HIV Counseling Research Articles

Effectiveness of an Intervention to Improve HIV Service Delivery for People Who Inject Drugs in Kazakhstan

The increasing HIV incidence rates and suboptimal rates of testing, engagement, and retention in care for people who inject drugs (PWID) in Kazakhstan underscore the need for effective HIV care continuum interventions for PWID. To determine the effectiveness of the Bridge HIV care continuum intervention implemented in needle and syringe programs (NSPs) in Kazakhstan. This stepped-wedge cluster trial was conducted from February 2017 to May 2020, with implementation beginning sequentially across 3 cities (Almaty, Karaganda-Temirtau, and Shymkent) in August 2017, January 2018, and May 2019. Intervention effect sizes were estimated via population-averaged models, and hypothesis testing relied on a permutation testing approach. The primary unit of analysis was an NSP. Data analysis was performed from October 2020 to April 2022. The intervention addresses the full HIV care continuum: identification, testing, referral to services, and linkage to HIV care. The 3 intervention components were (1) a social network strategy, a peer-driven recruitment approach for HIV testing; (2) HIV counseling, rapid testing, and referral following international and national guidelines and protocols; and (3) enhanced antiretroviral treatment and access to services. The primary outcomes were the effectiveness of implementing Bridge's enhanced service integration approach in increasing the number of PWID served at NSPs, increasing the number of PWID who are tested for HIV in NSPs, and improving linking HIV-positive PWID with HIV care. Secondary outcomes included numbers of clients registered for HIV care, initiation of antiretroviral therapy, and viral suppression. Twenty-four NSPs (8 in each city) served a total of 1225 PWID (369 in Almaty, 618 in Karaganda-Temirtau, and 238 in Shymkent) at the preimplementation study step; 1015 clients (82.9%) were male, and the mean (SD) age was 36.7 (7.1) years. Compared with preimplementation study steps, during Bridge intervention implementation steps, NSPs experienced a significant increase in the number of PWID clients registered (incidence rate ratio, 2.37; 95% CI, 1.48-3.78) and the number of PWID who received rapid HIV tests (incidence rate ratio, 3.98; 95% CI, 2.30-6.90). No significant increase in referral to HIV care was observed. The study also found significant support for secondary outcomes of antiretroviral therapy initiation and the number of clients who achieved viral suppression. In this stepped-wedge cluster trial, the findings suggest that implementation of the Bridge intervention was associated with significant improvement in several steps in the continuum of HIV care for PWID in Kazakhstan. ClinicalTrials.gov Identifier: NCT02796027.

A QUALITATIVE STUDY OF THE KNOWLEDGE OF INFORMAL CAREGIVERS OF CHILDREN WITH HIV/AIDS ON ANTIRETROVIRAL THERAPY ADHERENCE

The burden faced by informal caregivers in caring for a child diagnosed with HIV/AIDS, and placed on Antiretroviral Therapy (ART) is high due to the nature of the child’s dependence on the caregiver for fulfilling the child’s necessary needs. Evidence linking knowledge to the likelihood of performing the desired action exists. It is therefore crucial to explore caregivers’ knowledge of ART, and how that influences their children’s adherence to ART. The sought to explore the knowledge of informal caregivers on adherence to ART among their children with HIV/AIDS who received care at St. Joseph’s Hospital, Jirapa, Ghana. A qualitative phenomenology design was used. Data were collected from 13 purposively chosen caregivers of children with HIV/AIDS on ART at a hospital, using a semi-structured in-depth interview guide. A reflexive thematic analysis approach was used for data analysis. Informal caregivers were knowledgeable in the regularity of visits to the HIV Testing and Counselling (HTC) Centre for ARTs, identifying ARTs, ARTs administration, ARTs side effects identification, HIV transmission, and the nutritional restrictions for ARTs. A few, however, had misconceptions about HIV transmission. Informal caregivers still need education in the area of HIV transmission. The findings will guide nurses to focus on areas of education for informal caregivers to improve upon their knowledge of ART and to ensure increased adherence among children living with HIV/AIDS under their care.

