Human Immunodeficiency Virus Services Research Articles

Approaches for prevention of mother-to-child transmission of HIV services during coronavirus disease 2019

Background: During the coronavirus disease 2019 (COVID-19) pandemic, there was a reduction in access to prevention of mother-to-child transmission (PMTCT) of human Immunodeficiency virus (HIV) services globally, yet this programme is critical for reducing paediatric HIV incidence. To minimise the impact of COVID-19 and prevent disruptions to the PMTCT service provision, innovative strategies had to be developed and implemented.Aim: The study aimed to describe the approaches that were developed and utilised during the COVID-19 pandemic in enhancing PMTCT services in Tshwane primary healthcare facilities.Settings: Three primary healthcare facilities that were providing PMTCT services during the COVID-19 pandemic located in the Tshwane district, Gauteng province, South Africa.Methods: The study is part of a larger study that focused on the experiences of healthcare workers who were rendering PMTCT services during the COVID-19 pandemic. An interpretative phenomenological analysis (IPA) design was employed to gain insight into the experiences of 16 purposively sampled healthcare workers who were providing PMTCT services during the pandemic in Tshwane district facilities. In-depth individual audio-recorded interviews were conducted with study participants, following a semi-structured interview guide. Data analysis was performed using an IPA framework.Results: Three superordinate themes emerged: strategies utilised for providing care, community-based initiatives, and support systems to enhance the PMTCT service access.Conclusion: Strengthening community-based initiatives and support systems is important for the enhancement of the PMTCT programme during and beyond the pandemic.Contribution: Community-based initiatives are critical in continuity of PMTCT services, reducing HIV incidence, under-five child morbidity and mortality particularly during emergency situations.

Reasons for implementation success despite health system constraints: qualitative insights on ‘what worked’ for cotrimoxazole preventive therapy

BackgroundAlthough Cotrimoxazole preventive therapy (CPT) has shown to be highly efficacious in reducing morbidity and mortality among people living with Human immunodeficiency virus (HIV) under ‘ideal world’ study conditions, operational challenges are limiting its effectiveness when implementing in countries most affected by the HIV epidemic. The fact that Mozambican authorities reported high coverage of CPT among patients with HIV, has led to this qualitative case study aimed at exploring possible factors responsible for the successful implementation of CPT in the Province of Maputo.MethodsBetween February and April 2019, we individually interviewed nine governmental stakeholders, including the person responsible for the HIV Program, the person responsible for the TB Program and the person responsible for Pharmaceutical management at three administrative levels (central, provincial and district level). Interviews were recorded, transcribed, and analysed thematically using MAXQDA Analytics Pro. Findings were translated from Portuguese into English.ResultsFive themes iteratively emerged: (a) Role of governance & leadership, (b) Pharmaceutical strategies, (c) Service delivery modifications, (d) Health care provider factors, and (e) Patients’ perspectives.Interviews revealed that continuous supply of cotrimoxazole (CTZ) had been facilitated through multiple-source procurement and a push-pull strategy. One part of CTZ arrived in kits that were imported from overseas and distributed to public health facilities based on their number of outpatient consultations (push strategy). Another part of CTZ was locally produced and distributed as per health facility demand (pull strategy). Strong district level accountability also contributed to the public availability of CTZ. Interviewees praised models of differentiated care, the integrated HIV service delivery and drug delivery strategies for reducing long queues at the health facility, better accommodating patients’ needs and reducing their financial and organisational burden.ConclusionsThis study presents aspects that governmental experts believed to be key for the implementation of CPT in the Province of Maputo, Mozambique. Enhancing the implementation outcomes – drug availability and feasibility of the health facility-based service delivery – seemed crucial for the implementation progress. Reasons for the remarkable patient acceptability of CPT in our study setting should be further investigated.

Provider and female client economic costs of integrated sexual and reproductive health and HIV services in Zimbabwe.

