods study

BackgroundIn Mozambique, HIV infection remains a leading cause of adolescent mortality. With advances in antiretroviral treatment (ART), the population of adolescents living with vertically-acquired HIV is growing. Most studies of adolescents living with HIV (ALHIV) focus on older youth with horizontal infection. As part of a larger study, we examined the characteristics and health care needs of younger ALHIV, including those with vertically-acquired infection to inform preventive interventions.MethodsWe used a convergent mixed-methods design and recruited ALHIV aged 12–14 years who were enrolled in HIV care in three health clinics in Nampula, Mozambique. From 11/2019–3/2020, we conducted 61 quantitative surveys and 14 in-depth interviews with a purposively selected subset of ALHIV who were aware of their HIV status. Descriptive statistical analysis was conducted for quantitative data. Qualitative data were transcribed and analyzed using thematic analysis.ResultsThe median age of ALHIV was 13 years, 50% were female, 67% lived with ≥1 parent, 70% had lost a parent, 100% were in school; 10% were in a relationship, and 3% had initiated sexual activity. Among 31 ALHIV aware of their serostatus, the median age of antiretroviral treatment (ART) initiation was 8 years (IQR: 6–11); 55% received caregiver support for ART management; 35% reported missing ≥1 ART dose in the last 30 days; 6% had disclosed their HIV-status to friends and 48% reported no one to talk to about HIV-specific issues. Four main themes emerged from the qualitative interviews with ALHIV: a) learning one’s HIV-positive status as the beginning of a secret life; b) importance of caregivers’ support for ART management; c) high value of ALHIV peer support to overcome isolation, increase HIV literacy, and support adherence; and d) unmet needs for sexual and reproductive health education.ConclusionHIV-related secrecy prevails among ALHIV, a situation exacerbated by caregivers and healthcare providers. Caregivers play a major role in supporting adherence among young ALHIV, yet ALHIV could also benefit from adolescent-friendly services, including peer support, sexual and reproductive health services and preparation for independent health management. Integrating such programs into ART services in Mozambique may be critical to promoting ALHIV health.

Patient costs for prevention of mother-to-child HIV transmission and antiretroviral therapy services in public health facilities in Zimbabwe.

Zimbabwe has made large strides in addressing HIV. To ensure a continued robust response, a clear understanding of costs associated with its HIV program is critical. We conducted a cross-sectional evaluation in 2017 to estimate the annual average patient cost for accessing Prevention of Mother-To-Child Transmission (PMTCT) services (through antenatal care) and Antiretroviral Treatment (ART) services in Zimbabwe. Twenty sites representing different types of public health facilities in Zimbabwe were included. Data on patient costs were collected through in-person interviews with 414 ART and 424 PMTCT adult patients and through telephone interviews with 38 ART and 47 PMTCT adult patients who had missed their last appointment. The mean and median annual patient costs were examined overall and by service type for all participants and for those who paid any cost. Potential patient costs related to time lost were calculated by multiplying the total time to access services (travel time, waiting time, and clinic visit duration) by potential earnings (US$75 per month assuming 8 hours per day and 5 days per week). Mean annual patient costs for accessing services for the participants was US$20.00 [standard deviation (SD) = US$80.42, median = US$6.00, range = US$0.00-US$12,18.00] for PMTCT and US$18.73 (SD = US$58.54, median = US$8.00, range = US$0.00-US$ 908.00) for ART patients. The mean annual direct medical costs for PMTCT and ART were US$9.78 (SD = US$78.58, median = US$0.00, range = US$0.00-US$ 90) and US$7.49 (SD = US$60.00, median = US$0.00) while mean annual direct non-medical cost for US$10.23 (SD = US$17.35, median = US$4.00) and US$11.23 (SD = US$25.22, median = US$6.00, range = US$0.00-US$ 360.00). The PMTCT and ART costs per visit based on time lost were US$3.53 (US$1.13 to US$8.69) and US$3.43 (US$1.14 to US$8.53), respectively. The mean annual patient costs per person for PMTCT and ART in this evaluation will impact household income since PMTCT and ART services in Zimbabwe are supposed to be free.