A QUALITATIVE STUDY OF THE KNOWLEDGE OF INFORMAL CAREGIVERS OF CHILDREN WITH HIV/AIDS ON ANTIRETROVIRAL THERAPY ADHERENCE

The burden faced by informal caregivers in caring for a child diagnosed with HIV/AIDS, and placed on Antiretroviral Therapy (ART) is high due to the nature of the child’s dependence on the caregiver for fulfilling the child’s necessary needs. Evidence linking knowledge to the likelihood of performing the desired action exists. It is therefore crucial to explore caregivers’ knowledge of ART, and how that influences their children’s adherence to ART. The sought to explore the knowledge of informal caregivers on adherence to ART among their children with HIV/AIDS who received care at St. Joseph’s Hospital, Jirapa, Ghana. A qualitative phenomenology design was used. Data were collected from 13 purposively chosen caregivers of children with HIV/AIDS on ART at a hospital, using a semi-structured in-depth interview guide. A reflexive thematic analysis approach was used for data analysis. Informal caregivers were knowledgeable in the regularity of visits to the HIV Testing and Counselling (HTC) Centre for ARTs, identifying ARTs, ARTs administration, ARTs side effects identification, HIV transmission, and the nutritional restrictions for ARTs. A few, however, had misconceptions about HIV transmission. Informal caregivers still need education in the area of HIV transmission. The findings will guide nurses to focus on areas of education for informal caregivers to improve upon their knowledge of ART and to ensure increased adherence among children living with HIV/AIDS under their care.

Results of an interventional HIV testing programme in the context of a mpox (formerly monkeypox) vaccination campaign in Latium Region, Italy, August to October 2022.

HIV testing was offered to 2,185 people receiving mpox (formerly monkeypox) vaccination, who reported not being HIV positive. Among them 390 were current PrEP users, and 131 had taken PrEP in the past. Of 958 individuals consenting testing, six were newly diagnosed with HIV. Two patients had symptomatic primary HIV infection. None of the six patients had ever taken PrEP. Mpox vaccination represents an important opportunity for HIV testing and counselling about risk reduction and PrEP.

Hiv testing and counseling services in Kassala State, Sudan: what are the relevant beliefs of private healthcare providers?

ABSTRACT HIV testing and counseling (HTC) services are essential for all HIV prevention and treatment interventions. Evidence is limited on the role of private healthcare providers in providing HTC services. This study assessed the relevant beliefs for intervention to enhance the intention to offer HTC services among private healthcare providers. A cross-sectional study included 387 private healthcare providers who completed a questionnaire about beliefs and intentions regarding offering HTC services. A Confidence Interval Based Estimation of Relevance (CIBER) approach was used to identify the most relevant beliefs. The behavioral belief “Offering HTC services would cause patients to feel worries” and the normative belief “My managers believe that I should offer HTC services to patients” were relevant beliefs for intervention. The control beliefs “If I offer HTC services, I spend more time with the patients” and “Patients are at low risk of HIV, and they would not need HTC services” were significantly associated with intention and important intervention candidates. The belief “If I offer HTC services, I would be concerned about HIV test results confidentiality” was a relevant belief to target with intervention. The beliefs of private service providers differ in their association with relevance to their intention to offer HTC services. More relevant beliefs need to be selected to increase the potential effectiveness of the interventions to promote the private healthcare providers’ intentions to offer HTC services.

Considerations to Improve Pediatric HIV Testing and Close the Treatment Gap in 16 African Countries.

In 2019, South Africa, Nigeria, Tanzania, Democratic Republic of Congo, Uganda, Mozambique, Zambia, Angola, Cameroon, Zimbabwe, Ghana, Ethiopia, Malawi, Kenya, South Sudan and Côte d'Ivoire accounted for 80% of children living with HIV (CLHIV) not receiving HIV treatment. This manuscript describes pediatric HIV testing to inform case-finding strategies. We analyzed US President's Emergency Plan for AIDS Relief monitoring, evaluation, and reporting data (October 1, 2018 to September 30, 2019) for these 16 countries. Number of HIV tests and positive results were reported by age band, country, treatment coverage and testing modality. The number needed to test (NNT) to identify 1 new CLHIV 1-14 years was measured by testing modality and country. The pediatric testing gap was estimated by multiplying the estimated number of CLHIV unaware of their status by NNT per country. Among children, 6,961,225 HIV tests were conducted, and 101,762 CLHIV were identified (NNT 68), meeting 17.6% of the pediatric testing need. Index testing accounted for 13.0% of HIV tests (29.7% of positive results, NNT 30), provider-initiated testing and counseling 65.9% of tests (43.6% of positives, NNT 103), and universal testing at sick entry points 5.3% of tests (6.5% of positives, NNT 58). As countries near HIV epidemic control for adults, the need to increase pediatric testing continues. Each testing modality - PITC, universal testing at sick entry points, and index testing - offers unique benefits. These results illustrate the comparative advantages of including a strategic mix of testing modalities in national programs to increase pediatric HIV case finding.