A retrospective facility-based costing study was undertaken to estimate the comparative cost per visit of five integrated sexual and reproductive health and HIV (human immuno-deficiency virus) services (provider perspective) within five clinic sites. These five clinics were part of four service delivery models: Non-governmental-organisation (NGO) directly managed model (Chitungwiza and New Africa House sites), NGO partner managed site (Mutare site), private-public-partnership (PPP) model (Chitungwiza Profam Clinic), and NGO directly managed outreach (operating from New Africa House site. In addition client cost exit interviews (client perspective) were conducted among 856 female clients exiting integrated services at three of the sites. Our costing approach involved first a facility bottom-up costing exercise (February to April 2015), conducted to quantify and value each resource input required to provide individual SRH and HIV services. Secondly overhead financial expenditures were allocated top-down from central office to sites and then respective integrated service based on pre-defined allocation factors derived from both the site facility observations and programme data for the prior 12 months. Costs were assessed in 2015 United States dollars (USD). Costs were assessed for HIV testing and counselling, screening and treatment of sexually transmitted infections, tuberculosis screening with smear microscopy, family planning, and cervical cancer screening and treatment employing visual inspection with acetic acid and cervicography and cryotherapy. Variability in costs per visit was evident across the models being highest for cervical cancer screening and cryotherapy (range: US$6.98-US$49.66). HIV testing and counselling showed least variability (range; US$10.96-US$16.28). In general the PPP model offered integrated services at the lowest unit costs whereas the partner managed site was highest. Significant client costs remain despite availability of integrated sexual and reproductive health and HIV services free of charge in our Zimbabwe study setting. Situating services closer to communities, incentives, transport reimbursements, reducing waiting times and co-location of sexual and reproductive health and HIV services may help minimise impact of client costs.

HIV Voluntary Counselling and Testing Utilisation among School of Healthcare Sciences Undergraduate Students at the University of Limpopo.

Existing evidence indicates that South African university students have low utilisation of Human Immunodeficiency Virus (HIV) Voluntary Counselling and Testing (VCT). A cross-sectional survey was conducted to determine the utilisation of HIV VCT among undergraduate students in the School of Healthcare Sciences. Structured questionnaires were used to collect data through Google Forms. The results are presented through descriptions and percentages and illustrated in tables. Out of 389 undergraduate students, only 324 completed the questionnaire. The majority (97.2%) were aware of the health centre on campus, while only (74.7%) knew about the HIV VCT services offered on campus. Despite the awareness, many (36.7%) do not utilise the campus HIV VCT services, and some (9.6%) have never tested for HIV. There was an association between awareness of Voluntary Counselling and Testing of HIV services offered at the campus health and wellness centre and utilisation of HIV Voluntary Counselling and Testing at (<0.001). Therefore, it is imperative to urgently escalate the level of HIV/AIDS education in higher institutions of learning and emphasise the mounting danger of HIV infection and the immense importance of regular HIV testing. The findings of this study could serve as a foundation for creating HIV prevention and control programmes for youth, particularly in higher education institutions.

Impact de la COVID-19 sur les services de prévention du VIH et de prise en charge des personnes vivant avec le VIH dans la ville de Bukavu : une étude mixte séquentielle explicative

Introduction : Depuis son apparition fin 2019 en Chine, les mesures de riposte contre l’infection à COVID-19 ont perturbé la prestation des services de santé primaires dont ceux liés au virus de l’immunodéficience humaine (VIH). En République démocratique du Congo, l’effet des mesures anti-COVID-19 (confinement) sur l’utilisation des services de prévention du VIH et de prise en charge des personnes vivant avec le VIH (PVVIH) reste peu décrit à ce jour. Objectif : Comparer et comprendre l’effet des mesures anti-COVID-19 sur l’utilisation des services préventifs du VIH et de prise en charge des PVVIH dans les Centres de traitement ambulatoire (CTA) de Bukavu avant (octobre 2019 à février 2020) et pendant (mars à juillet 2020) la période des mesures anti-COVID-19. Méthodes : Étude mixte multisite avec un devis séquentiel explicatif réalisée à Bukavu entre juillet et septembre 2021. La phase quantitative est observationnelle, descriptive, rétrospective et basée sur des données programmatiques issues des CTA. La phase qualitative, guidée par les résultats quantitatifs, est basée sur 31 entretiens semi-structurés avec les soignants et les PVVIH. Résultats : Par comparaison avec la période pré-COVID-19, les mesures anti-COVID-19 ont entrainé une baisse de 11 à 20% des services de prévention du VIH et de prise en charge des PVVIH. Elles ont également induit les ruptures de stock d’antirétroviraux et de tests VIH, la réorganisation des services VIH, la contamination de certains soignants à la COVID-19 et le décès d’autres, ainsi qu’une baisse de l’utilisation des services VIH. Discussion et conclusion : À Bukavu, les mesures anti-COVID-19 ont eu un impact négatif sur le parcours de soins des personnes à risque et infectées par le VIH. Elles ont entravé les progrès vers les objectifs : 95% des personnes dépistées au VIH, 95% des PVVIH sous traitement et 95% des PVVIH avec une charge virale supprimée.