Improving public health service delivery response to address contraceptive needs of socio-economically disadvantaged HIV positive people in Maharashtra, India

BackgroundPeople living with HIV (PLHIV) receive free antiretroviral treatment (ART) in public health facilities of India. With improved life expectancy, unmet sexual and reproductive health needs of PLHIV have to be addressed through a converged programmatic response strategy. Evidence shows that socioeconomically disadvantaged women are most vulnerable to high reproductive morbidities, especially HIV positive women with an unmet need of contraception.MethodsProgrammatic convergence by linking ART and family planning services were strengthened at two public health facilities (district hospitals) generally accessed by disadvantaged socio-economic sections of the society. Barriers to linking services including stigma and discrimination were addressed through analysis of existing linkage situation, sensitization and training of healthcare providers and system-level interventions. This facilitated provider-initiated assessment of contraceptive needs of PLHIV, counseling about dual contraception using a couple approach, linkage to family planning centers and maintaining data about these indicators. Six hundred eligible PLHIV seeking care at ART centers were enrolled and followed up for a duration of 6 months. Acceptance of family planning services as a result of the intervention, use of dual contraception methods and their determinants were assessed.ResultsEighty-seven percent HIV couples reached FP centers and 44.6% accepted dual methods at the end of the study period. Dual methods such as oral contraceptive pills (56.2%), IUCDs (19.4%), female sterilization (11.6%), injectable contraception (9.9%) and vasectomy (2.9%) in addition to condoms were the most commonly accepted methods. Condom use remained regular and consistently high throughout. The study witnessed seven unintended pregnancies, all among exclusive condom users. These women availed medical abortion services and accepted dual methods after counseling. Female index participants, concordant couples, counseling by doctors and women with CD4 count above 741 had higher odds of accepting dual contraception methods. Standard operating procedures (SOP) were developed in consultation with key stakeholders to address operational linkage of HIV and family programs.ConclusionThe study saw significant improvement in acceptance of dual contraception by PLHIV couples as a result of the intervention. Implementation of SOPs with supportive supervision can ensure efficient linkage of programs and provide holistic sexual and reproductive healthcare for PLHIV in India.

Short-Term Effects of the COVID-19 Pandemic on HIV Care Utilization, Service Delivery, and Continuity of HIV Antiretroviral Treatment (ART) in Haiti.

IntroductionOur study describes changes in HIV care service delivery and continuity of HIV antiretroviral therapy (ART) for people living with HIV (PLHIV) during the 8 weeks before and after diagnosis of the first coronavirus disease 2019 (COVID-19) cases in Haiti on March 19, 2020.MethodsUsing data from 96 out of 167 health facilities offering ART services, we compared four ART program indicators: (1) count of HIV visits; (2) proportion of ART dispenses in community-based settings (DAC); (3) proportion of multi-month dispensing of ART medications > 6 months (> 6 m MMD); and (4) proportion of timely ART refills. We used uncontrolled interrupted time series (ITS) models to estimate slope and level changes in each indicator with the arrival of COVID-19.Results and DiscussionFrom week 1 to week 16, the average number of HIV visits fell from 121.5 to 92.5 visits, the proportion of DAC rose from 22.7% to 36.7%, the proportion of > 6 m MMD rose from 29.4% to 48.4%, and the proportion of timely ART refills fell from 51.9% to 43.8%. The ITS models estimated abrupt increases of 36% in > 6 m MMD (p < 0.001) and 37% in DAC (p < 0.001) at the time of COVID-19 arrival, and no change after arrival of COVID-19. The was an abrupt decline of 18% in timely ART refills with the arrival of COVID-19 and a decline of 1% per week thereafter, both non-statistically significant changes.ConclusionsThe sudden changes in HIV service utilization represent dramatic adaptations needed to mitigate primary and secondary effects of the COVID-19 pandemic on PLHIV. This study underscores the urgency of optimizing ART delivery models in Haiti and beyond, in order to maintain progress toward HIV epidemic control.

Did sexual behaviour differences between HIV infection and treatment groups offset the preventative biological effects of ART roll-out in Zimbabwe?