“Why should I?”

This study aimed to discover what specific beliefs of students at a South African universityshould be addressed when trying to persuade them to go for HIV counselling and testing (HCT).The participants were 113 students from a previously disadvantaged university. The studentscompleted a questionnaire that included questions about participants’ HCT intentions and aboutpossible predictors of such intentions. Students’ HCT intention proved to be positively related totheir perception of having control over their HCT behaviour (self-efficacy), and to their perceptionof social pressure towards going for HCT (perceived norm). The students’ belief that they wouldnot be either too afraid or too stressed to go for HCT contributed positively to their self-efficacy,as did the belief that they would be able to deal with the possibly disadvantageous outcome of theHIV test. The students’ belief that their parents would approve of their going for HCT proved to bea strong and positive predictor of their perceived norm. Furthermore, perceived susceptibility toHIV/AIDS was positively related to HCT intention, and stigmatising attitude towards people livingwith HIV/AIDS (PLWHAs) was negatively related to HCT intention. These outcomes suggestthat in trying to convince black students in South Africa to go for HCT, developers of promotionmessages should focus on students’ susceptibility to HIV, on how to deal with the possibilitythat their parents might not approve of their going for HCT, and on how to cope with a possiblydisadvantageous test outcome.

Alcohol consumption and utilization of HIV prevention services among men who have casual sex with women in China

ABSTRACT Men who have casual sex with women (MCSW) have played an important role in HIV new infections in China. Research studies have shown that heavy alcohol consumption can increase the risk of HIV infection. The cross-sectional study was conducted in two cities in China from December 2018 to May 2019 to examine the association between alcohol consumption and utilization of HIV prevention services among MCSW. Convenience sampling was used to recruit participants and 400 MCSW were recruited in this study. There were 238 (59.6%), 213 (53.4%) and 129 (32.4%) participants having utilized HIV prevention services, condom promotion and distribution or HIV counseling and testing (CPD/HCT) services, and peer education services in the past 12 months, respectively. MCSW who were identified as heavy drinkers were less likely to utilize HIV prevention services and CPD/HCT services compared with non-drinkers. For youngsters, those who are in the local household and those who are married/cohabitating, heavy drinkers was less likely to utilize HIV prevention services. This study highlights the significance of intensive education on heavy drinkers of MCSW, particularly for high-risk subgroups. Targeting resources for integrated HIV prevention efforts with alcohol-using MCSW should be considered by public health policymakers.

Trends and Factors Associated with HIV Testing among Adolescent Girls and Young Women in Lesotho: Results from 2004 to 2014 Lesotho Demographic and Health Surveys

HIV/AIDS is prevalent among adolescent girls and young women (AGYW) in Lesotho, and among the top five infectious diseases causing a high mortality rate in Africa. The paramount management of HIV is based on screening, prevention, and therapeutic interventions, of which HIV testing and counselling (HTC) is the gateway. The utilization of HTC services among AGYW is limited owing to numerous barriers encountered by this population group. The aim of this study was to assess trends and factors associated with HTC among AGYW in Lesotho. A secondary data analysis was used to analyze data sets extracted from the 2004, 2009, and 2014 Lesotho Demographic Health Surveys (LDHS). The LDHS was conducted using a cross-sectional study design and samples drawn were representative of the whole population of Lesotho. We used descriptive analysis to determine trends in HTC. In determining factors associated with the uptake of HTC, univariate and multivariable logistic regression models were applied on the 2014 LDHS. All analyses were adjusted for unequal sampling probabilities using survey weights. The number of AGYWs analyzed were 2743 in 2004, 2393 in 2009, and 2842 in 2014. The overall prevalence estimates of HTC uptake were 12%, 62.2%, and 72.5%, respectively. For the 15–19 years AGYW, HTC uptake rose from 6.2% (2004), 46.3% (2009), to 57.9% (2014), while for the 20–24 years age group, the rates were 18.7%, 80.2%, and 88.3%, respectively. For the 2842 AGYW in 2014, the odds of ever having an HIV test were significantly higher for those aged 20–24 years (aOR 2.15, 95% CI 1.61 to 2.87, p < 0.001), in a union (aOR 3.21, 95%CI 2.25 to 4.58, p < 0.001), with Mother-to-child transmission of HIV (MTCT) knowledge (aOR 1.53, 95%CI: 1.21 to 1.94, p < 0.001), with HIV non-discriminatory attitudes (aOR 2.50, 95%CI 1.87 to 3.34, p < 0.001), and those who had ever been pregnant (aOR 11.53, 95%CI 7.46 to 17.84, p < 0.001). HTC uptake among AGYW in Lesotho is below expected targets, hence we recommend optimizing access to HTC services, especially for AGYW aged 15–19 years.