Assisted Partner Notification Services in Namibia: Comparison of Case-Finding in Persons With New and Previously Diagnosed Human Immunodeficiency Virus, and Success as a Platform for PrEP Referral.

Assisted partner notification services (APS) are widely implemented throughout sub-Saharan Africa. The effectiveness of APS among persons with previously diagnosed human immunodeficiency virus (HIV) infection is uncertain, and there are few published data on the success of integrating referrals for HIV preexposure prophylaxis (PrEP) into APS. Staff in 22 Namibian Ministry of Health and Social Service clinics offered APS to patients newly and previously diagnosed with HIV (index cases [ICs]) between October 2019 and June 2021. Counselors used a structured interview guide to elicit ICs' sex partners and biological children and assisted ICs to arrange testing of contacts. Contacts testing HIV-positive were linked to HIV services and those 14 years or older testing negative were offered PrEP. The primary outcome was the case-finding index (contacts testing HIV-positive ÷ ICs receiving APS). Staff provided APS to 1222 (78%) of 1557 newly diagnosed ICs eliciting 1155 sex partners and 649 biological children. Among 280 previously diagnosed ICs, 279 sex partners and 158 biological children were elicited. The case-finding index was higher among ICs with newly diagnosed HIV compared with previously diagnosed HIV (0.14 vs 0.09, P = 0.46), though this difference was not statistically significant. Most sex partners testing HIV-negative were initiated on PrEP (67% in sex partners from newly diagnosed ICs; 74% in sex partners from previously diagnosed ICs). Assisted partner notification services successfully identified sex partners and biological children with undiagnosed HIV infection when provided to both newly and previously diagnosed ICs. Integration of referral to PrEP resulted in many HIV-negative partners initiating PrEP.

HIV Infection and Associated Factors Among Out-of-School MSM Aged 16-24 Years - 6 Cities and Tianjin Municipality, China, 2022-2023.

Approximately 80% of newly diagnosed human immunodeficiency virus (HIV) cases among individuals aged 15-24 years in China are attributed to out-of-school youth. This study presents findings on HIV prevalence and comprehensive insights into HIV service utilization, risky behaviors, and prevention knowledge among young out-of-school men who have sex with men (MSM) aged 16-24 years in China. This population exhibits a disproportionately high burden of HIV, with only 51.6% of HIV cases previously diagnosed. HIV services should be expanded to include these key populations. Tailored interventions are needed to remove barriers to regular HIV services faced by young key populations.

Health-related quality of life among people living with HIV in the era of universal test and treat: results from a cross-sectional study in KwaZulu-Natal, South Africa

Background The World Health Organisation’s (WHO) key population-based strategy for ending the human immunodeficiency virus (HIV) epidemic is universal HIV test and treat (UTT) along with pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP). Despite the successful scale-up of the UTT strategy in sub-Saharan Africa (SSA), the quality of life (QoL) of people living with HIV (PLHIV) remains sub-optimal. Poor QoL in PLHIV may threaten the UNAIDS 95-95-95 programme targets. Monitoring QoL of PLHIV has become a key focus of HIV research among other outcomes so as to understand health-related QoL (HRQoL) profiles and identify interventions to improve programme performance. This study aimed to describe HRQoL profiles and identify their predictors in PLHIV in KwaZulu Natal, South Africa. Methods We conducted a secondary data analysis of a cross-sectional survey conducted between May and June 2022 among PLHIV (n = 105) accessing HIV services at an outpatient clinic in KwaZulu-Natal, South Africa. Socio-demographic, HRQoL (EQ-5D-5L index scores), clinical data, depressive symptoms (CES-D-10), and viral load data were collected from all participants. We examined predictors of HRQoL using generalised linear models controlling for age and sex. Results The mean age of the participants was 45 years (SD = 13). The proportion of participants with disabilities and comorbidities were 3% and 18%, respectively. Depressive symptoms were present in 49% of the participants. Participant’s mean EQ-5D-5L index score was 0.87 (SD = 0.21) and ranged from 0.11 to 1.0. The mean general health state (EQ-VAS) was 74.7 (SD = 18.8) and ranged from 6 to 100. Factors that reduced HRQoL were disability (β = −0.607, p ≤ 0.001), comorbidities (β = − 0.23, p ≤ 0.05), presence of depressive symptoms (β = −0.10, p ≤ 0.05), and old age (β = −0.04, p ≤ 0.05). Factors that increased HRQoL were a good perceived health state (β = 0.147, p ≤ 0.001) and availability of social support (β = 0.098, p ≤ 0.05). Conclusion A combination of old age (60 years and above), any disability and comorbidities had a considerable effect on HRQoL among PLHIV. Our findings support the recommendation for an additional fourth UNAIDS target that should focus on ensuring that 95% of PLHIV have the highest possible HRQoL. Psycho-social support interventions are recommended to improve the HRQoL of PLHIV.

