Joint United Research Articles

Pre-exposure prophylaxis (PrEP) awareness, attitudes and uptake willingness among young people: gender differences and associated factors in two South African districts

ABSTRACT Background: Pre-exposure prophylaxis (PrEP) for HIV prevention is safe and effective in reducing HIV incidence. However, more evidence of PrEP knowledge, willingness and distribution preferences is required for scale-up among young people at-risk. Objective: To understand young people PrEP awareness, willingness and roll-out preferences. Methods: Young people (18–24y) were selected through multi-stage sampling in a cross-sectional household survey in low-income communities. Self-administered interviews collected participants’ data about PrEP awareness, attitudes, willingness and HIV-risk practices. Data were descriptively analysed by gender. Regression models assessed factors associated with PrEP awareness and willingness by district. Results: Of the 1917 participants interviewed 44.6% (men = 39.4% vs women = 49%, p = 0.001) were PrEP aware, 49.0% were willing to use PrEP. Participants most preferred PrEP distribution channels were public clinics (51.2%) and hospitals (23.8%). More men than women preferred distribution through schools (11.9% vs7.8%; p = 0.002) and NGOs (8.5%vs5.4%; p = 0.008). The biggest barrier to PrEP willingness was inadequate PrEP knowledge (10.0%) but more men than women disliked taking pills daily (4.1%vs2.0%; p-value = 0.007). Gendered determinants to use PrEP were side effects (51%; men = 47% vs women = 55%; p = 0.001) and pill effectiveness (29.5%; men = 26.4% vs women = 32.6%; p = 0.003). In both districts PrEP knowledge was associated with being female and media use. The associations between PrEP awareness and having multiple sexual partnerships, HIV knowledge, HIV self-test willingness and belonging to social clubs differed by district. PrEP willingness was positively associated with having TB and PrEP knowledge in each district but district differences were observed in media and occupation factors. Conclusions: The study shows young people’s low levels of PrEP awareness. It also shows relatively increased willingness, gendered PrEP awareness and distribution preferences. Promoting youth’s PrEP awareness requires a multifarious media strategy. Abbreviations: HIV: human immunodeficiency virus; AIDS: Acquired immunodeficiency syndrome; aOR: Adjusted Odds ratio; PLWH: People living with HIV; PrEP: Pre-exposure Prophylaxis; UNAIDS: Joint United Nations Programme on HIV and AIDS; uOR: Unadjusted odds ratio; TB: Tuberculosis; WHO: World health Organisation; MSM: Men who have sex with men

The impact of immigration on tuberculosis and HIV burden between Colombia and Venezuela and across frontier regions.

Historically, human migrations have determined the spread of many infectious diseases by promoting the emergence of temporal outbreaks between populations. We aimed to analyze health indicators, expenditure, and disability caused by tuberculosis (TB) and HIV/AIDS burden under the Colombian-Venezuelan migration flow focusing on the Northeastern border. A retrospective study was conducted using TB and HIV/AIDS data since 2009. We consolidated a database using official reports from the Colombian Surveillance System, World Health Organization, Indexmundi, the Global Health Observatory, IHME HIV atlas, and Joint United Nations Programme on HIV/AIDS (UNAIDS). Disability metrics regarding DALYs (disability adjusted life years) and YLDs (years lived with disability), were compared between countries. Mapping was performed on ArcGIS using official migration data of Venezuelan citizens. Our results indicate that TB profiles from Colombia and Venezuela are identical in terms of disease burden, except for an increase in TB incidence in the Colombian-Venezuelan border departments in recent years, concomitantly with the massive Venezuelan immigration since 2005. We identified a four-fold underfunding for the TB program in Venezuela, which might explain the low-testing rates for cases of multidrug-resistant TB (67%) and HIV/AIDS (60%), as well as extended hospital stays (150 days). We found a significant increase in DALYs of HIV/AIDS patients in Venezuela, specifically, 362.35 compared to 265.37 observed in Colombia during 2017. This study suggests that the Venezuelan massive migration and program underfunding might exacerbate the dual burden of TB and HIV in Colombia, especially towards the Colombian-Venezuelan border.

Seçilmiş Bazı Avrupa Ülkelerindeki HIV Enfeksiyonu ve Tüberkülozun İnsidanslarının İstatistiksel Proses Kontrol Yöntemi ile İzlenmesi

Objective: Statistical process control (SPC) is a method of analysis developed for examining the data of a process and which facilitates understanding of that process. The aim of this study is to investigate whether or not human immune deficiency virus (HIV) infection and tuberculosis (TB) were brought under control in some selected European countries between the years 1990 and 2016, as well as to examine the association between HIV and TB in the years when they went out of control. Moreover, the relationship between these diseases and selected Organisation for Economic Co-operation and Development criteria will be examined. Material and Methods: The time course of HIV and TB in some selected European countries was examined with SPC based on years, the HIV and TB incidence data on the World Health Organization (WHO) and Joint United Nations Programme on HIV and AIDS (acquired immune deficiency syndrome ) databases between the years 1990 and 2016 were utilised. The mid-year population figures of the European countries were taken from the WHO database. The European countries (Germany, France, Great Britain, Spain, Italy, Hungary, Turkey, Poland and Ukraine) included in the study were selected based on the WHO European Region classification. Results: HIV and TB have been brought under control in Western European countries. However, in Central European countries, TB is under control, whereas HIV is out of control. In Ukraine, which represents the Eastern European countries, both infections are out of control. Conclusion: When an assessment is made in terms of factors that affect bringing HIV under control, it is striking that there are significant epidemiological and HIV treatment cascade differences between countries. When policies are being created especially for bringing the HIV infection under control, the policies of countries which have brought this infection under control also need to be examined.