The early-stage comprehensive costs of routine PrEP implementation and scale-up in Zambia.

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention option, but cost-effectiveness is sensitive to implementation and program costs. Studies indicate that, in addition to direct delivery cost, PrEP provision requires substantial demand creation and client support to encourage PrEP initiation and persistence. We estimated the cost of providing PrEP in Zambia through different PrEP delivery models. Taking a guidelines-based approach for visits, labs and drugs, we estimated the annual cost of providing PrEP per client for five delivery models: one focused on key populations (men-who-have-sex-with-men (MSM) and female sex workers (FSW), one on adolescent girls and young women (AGYW), and three integrated programs (operated within HIV counselling and testing services at primary healthcare centres). Program start-up and support costs were based on program expenditure data and number of PrEP sites and clients in 2018. PrEP clinic visit costs were based on micro-costing at two PrEP delivery sites (2018 USD). Costs are presented in 2018 prices and inflated to 2021 prices. The annual cost/PrEP client varied by service delivery model, from $394 (AGYW) to $655 (integrated model). Cost differences were driven largely by client volume, which impacted the relative costs of program support and technical assistance assigned to each PrEP client. Direct service delivery costs ranged narrowly from $205-212/PrEP-client and were a key component in the cost of PrEP, representing 35-65% of total costs. The results show that, even when integrated into full service delivery models, accessing vulnerable, marginalised populations at substantial risk of HIV infection is likely to cost more than previously estimated due to the programmatic costs involved in community sensitization and client support. Improved data on individual client resource usage and outcomes is required to get a better understanding of the true resource utilization, expected outcomes and annual costs of different PrEP service delivery programs in Zambia.

Missed opportunities for HIV counselling and testing service delivery among pregnant women in Nigeria: Evidence from the 2018 National nutrition and health survey.

According to UNAIDS, the 90-90-90 strategy calls for 90% of HIV-infected individuals to be diagnosed by 2020, 90% of whom will be on anti-retroviral therapy (ART) and 90% of whom will achieve sustained virologic suppression. HIV counselling and testing (HCT) is an important entry point for effective prevention of mother-to-child transmission of HIV. However, evidence abounds that HCT is often missed by pregnant women during antenatal care in Nigeria. We used secondary data from the 2018 Nigerian National Nutrition and Health Survey (NNHS) to determine the pattern of missed opportunities within the HCT algorithm and the factors associated with the missed opportunities. Of the 8,329 eligible women, 2,327 (27.9%) missed HCT because of lack of antenatal care; 1,493 (24.9%) missed HIV pre-test counselling; 180 (4.0%) missed HIV testing after participating in pre-test counselling, while 793 (18.2%) missed collection of HIV result and post-test counselling. Generally, most of the women that missed HCT were from the North West (43.3%) and had their antenatal care with traditional birth attendants. The odds of missing ANC were higher in women in the Northern and Southern regions. Concerning pre-test HIV counselling, the odds of missing it were higher among women in the Northwest and Southeast while the odds of missing post-test counselling of HIV test were higher among women in the Northeast and Southeast relative to other regions. Using TBA as a care provider was associated with higher odds of women missing pre-test and post-test counselling of HIV during ANC compared to those that used doctors or midwives or CHEWs. Missed opportunities are common in different stages of HIV counselling and testing pathway in Nigeria, particularly in the Northern regions. Future studies would need to identify the specific reasons for these missed opportunities, enabling the targeting of more specific policy reform and interventions.