Assessment of community pharmacies readiness to dispense antiretroviral medicines in Rwanda.

Since the introduction of the 'Test and treat' approach in the Human Immunodeficiency Virus (HIV) management, various strategies have been devised and implemented by countries to relieve public health facilities of the large numbers of people coming for medicine refills and clinical follow-up. One of the strategies is the dispensing of antiretroviral medicines through community pharmacies. In Rwanda, community pharmacies are not yet involved in antiretrovirals (ARVs) dispensing, and no study has assessed their readiness to provide this service. This study aimed to assess the readiness of community pharmacy staff and infrastructure to implement a decentralised model of antiretroviral medicines dispensing. This cross-sectional study included data from 262 community pharmacies sampled across all districts of Rwanda. Primary data were collected using a structured questionnaire, from February to March 2023. Responses were received for 262 community pharmacies, representing the total sample size. Data analysis was done using quantitative descriptive and inferential statistical approaches. Frequency tables and graphs were produced using STATA15 and the outputs were exported to MS Excel as well as MS Word to allow document framing and designing. The research has shown a high proportion of community pharmacy staff trained in HIV prevention (82.4% trained on HIV testing), but a low level of training in treatment (30.5%) and psychosocial support of people living with HIV (29.8%). Infrastructure and storage conditions were found to be adequate, with 99.6% of surveyed Pharmacies having sufficient storage space. Majority (93.9%) expressed their willingness to dispense ARVs in the pharmacy premises. A large number of respondents (92.4%) felt that dispensing of antiretroviral medicines through community pharmacies would lead to an increase in sales of over the counter and other non-HIV related medicines. The main anticipated challenge that should be addressed to ensure effective implementation is the lack of interoperability between reporting systems used by community pharmacies and those used by health facilities providing HIV services (76.7% of respondents). Community pharmacies in Rwanda have majority of staff trained in various areas of HIV prevention, but a small proportion have been trained in HIV care and treatment. Community pharmacies have the necessary infrastructure to dispense ARVs, and those with shortcomings, such as the lack of a separate room for individual patient counselling, are willing to obtain such a room if they are authorised to dispense ARVs. Staffs are willing to dispense ARVs in community pharmacies if the model is recommended by policymakers. The model could have several benefits for community pharmacies and the public health system in general, but there are also challenges that should be mitigated to ensure effective implementation. The staff willingness and expected benefits constitute enabling factors that the Ministry of Health and the national HIV control programme may leverage to prepare for introducing the model of ARVs distribution through community pharmacies.

Sexually Transmitted Infection Risks and Symptoms Heightened Among Female Sex Workers who Started Selling Sex Before the Age of 18 in Five Cities in Cameroon

Many adolescents under 18 years old who sell sex are at elevated risk for sexually transmitted infection (STI) acquisition, which may persist into adulthood. There has been limited study of the burden of the risks and vulnerabilities among women who started selling sex as adolescents across Sub-Saharan Africa. In this study, a Adult female sex workers (FSW) recruited through respondent-driven sampling in five cities in Cameroon from December 2015 to October 2016 completed a questionnaire and human immunodeficiency virus (HIV) and syphilis testing. Multivariable logistic regression analysis controlling for age was used to identify factors associated with reporting selling sex before age 18. Selling sex before age 18 was reported by 11.5% (256/2,220) of FSW. Initiation of selling sex as an adolescent was positively associated with experiencing dysuria (adjusted odds ratio [aOR]:1.50, 95% confidence interval [CI]:1.08–2.10) or genital warts (aOR:1.78, 95% CI:1.08–2.94) and negatively associated with prior recent testing for HIV (aOR:0.71, 95% CI:0.53–0.96) or STIs (aOR:0.65, 95% CI:0.44–0.96). Consistent condom use with clients was negatively associated with early initiation of selling sex (aOR:0.58, 95% CI:0.42–0.80), while experience of recent sexual violence was positively associated with early initiation (aOR:1.74, 95% CI:1.15–2.63). There were no independent significant differences in HIV (24.5%) or syphilis (8.3%) prevalence. Given the limited use of HIV and STI testing services by women who sold sex as adolescents, the prevalence of forced sex, condomless sex, and STI symptoms were high. Programs serving FSW should more vigorously aim to serve adolescents and adults who began selling sex early.