Declines in HIV incidence have been slower than expected during the roll-out of antiretroviral treatment (ART) services in sub-Saharan African populations suffering generalized epidemics. Using data from a population-based, open cohort HIV sero-survey (2004–13), we found evidence for initial reductions in sexual activity and multiple sexual partnerships, followed by increases during the period of ART scale-up in areas of high HIV prevalence in Manicaland, east Zimbabwe. Recent population-level increases in condom use were also recorded, but largely reflected high use by the rapidly growing proportion of HIV-infected individuals on treatment. Sexual risk behaviour increased in susceptible uninfected individuals and in untreated (and therefore more infectious) HIV-infected men, which may have slowed the decline in HIV incidence in this area. Intensified primary HIV prevention programmes, together with strengthened risk screening, referral, and support services following HIV testing, could help to maximize the impact of ‘test-and-treat’ programmes in reducing new infections.

Patient satisfaction and associated factors among adults attending ART clinic at Dessie refferal Hospital, Amhara Region, Ethiopia

BackgroundThe pandemic of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome is a major public health problem globally. Anti-Retro Viral treatment (ART) is a life-saving treatment for People Living with Human Immunodeficiency. Satisfied patients are more likely to comply with their treatment, which is in turn associated with better clinical outcomes. ObjectiveThe objective of this study was to assess the level of satisfaction and associated factors among adult patients on ART in Dessie Referral Hospital, Wollo, Ethiopia, 2019. Methods and materialsAn institution-based cross-sectional study was conducted. A total of 375 Adult patients was involved in the study using systematic random sampling technique. Data were entered in to Epi data version 3.1 and exported to SPSS version 23 for analysis. Bivariate and multivariate analysis were applied to determine level and predictors of patient satisfaction. ResultThe overall level of satisfaction among patients attending ART service was 64.1%.Age of the respondents (AOR = 1.99, 95% CI: 1.22–3.27), educational status (AOR = 1.97. 95% CI: 1.20–3.21),time taken to reach hospital (30 min to 1 h (AOR = 0.24, 95% CI: 0.12–0.46) and >1 h (AOR = 0.41, 95% CI: 0.22–0.78) and perceived medium (AOR = 0.23, 95% CI: 0.12, 0.43) and high (AOR = 0.16, 95% CI: 0.07–0.38) level of stigma and discrimination was significantly associated with patient satisfaction. Conclusion and recommendationIn the present study the overall satisfaction of patients towards a hospital based ART services was moderate. The hospital management should work on increasing access to service, devise innovative ways to reduce perceived level of stigma and discrimination.

Knowledge on mother-to-child transmission of HIV, and sexuality and fertility desires among people living with HIV in North-Central, Nigeria.

Introductionmother-to-child transmission (MTCT) is the transmission of HIV from a mother to the child during pregnancy, labour and breastfeeding. People living with HIV (PLHIV) are sexually active and also HIV can be transmitted while trying to achieve pregnancy involving unprotected hetero-sexual intercourse. Fertility desire among PLHIV is increasing due to improved quality of life and survival following commencement of anti-retroviral treatment and available reproductive health services. The objective of the study was to determine the association between knowledge on MTCT of HIV and sexuality and fertility desire.Methodsthis study was descriptive cross-sectional applying systematic sampling technique among PLHIV using semi-structured interviewer administered questionnaires. Data was analysed using SPSS version 23.0. Chi square test was used for statistical analysis. At 95% confidence interval a P-value of <0.05 was considered to be statistically significant.Resultsa total of 168 PLHIV were studied, 63.3% females and 36.7% males. Majority (81.5%) of the respondents were sexually active and 64.1% had fertility desire. On awareness of MTCT 62.5% had heard of MTCT but only 28.2% had good knowledge. No association was found between knowledge of MTCT and sexuality and fertility desire respectively.ConclusionPLHIV had high awareness but poor knowledge on MTCT of HIV, hence the need for healthcare workers to provide sexual and reproductive health counselling including information on MTCT to both male and female PLHIV during routine clinic visits.

Efficiency of health facilities providing antiretroviral treatment services in Botswana

Efficiency of health facilities providing antiretroviral treatment services in Botswana

The Russian HIV residence ban and state control of migration.