Optimal utilization of prevention of mother-to-child transmission of HIV services among adolescents under group versus focused antenatal care in Eastern Uganda.

Group antenatal care (G-ANC), an alternative to focused ANC (F-ANC), involves grouping mothers by gestational and maternal age. In high-income countries, G-ANC has been associated with improved utilization of health care services like Prevention of Mother to Child Transmission (PMTCT) of HIV services. Some low-resource countries with poor utilization of health care services have piloted G-ANC. However, there is limited evidence of its efficiency. We, therefore, compared G-ANC versus F-ANC with regards to optimal utilization of PMTCT of HIV services and assessed associated factors thereof among adolescent mothers in eastern Uganda. We defined optimal utilization of PMTCT of HIV services as the adolescent being up to date with HIV counseling and testing. If found HIV negative, subsequent timely re-testing. If found HIV positive, initiation of antiretroviral therapy (ART) under option B plus for the mother. While for the infant, it entailed safe delivery, testing, feeding, and appropriate HIV chemotherapy. From February to April 2020, we conducted a cross-sectional study among 528 adolescent mothers in four sites in eastern Uganda. We assessed the optimal utilization of PMTCT of HIV services among adolescent mothers that had attended G-ANC versus F-ANC at the post-natal care or immunization clinics. We also assessed the factors associated with optimal utilization of PMTCT of HIV services among these mothers. Optimal utilization of PMTCT was higher among those in G-ANC than in F-ANC (74.7% vs 41.2, p-0.0162). There was a statistically significant association between having attended G-ANC and optimal utilization of PMTCT [PR = 1.080, 95%CI (1.067-1.093)]. Other factors independently associated with optimal utilization were; having a partner that tested for HIV [PR = 1.075, 95%CI (1.048-1.103)], trimester of first ANC visit: second trimester [PR = 0.929, 95%CI (0.902-0.957)] and third trimester [PR = 0.725, 95%CI (0.616-0.853)], and the health facility attended: Bugembe HCIV [PR = 1.126, 95%CI (1.113-1.139)] and Jinja regional referral hospital [PR = 0.851, 95%CI (0.841-0.861]. Adolescent mothers under G-ANC had significantly higher optimal utilization of PMTCT of HIV services compared to those under F-ANC. We recommend that the Ministry of Health considers widely implementing G-ANC, especially for adolescent mothers.

Psychosocial beliefs of health providers' intention and behavior of offering HIV testing and counseling services: Estimating their relevance for intervention.

Diagnosis of people with HIV is vital in achieving the 95-95-95 global targets. The proportion of people with HIV who know they have HIV in Sudan is low. Promoting engagement of healthcare providers (HCPs) in offering HIV Testing and Counseling (HTC) services would improve the percentage of diagnosed people with HIV in the country. This study aims to assess the psychosocial beliefs associated with HCPs' intention and behavior to offer HTC services and their relevance for intervention. This institutional cross-sectional study was conducted in Kassala State, from July 2019 to February 2020, among 438 healthcare providers from public health facilities. A self-administered questionnaire was used to assess behavior and intention to offer HTC services and related behavioral, normative, and control beliefs. Data were analyzed using R software. Confidence Interval Based Estimation of Relevance (CIBER) was used to estimate the relevance of the beliefs to interventions. The CIBER analysis showed that the belief "It causes many worries for patients if I offer or counsel them about HIV test" was negatively associated with HCPs' intention and behavior to offer HTC services and a highly relevant belief for intervention. The belief "My manager thinks I should offer or counsel patients about HIV test" was positively associated with the behavior and intention to offer HTC services and was a relatively highly relevant belief. The control belief "Patients are at low risk of HIV and do not need offering or counseling about HIV test" was negatively associated with HCPs' intention and behavior and was relevant for intervention. The control belief "If I offered or counseled patients about HIV test, I would spend more time with them" was negatively associated with the intention and behavior of HCPs toward HTC services, with high relevance to target with intervention. The belief "My colleagues think I should offer or counsel patients about HIV test" was weakly associated with behavior and intention, and it is a low relevant belief for intervention. Different psychosocial beliefs among healthcare providers can influence their intention and behavior to offer HTC services to patients. More relevant beliefs are required to be targeted with interventions to promote the intention and behavior of providing HTC services among health care providers.