Costing of HIV services, Uganda and United Republic of Tanzania.

To evaluate resource allocation and costs associated with delivery of human immunodeficiency virus (HIV) services in Uganda and the United Republic of Tanzania. We used time-driven activity-based costing to determine the resources consumed and costs of providing five HIV services in Uganda and the United Republic of Tanzania: antiretroviral therapy (ART); HIV testing and counselling; prevention of mother-to-child transmission; voluntary male medical circumcision; and pre-exposure prophylaxis. Country-based teams undertook time-driven activity-based costing with 1119 adults in Uganda and 886 adults in the United Republic of Tanzania. In Uganda, service delivery costs ranged from 8.18 United States dollars (US$) per visit for HIV testing and counselling to US$43.43 for ART (for clients in whom HIV was suppressed). In the United Republic of Tanzania, these costs ranged from US$3.67 per visit for HIV testing and counselling to US$28.00 for voluntary male medical circumcision. In both countries, consumables were the main cost driver, accounting for more than 60% of expenditure. Process maps showed that in both countries, registration, measurement of vital signs, consultation and medication dispensing were the steps that occurred most frequently for ART clients. Establishing a rigorous, longitudinal system for tracking investments in HIV services that includes thousands of clients and numerous facilities is achievable in different settings with a high HIV burden. Consistent engagement of implementation partners and standardized training and data collection instruments proved essential for the success of these exercises.

Impact of an Interprofessional HIV Quality Improvement Team on Patient Care and Resident Learning Opportunities.

Although human immunodeficiency virus (HIV) care is a recommended competency for family medicine training, many programs report a lack of HIV expertise among faculty. After the departure of faculty with HIV care experience, an interprofessional HIV quality improvement team (HIV-QIT) of physicians and pharmacists aimed to maintain on-site HIV care and retain learning opportunities for residents, using process improvement and panel reviews with a remote HIV specialist faculty member. This study reports on a multicycle quality improvement pilot project with pre- and postintervention chart reviews between December 2019 and May 2021. All patients received primary care and HIV-QIT chart reviews on-site. We compared patients with integrated HIV care on-site to those receiving external HIV specialty care. Primary outcomes included virologic suppression, CD4 count ≥200 cells/mm3, and adherence to guideline-recommended HIV care. In cycle 1 (January-June 2020), the HIV-QIT reviewed patient charts and sent guideline-based recommendations to physicians. In cycle 2 (July 2020-May 2021), the HIV-QIT implemented several HIV-specific processes, including decision support updates, note templates, order sets, and reference materials. Sustained process improvements included HIV panel chart audits every 3 to 6 months and subsequent provider education. Of 29 patients, more than half (55%, n=16) received integrated HIV care at the primary care site. We found no significant difference in care quality measures between primary and specialty care. Barriers to care completion included missed or canceled follow-up visits, on-site phlebotomy service closures, and declined HIV services. The HIV-QIT maintained on-site HIV treatment and retained experiential learning opportunities through process improvement and specialist-supported care recommendations to primary care physicians.

Impact of COVID-19 pandemic on Tuberculosis and HIV services in Ghana: An interrupted time series analysis.