This article explores how the Russian state exercises power over international migrants by continuing a 1995 ban on residence for HIV-positive foreigners. International migrants look for work in Russia, the largest host country for migration in the region of East Europe and Central Asia. I conducted qualitative interviews with service providers and health experts and analyzed cases in the database of a Moscow-based non-governmental organization (NGO) where HIV-positive international migrants seek HIV care. To secure permits to work and reside in Russia, they must prove HIV-negative status. I explored how Russia created legal uncertainty for those who are HIV-positive due to lack of legal employment and irregular residence status. I also explain how difficult it is to obtain antiretroviral treatment or other health services for HIV-positive migrants, and discuss epidemiologic, economic, and social implications of the Russian HIV residence ban in the light of the Russian migration policy.

Modelling integrated antiretroviral treatment and harm reduction services on HIV and overdose among people who inject drugs in Tijuana, Mexico.

IntroductionThe HIV epidemic in Tijuana, Mexico is concentrated in key populations, including people who inject drugs (PWID). However, HIV interventions among PWID are minimal, and federal funding was provided for compulsory abstinence programmes associated with HIV and overdose. Alternatively, opioid agonist therapy reduces overdose, reincarceration, HIV, while improving antiretroviral therapy (ART) outcomes. We assessed potential impact and synergies of scaled‐up integrated ART and opioid agonist therapy, compared to scale‐up of each separately, and potential harms of compulsory abstinence programmes on HIV and fatal overdose among PWID in Tijuana.MethodsWe developed a dynamic model of HIV transmission and overdose among PWID in Tijuana. We simulated scale‐up of opioid agonist therapy from zero to 40% coverage among PWID. We evaluated synergistic benefits of an integrated harm reduction and ART scale‐up strategy (40% opioid agonist therapy coverage and 10‐fold ART recruitment), compared to scale‐up of each intervention alone or no scale‐up of low coverage ART and no harm reduction). We additionally simulated compulsory abstinence programmes (associated with 14% higher risk of receptive syringe sharing and 76% higher odds of overdose) among PWID.ResultsWithout intervention, HIV incidence among PWID could increase from 0.72 per 100 person‐years (PY) in 2020 to 0.92 per 100 PY in 2030. Over ten years, opioid agonist therapy scale‐up could avert 31% (95% uncertainty interval (UI): 18%, 46%) and 22% (95% UI: 10%, 28%) new HIV infections and fatal overdoses, respectively, with the majority of HIV impact from the direct effect on HIV transmission due to low ART coverage. Integrating opioid agonist therapy and ART scale‐up provided synergistic benefits, with opioid agonist therapy effects on ART recruitment/retention averting 9% more new infections compared to ART scale‐up alone. The intervention strategy could avert 48% (95% UI: 26%, 68%) of new HIV infections and one‐fifth of fatal overdoses over ten years. Conversely, compulsory abstinence programmes could increase HIV and overdoses.ConclusionsIntegrating ART with opioid agonist therapy could provide synergistic benefits and prevent HIV and overdoses among PWID in Tijuana, whereas compulsory abstinence programmes could cause harm. Policymakers should consider the benefits of integrating harm reduction and HIV services for PWID.

Optimizing Antiretroviral Uptake in Rural Botswana: Advancing the World Health Organization’s Treat All Program

Botswana was the first African country to introduce free antiretroviral treatment (ART) to people living with human immunodeficiency virus (HIV), but today it has the third highest HIV prevalence rate (20.3 per 100 population) in the world. This study investigates the availability and accessibility of ART facilities in Botswana and the utilization of ART services in districts with high HIV prevalence and low percentages of ART uptake. Availability and accessibility are measured using Botswana’s ART site model and road network analysis. Microdata on HIV status from the Botswana AIDS Impact Survey IV (BAIS IV) survey, and patient data on antiretroviral (ARV) utilization is examined at the health district level. The results show the spatial mean centers of hierarchically clustered ART facilities within ART sites are strategically located in areas of high population density. Many rural people across the country travel more than three hours to ART services. Within five rural health districts there are substantial ART facility patient deficits. Future planning should focus on increasing ART services and road infrastructure in rural areas, ART uptake for men, and ART adherence in relation to circular migration and social stigmas in rural destinations to ensure the success of the Treat All Program in Botswana.