Impact of coronavirus disease 2019 on the HIV testing and health care delivery at a university hospital in Taiwan, 2020–2021

BackgroundTo contain the coronavirus disease 2019 (Covid-19) pandemic, non-pharmacologic interventions, including lockdown and social distancing, may have adverse impact on access to HIV testing and care. This study investigated the impact of Covid-19 on HIV testing and care at a major hospital in Taiwan in 2020–2021.MethodsThe numbers of clients seeking anonymous HIV voluntary counseling and testing were compared 2 years before (2018–2019) and 2 years after Covid-19 outbreak (2020–2021). People living with HIV (PLWH) who sought care at the hospital during 2018–2021 were included to examine the status of HIV care delivery and disposition.ResultsThe annual number of HIV screening tests performed had significantly decreased from 2507 to 2794 in 2018 and 2019, respectively, to 2161 and 1737 in 2020 and 2021, respectively. The rate of discontinuation of HIV care among PLWH was 3.7% in 2019, which remained unchanged in 2020 (3.7%) and 2021 (3.8%). The respective percentage of annual plasma HIV RNA testing <2 times increased from 8.4% to 7.8% in 2018 and 2019 to 7.0% and 10.7% in 2020 and 2021, so was that of annual syphilis testing <2 times (10.1% and 8.8%–7.9% and 12.0%). The rates of plasma HIV RNA <200 copies/ml ranged from 97.0% to 98.1% in 2018–2021.ConclusionsDuring the Covid-19 pandemic, access to HIV counseling and testing was significantly limited. While the number of HIV-related testing decreased, the impact of Covid-19 on the continuity of antiretroviral therapy and viral suppression among PLWH appeared to be minimal in Taiwan.

Initial implementation of HIV pre-exposure prophylaxis for people who are incarcerated in Zambia: a cross-sectional observational study

There are over 23 000 incarcerated people in Zambia, a population which has higher HIV prevalence than the general population yet has no access to HIV prevention. To evaluate the feasibility of HIV pre-exposure prophylaxis (PrEP) implementation in Zambian criminal justice facilities, we offered PrEP services to incarcerated people and aimed to describe early implementation outcomes. In this cross-sectional observational study, we implemented a PrEP programme between Oct 1, 2020, and March 31, 2021, supporting 16 criminal justice facilities in four Zambian provinces. Before implementation, we held stakeholder engagement meetings with Zambia Correctional Service officials to discuss PrEP benefits, and trained Zambia Correctional Service health-care workers in PrEP management using the national PrEP training package. People who were incarcerated and screened positive for substantial HIV risk by use of a standardised HIV risk assessment tool were offered voluntary HIV testing and counselling. Those who tested positive were linked to antiretroviral therapy, and those who tested negative and met national HIV prevention eligibility criteria were offered PrEP. We assessed PrEP uptake and used descriptive statistics to characterise programme beneficiaries and the cascade of PrEP services. During the study period, we reached 12 367 people older than 15 years with HIV risk assessment and counselling, including 11 794 (95·4%) men and 573 (4·6%) women. Of these, 2610 people received HIV testing, with 357 (13·7%) testing HIV positive; positivity was significantly higher in women (20·6%) than men (13·2%, p=0·011). 1276 people were identified as HIV negative and PrEP eligible. Of these, 1190 (93·3%) initiated PrEP. The age group with the highest proportion reached and initiated on PrEP was those aged 25-29 years, representing 19·2% (2377 of 12 367) of all people reached and 24·1% (287 of 1190) of those who initiated PrEP. Delivery of PrEP to people who are incarcerated is feasible with adequate resourcing and support to the criminal justice health system, and can result in high uptake among eligible individuals. Further assessment is needed of PrEP persistence and adherence, and the perceptions of people who are incarcerated regarding their HIV risk and preferences for combination HIV prevention services. US President's Emergency Plan for AIDS Relief through the US Centers for Disease Control and Prevention.