The Coronavirus disease 2019 (COVID-19) burden, coupled with unprecedented control measures including physical distancing, travel bans, and lockdowns of cities, implemented to stop the spread of the virus, have undoubtedly far-reaching aftereffects on other diseases. In low and middle-income countries (LMICs), a particular worry is the potential impact on Human Immunodeficiency Virus (HIV) and Tuberculosis (TB), as a consequence of possible disruption to health services and limiting access to needed life-saving health care. In Ghana, there is a paucity of information regarding the impact of COVID-19 on disease control, particularly TB and HIV control. This study sought to contribute to bridging this knowledge gap. The study involved the analysis of secondary data obtained from the District Health Information Management System-2 (DHIMS-2) database of Ghana Health Service, from 2016 to 2020. Data were analysed using an interrupted time-series regression approach to estimate the impact of COVID-19 on TB case notification, HIV testing, and Antiretroviral Therapy (ART) initiations, using March 2020 as the event period. The study showed that during the COVID-19 pandemic period, there was an abrupt decline of 20.5% (955CI: 16.0%, 24.5%) in TB case notifications in April and 32.7% (95%CI: 28.8%, 39.1%) in May 2020, with a median monthly decline of 21.4% from April-December 2020. A cumulative loss of 2,128 (20%; 95%CI: 13.3%, 26.7%) TB cases was observed nationwide as of December 2020. There was also a 40.3% decrease in people presenting for HIV tests in the first month of COVID-19 (April 2020) and a cumulative loss of 262620 (26.5%) HIV tests as of December 2020 attributable to the COVID-19 pandemic. ART initiations increased by 39.2% in the first month and thereafter decreased by an average of 10% per month from May to September 2020. Cumulatively, 443 (1.9%) more of the people living with HIV initiated ART during the pandemic period, however, this was not statistically significant. This study demonstrated that the COVID-19 pandemic negatively impacted TB case notifications and HIV testing and counselling services, However, ART initiation was generally not impacted during the first year of the pandemic. Proactive approaches aimed at actively finding the thousands of individuals with TB who were missed in 2020 and increasing HIV testing and counselling and subsequent treatment initiations should be prioritised.

Modeling one-stop-shop integration of family planning and HIV services in Zimbabwe, 2021

Objectives: In October 2020, the Ministry of Health and Child-care Zimbabwe commenced integrating reproductive health with human immunodeficiency virus (HIV) services. Family planning (FP), sexually transmitted infection (STI) screening and treatment, HIV testing services (HTS), pre-exposure prophylaxis (PrEP), and antiretroviral therapy (ART) services were offered through an integrated one-stop-shop model. The project aimed to address unacceptably high incidences of HIV and STIs among FP clients and demonstrate improved access and uptake of integrated services at dedicated FP centers. Materials and Methods: We conducted an intervention study. A service package of STI symptom screening and HTS (including HIV self-test [HIVST] primary and secondary distribution) was offered to all FP clients by multi-skilled nurses. Service uptake was measured pre and post-introduction of the intervention, before which services were provided by different nurses, in different rooms. HIV-diagnosed clients were linked to ART and eligible negative testers were offered PrEP. Service uptake was measured at 1 year of implementation against the same period before. Results: A total of 20,947 clients were recruited between October 2019 and September 2021, 9386 pre-intervention and 11,561 post-intervention. We observed a 5.2% total increase in clients seen and a 27.1% increase in the average uptake of all integrated services (FP, STI, HTS, PrEP, and ART). Most (93.5%) clients received oral contraception (Progestogen-only pills and combined-oral-contraceptives), while fewer (4.8%) received injectables and implants (1.1%). Following the intervention, STI screening increased by 30.2% (2730 vs. 11,028). HTS delivery increased by 38.9% and PrEP by 44.1%. HIV positivity yield increased significantly (10.1%, 62/615 vs. 16.6%, 813/4910) and linkage to ART improved by 44.4%. HIVST distribution contributed to improved access to HIV testing with 3754 FP clients accepting distribution compared with 4910 receiving HTS by nurses, provider-delivered testing was accessed by reactive self-testers. The project increased (?) improved linkage to preventive and treatment services and reduced missed opportunities associated with fragmented services. Conclusion: The integrated one-stop-shop model demonstrated improved service uptake during the intervention period. This project shows the benefits of integrated FP/STI/HTS/PrEP in Zimbabwe’s high HIV burden settings.

How the COVID-19 Pandemic Influenced HIV Care: Are We Prepared Enough for Future Pandemics? An Assessment of Factors Influencing Access, Utilization, Affordability, and Motivation to Engage with HIV Services amongst African, Caribbean, and Black Women.