Assessing the sustainability of the Systems Analysis and Improvement Approach to increase HIV testing in family planning clinics in Mombasa, Kenya: results of a cluster randomized trial

BackgroundIn Kenya, HIV incidence is highest among reproductive-age women. A key HIV mitigation strategy is the integration of HIV testing and counseling (HTC) into family planning services, but successful integration remains problematic. We conducted a cluster-randomized trial using the Systems Analysis and Improvement Approach (SAIA) to identify and address bottlenecks in HTC integration in family planning clinics in Mombasa County, Kenya. This trial (1) assessed the efficacy of this approach and (2) examined if SAIA could be sustainably incorporated into the Department of Health Services (DOHS) programmatic activities. In Stage 1, SAIA was effective at increasing HTC uptake. Here, we present Stage 2, which assessed if SAIA delivery would be sustained when implemented by the Mombasa County DOHS and if high HTC performance would continue to be observed.MethodsTwenty-four family planning clinics in Mombasa County were randomized to either the SAIA implementation strategy or standard care. In Stage 1, the study staff conducted all study activities. In Stage 2, we transitioned SAIA implementation to DOHS staff and compared HTC in the intervention versus control clinics 1-year post-transition. Study staff provided training and minimal support to DOHS implementers and collected quarterly HTC outcome data. Interviews were conducted with family planning clinic staff to assess barriers and facilitators to sustaining HTC delivery.ResultsOnly 39% (56/144) of planned SAIA visits were completed, largely due to the COVID-19 pandemic and a prolonged healthcare worker strike. In the final study quarter, 81.6% (160/196) of new clients at intervention facilities received HIV counseling, compared to 22.4% (55/245) in control facilities (prevalence rate ratio [PRR]=3.64, 95% confidence interval [CI]=2.68–4.94). HIV testing was conducted with 60.5% (118/195) of new family planning clients in intervention clinics, compared to 18.8% (45/240) in control clinics (PRR=3.23, 95% CI=2.29–4.55). Interviews with family planning clinic staff suggested institutionalization contributed to sustained HTC delivery, facilitated by low implementation strategy complexity and continued oversight.ConclusionsIntervention clinics demonstrated sustained improvement in HTC after SAIA was transitioned to DOHS leadership despite wide-scale healthcare disruptions and incomplete delivery of the implementation strategy. These findings suggest that system interventions may be sustained when integrated into DOHS programmatic activities.Trial registrationClinicalTrials.gov (NCT02994355) registered on 16 December 2016.

Pregnancy and childbirth: male partner involvement in Uasin Gishu, Kenya

IntroductionIn many African countries, pregnancy and childbirth has traditionally been regarded as a woman’s affair. As a result, male partner involvement and participation in pregnancy and childbirth has been minimal, which is thought to have contributed to the high rate of maternal and neonatal morbidities and mortalities. Male partners are often key decision-makers in African households for cultural reasons, yet their role in pregnancy and childbirth is not clearly defined. The aim of this study was to examine and document male partner involvement in maternal healthcare in Kenya.MethodsA health facility-based cross-sectional descriptive study design was used. Systematic random sampling was used to select 384 women seeking maternal and child healthcare at Uasin Gishu County Hospital. The participants were interviewed using structured interviewer-administered questionnaires.ResultsAlmost a third of participants (32%) reported never being accompanied by their partners to maternity clinic visits, while 41% were accompanied only for HIV counselling and testing. Over half of respondents reported that their partners provided a fare or transport to the antenatal clinic (55%) and that they were supported when taking iron and folic acid supplements (58%). Just over a third of participants reported their partners took them to the hospital during labour (37%). Only 8% of male partners were present during labour and birth, 55% provided money to travel home after the birth and less than a fifth (19%) accompanied their wives home after birth.ConclusionsMale partner involvement in maternal care is very low in Uasin Gishu county. Male partner involvement needs to be recognised and addressed in health education because of the potential benefits to both maternal and child health outcomes. Health systems should focus on providing couple-friendly antenatal care services. Maternal health intervention strategies and policies that inadvertently isolate men from active engagement in antenatal and postnatal health programmes should be reviewed.