The COVID-19 pandemic resulted in disruption in healthcare delivery for people living with human immunodeficiency virus (HIV). African, Caribbean, and Black women living with HIV (ACB WLWH) in British Columbia (BC) faced barriers to engage with HIV care services prior to the COVID-19 pandemic that were intensified by the transition to virtual care during the pandemic. This paper aims to assess which factors influenced ACB WLWH's access to, utilization and affordability of, and motivation to engage with HIV care services. This study utilized a qualitative descriptive approach using in-depth interviews. Eighteen participants were recruited from relevant women's health, HIV, and ACB organizations in BC. Participants felt dismissed by healthcare providers delivering services only in virtual formats and suggested that services be performed in a hybrid model to increase access and utilization. Mental health supports, such as support groups, dissolved during the pandemic and overall utilization decreased for many participants. The affordability of services pertained primarily to expenses not covered by the provincial healthcare plan. Resources should be directed to covering supplements, healthy food, and extended health services. The primary factor decreasing motivation to engage with HIV services was fear, which emerged due to the unknown impact of the COVID-19 virus on immunocompromised participants.

A Comparison of HIV Knowledge, Sex Risk Reduction, HIV Services &amp; Testing, and Risk Reduction Skills in the WaySafe and StaySafe Interventions

Justice-involved people with substance use disorders are an at-risk population for health risk behaviors, particularly those related to Human Immunodeficiency Virus (HIV) and other sexually transmitted infections. Risk-reduction programs provide correctional agencies with a practical solution in to reducing HIV-related health risks in justice-involved populations. This study compared two interventions (in-prison, group-based WaySafe with self-adminstered, tablet-based StaySafe for people on probation) to determine whether one intervention was more effective than the other in terms of common outcomes. Multi-level analyses compared effect sizes from outcome studies testing WaySafe and StaySafe. Results showed the interventions had similar effects with regard to measures of HIV Knowledge, HIV Services and Testing, and Risk Reduction Skills. Collectively, this study suggests the StaySafe intervention can be used in situations where the more intensive WaySafe intervention is not feasible and affords correctional agencies the flexibility to implement the curriculum that best meets their organization’s goals and needs.

High satisfaction among patients at HIV clinics in Harare, Zimbabwe: a time and motion evaluation and patient satisfaction study.

Patient satisfaction is an important component of health and healthcare utilization, which measures the perceived needs and expectations for healthcare services. Patient satisfaction surveys are effective in improving health outcomes by informing health facilities on service and provider gaps and guiding the development of effective action plans and policies for quality improvement within a healthcare organization. Although patient satisfaction and patient flow analyses have been conducted in Zimbabwe, the combination of these two quality improvement measures in the context of Human Immunodeficiency Virus (HIV) clinics has not previously been evaluated. This study assessed and evaluated patient flow and patient satisfaction to enhance care quality and improve HIV service delivery to optimize patient health. We collected time and motion data from HIV patients who attended three purposively selected City of Harare Polyclinics in Harare, Zimbabwe. All patients who sought care at the clinic were given time and motion forms to track their movement and the time spent at each service area. After services were completed, patients were invited to participate in a satisfaction survey regarding their services and care. The average waiting time from clinic arrival to see the provider was 2 hr and 14 min. The areas with the longest waiting time and bottlenecks occurred at registration (49 min) and the HIV clinic waiting area (44 min). Despite these extended times, the overall patient satisfaction for HIV services was high at 72%, with over half (59%) reporting that there was nothing they did not like about their services. Patients were most satisfied with services provided (34%), timely service (27%), and antiretroviral medications (19%). The areas of least satisfaction were related to time delays (24%) and cashier delays (6%). Despite prolonged waiting times, patients' overall satisfaction with their clinic experience remains high. Perceptions of satisfaction are influenced by experience, culture, and context. However, there are still several areas of recommendations to improve service, care, and quality. Specifically, reducing or eliminating service fees, increasing clinic hour times, and having available medication were most cited. Support from the Zimbabwe Ministry of Health and Child Care, City of Harare, and other decision-makers is needed to improve patient satisfaction and address patients' recommendations within the City of Harare Polyclinic organization in accordance with the 2016-20 National Health Strategies for Zimbabwe.

Access to HIV prevention, treatment, and care services during COVID-19 by men who have sex with men in Zimbabwe, An interpretive phenomenological analysis study.