Satisfaction of the Clients Attending Integrated Counseling and Testing Center in a Teaching Hospital of North-Eastern India

Background: Integrated Counseling and Testing Centers (ICTC) provide counseling and testing for HIV to the clients. Satisfaction of the clients attending an ICTC determines its acceptance among people, and it is crucial for preventing this disease. Objectives: To estimate the level of satisfaction and to determine its association with sociodemographic parameters of the clients attending ICTC in a teaching hospital. Methodology: This hospital-based cross-sectional study was conducted in October 2019 among 213 clients attending ICTC of Agartala Government Medical College, chosen by census technique. An interview schedule containing information regarding age, sex, marital status, education, socioeconomic class, along with a component for evaluating HIV counseling and testing services initially used by UNAIDS, was used for data collection. Results: Among the clients, 54.5% (116) were male, 45.5% were aged between 35 and 80 years, 79.3% were from rural areas, 87.8% were Hindu by religion, 33.8% belonged to scheduled caste community, 63.4% were primary educated, 35.2% belonged to BG Prasad's Class II socioeconomic status, 83.6% were married, and 10.3% attended ICTC by self-initiated approach. Only 39% of the clients were found to be satisfied with the services of this ICTC. Waiting time in queue was found to be significantly associated with client's satisfaction. Conclusion: The client's satisfaction level was found to be low. Reduction in queuing time, caring attitude, and use of the client's own language might improve the scenario.

Compliance to HIV testing and counseling guidelines at antenatal care clinics in the Kassena-Nankana districts of northern Ghana: A qualitative study.

Utilization of antenatal care services in Ghana has substantially increased over the years, but the rates of mother-to-child transmission of HIV is still high. The high burden of HIV among pregnant women has serious implications for mother-to-child transmission. The main objective of this study was to assess the compliance of HIV testing and counseling provided at antenatal care clinics in two rural districts in northern Ghana by comparing reported practices to the national guidelines. This study was a descriptive qualitative study conducted in the Kassena-Nankana Districts of northern Ghana. In-depth interviews were conducted with 10 midwives, 10 mothers, and 2 public health nurses who were recruited through purposive and snowball sampling. All interviews were audio recorded, transcribed into English, and imported into NVivo 12.0 software for open, axial, and selective coding. The findings indicate that not all pregnant women were informed prior to testing nor informed of their test results. Many mothers indicated that pre-test counseling is limited although the midwives claimed to provide it. Post-test counseling is primarily given to those who test positive, and several midwives agreed that there is no need to counsel HIV-negative women. Perceptions of the lack of confidentiality and privacy were pervasive among mothers despite the emphasis placed on its importance by the midwives. There were conflicting reports on whether HIV testing during antenatal care is voluntary or compulsory. The challenges with HIV testing and counseling that were mentioned by midwives include lack of adequate infrastructure, language barriers, and insufficient training. HIV testing and counseling provided at antenatal care is not uniform across all health facilities and does not strictly adhere to national guidelines. Future interventions that focus on standardization, monitoring, privacy, and capacity building are likely to prove valuable in ensuring quality services are provided.

Effects of a structured health education on prevention of HIV risky behaviours among adolescents in Nigeria – a pragmatic randomized controlled trial

ABSTRACT Infection with HIV/AIDS continues to be a major public health concern around the world, particularly in low- and middle-income nations. To assess the effectiveness of structured health education on the prevention of HIV/AIDS risky behaviours among adolescents in secondary school. A pretest-posttest-control group randomized controlled trial where a sample of 647 adolescents was drawn from the population of 2,890 secondary school students and was block-randomized into the intervention (n = 400) and control (n = 224) groups. Data were collected using a content-validated (CVI = 4.2/5) and reliable (k = 0.791) self-developed structured questionnaire. Data were analyzed using descriptive statistics and with inferential statistics of independent and paired t-tests at α = 0.05. Pre-intervention risky behaviours in both groups were below average though lower in the intervention than in the control group. Pre-intervention risky behaviour was significantly higher among males than females in the rural school (p < 0.001) and in both schools together (p < 0.001). Health education significantly affected risky behaviour with the intervention group being associated with lesser risky behaviour than the control group. There was no significant difference in the post-intervention risky behaviour between males and females in the rural (0.285), urban (0.179) and both schools together (p = 0.956). Post-intervention reduced risky behaviours more significantly in the intervention than in the control groups. HIV/AIDS health education should be part of schools’ curriculum, guidance and counsellor teachers should be trained as HIV counsellors