Key populations are disproportionately affected by the human immunodeficiency virus (HIV) but have less access to HIV prevention and treatment services. The Coronavirus disease-2019 (COVID-19) pandemic is reinforcing health inequities among vulnerable populations, including men who have sex with men (MSM). Therefore, this article presents the findings describing the experiences of MSM in accessing HIV services during COVID-19 in the second largest city of Zimbabwe. An interpretative phenomenological analysis design was applied to gain some insights regarding the lived experiences of MSM in accessing HIV prevention, treatment, and care services during COVID-19 lockdowns era in Zimbabwe. Data were collected from 14 criterion purposively selected MSM using in-depth, one-on-one interviews. Data were analysed thematically guided by the interpretative phenomenological analysis framework for data analysis. The findings demonstrated that during the COVID -19 lockdowns in Zimbabwe, MSM faced several barriers as they tried to access HIV services. Some of the barriers included the need for travel authorisation letters and treatment interruption. The study also found that COVID-19 and related restrictive measures had psychosocial and economic effects that encompassed loss of income, intimate partner violence and psychological effects. Limited access to healthcare services by MSM due to COVID-19 lockdown may negatively affect the viral suppression and fuel the spread of HIV, which may reverse the gains toward the control of HIV epidemic. To sustain the gains toward HIV epidemic control and to ensure continuity of treatment, particularly for members of key populations, it is critical that the health-care delivery system adjusts by taking service to the community through adopting a differentiated service delivery approach.

Prevalence, Awareness, Treatment, Control of Hypertension, and Availability of Hypertension Services for Patients Living With Human Immunodeficiency Virus (HIV) in Sub-Saharan Africa (SSA): A Systematic Review and Meta-analysis.

Sub-Saharan Africa (SSA) is faced with a dual burden of hypertension and human immunodeficiency virus (HIV). In this review we sought to determine the prevalence, awareness, and control of hypertension among persons living with HIV (PLHIV), and the availability of hypertension services at the HIV care points in SSA. We searched the PubMed, Embase, Scopus, Cochrane library, Global index Medicus, African Journal online, and WHO Institutional Repository for Information Sharing (IRIS) for studies on the epidemiology of hypertension, and hypertension services for PLHIV in SSA. Twenty-six articles were identified for the review, with 150,886 participants; weighted mean of age 37.5 years and female proportion of 62.6%. The pooled prevalence was 19.6% (95% confidence interval [CI], 16.6%, 22.5%); hypertension awareness was 28.4% (95% CI, 15.5%, 41.3%), and hypertension control was 13.4% (95% CI, 4.7%, 22.1%). HIV-related factors like CD4 count, viremia, and antiretroviral therapy regimen were not consistently associated with prevalent hypertension. However, high body mass index (BMI) above 25 kg/m2[odds ratio: 1.64, 95% CI (1.26, 2.02)] and age above 45 years [odds ratio: 1.44, 95% CI (1.08, 1.79)] were associated with prevalent hypertension. Even when PLHIV on ART were more likely to be screened for hypertension and monitored, there was infrequent screening and treatment of hypertension in most HIV clinics. Most studies recommended integrating of HIV and hypertension services. We report a high prevalence of hypertension in a relatively young population of PLHIV with suboptimal screening, treatment, and control of hypertension. We recommend strategies to integrate HIV and hypertension services.

A Peer-support Mini-counseling Model to Improve Treatment in HIV-positive Pregnant Women in Kupang City, East Nusa Tenggara, Indonesia.

Low adherence to antiretroviral (ARV) therapy in pregnant women with human immunodeficiency virus (HIV) increases the risk of virus transmission from mother to newborn. Increasing mothers' knowledge and motivation to access treatment has been identified as a critical factor in prevention. Therefore, this research aimed to explore barriers and enablers in accessing HIV care and treatment services. This research was the first phase of a mixed-method analysis conducted in Kupang, a remote city in East Nusa Tenggara Province, Indonesia. Samples were taken by purposive sampling of 17 people interviewed, consisting of 6 mothers with HIV, 5 peer facilitators, and 6 health workers. Data were collected through semi-structured interviews, focus group discussions, observations, and document review. Inductive thematic analysis was also performed. The existing data were grouped into several themes, then relationships and linkages were drawn from each group of informants. Barriers to accessing care and treatment were lack of knowledge about the benefits of ARV; stigma from within and the surrounding environment; difficulty in accessing services due to distance, time, and cost; completeness of administration; drugs' side effects; and the quality of health workers and HIV services. There was a need for a structured and integrated model of peer support to improve ARV uptake and treatment in pregnant women with HIV. This research identified needs including mini-counseling sessions designed to address psychosocial barriers as an integrated approach to support antenatal care that can effectively assist HIV-positive pregnant women in improving treatment adherence.