Use of Trained Non-Medical Staff to Improve Access to HIV Testing Services in Africa: Implementation of the World Health Organization Opt-out Approach in Cameroon.

Background:The Joint United Nations Programme on HIV/AIDS (UNAIDS) in 2019 estimated that 450,000 to 50,000 people in Cameroon were living with HIV, yet only 79% knew their HIV status which is far from the 90% target for 2020. To address this situation, Cameroon adopted the “Opt-out” strategy of the World Health Organization (WHO) and use of trained non-medical cadre (psychosocial agents) to reach out to more people with HIV testing services (HTS). This describes the implementation and outcomes of this strategy by reviewing the activity of a typical day in the Yaoundé Central Hospital (YCH) in Cameroon.Methods:HTS were offered to hospitalized and ambulatory patients (including their companions) in different departments of the YCH. Following screening for recent HIV testing, those with unknown HIV status that gave consent or did not explicitly refuse testing (as per the “Opt-out Strategy”), were counseled and tested for HIV. Testing followed the “National HIV Rapid Testing Algorithm” using rapid diagnostic test kits. Results were either positive, negative or indeterminate. Patients with positive HIV results were linked to the Care and Treatment Center for treatment initiation.Results:Of the 350 patients screened and offered HTS using non-medical cadre (psychosocial agents), 193 (55.1%) were hospitalized and 157 (44.9%) came for outpatient visits. The age of participants ranged from 14 to 92 years and the yield of HIV testing in the sample population was 5.1% (6.2% for hospitalized patients and 3.8% for outpatient clinics). Statistics revealed that five HIV-positive patients had never been offered HTS before the study. The study revealed that HTS acceptance rate among hospitalized patients was 69.6% and that all new positive patients started antiretroviral treatment on the same day.Conclusion and Global Health Implications:It is feasible to use trained non-medical staff for HIV testing services (HTS). Task-shifting by using trained psychosocial agents can help in case identification and linkage to HIV treatment services.

ВЕРОЯТНОСТНО-СТАТИСТИЧЕСКИЕ ЗАКОНОМЕРНОСТИ ФУНКЦИОНИРОВАНИЯ ВОЕНИЗИРОВАННЫХ ГОРНОСПАСАТЕЛЬНЫХ ОТРЯДОВ НА ОБЪЕКТАХ ГОРНОРУДНОЙ ПРОМЫШЛЕННОСТИ

Purpose. The article discusses the possibility and necessity of forming and functioning of emergency rescue squads capable of carrying out a wide range of emergency rescue and other urgent operations at the mining industry facilities. Methods. The basis for theoretical researches was mathematical statistics methods, the mathematical modeling method, modeling and calculations related to the assessment of joint units forming and functioning for servicing hazardous production facilities of the mining industry. Findings. The study of statistical data on responses of the most loaded paramilitary mine rescue squads carried out on the territory of guarded hazardous production facilities of the mining industry of the Russian Federation for the period from 2015 to 2019 has been carried out. Substantiating the number of the mine rescue squads detachments for servicing calls has been carried out. The probabilistic, time and frequency characteristics of the failure-free call service have been used as criteria to substantiate the number n of the detachments. It has been found that accidents and incidents at mining sites are of a different nature, and mine rescue squads have a different load associated with the operational activity, which is explained by the industrial hazard of protected mining sites and industrial infrastructure. The main share of registered accidents at mining facilities are fires (52.4 %) and collapses (22.9 %). Research application field. The data obtained can be used in the organizational design of mine rescue units and services. Conclusions. The flow of destructive events at the mining industry facilities obeys the Poisson stationary distribution law, and the temporal characteristics of the mine rescue squads response process are described by the Erlang distribution. Methods of mathematical modeling functioning processes of urgent emergency rescue services can be used for organizational design of emergency rescue services and units at the mining industry facilities.

A Child with HIV (Human Immunodeficiency Virus) Infection Accompanied by Severe Acute Malnutrition: A Case Report

Joint United Nations Programme in HIV/AIDS (UNAIDS) reported that 1.8 million children under 15 years old had HIV with 150,000 new pediatric cases in 2015, and only 49% had an antiretroviral (ARV) therapy. Mortality in HIV-infected children with severe acute malnutrition was 30.4% in Africa. A 1-year and 8-months-old girl was hospitalized due to diarrhea, vomiting, oral thrush, and recurrent fever before admission. She has been hospitalized for HIV infection one month ago and treated with ARV. Her mother was treated with ARV before. Physical examination showed a severely ill, poorly nourished, stunting, and conscious child with normal vital signs. There was oral thrush. The evidence of nutritional marasmus was old man face, piano sign, wasting, and baggy pants. Laboratory findings revealed anemia, positive antigen and antibody of HIV infection, and low Cluster of Differentiation 4 (CD4). She was treated with ARV, Cotrimoxazole, and management of malnutrition and diarrhea. The prognosis of the patient was poor. A 1-year and 8-months-old girl with HIV infection complicated with severe acute malnutrition, acute diarrhea, oral thrush, and anemia of chronic disease were reported. The diagnosis was based on clinical and laboratory findings. Management focused on the therapy of HIV and accompanying illness. The prognosis was poor.

Human Immunodeficiency Virus (HIV) Care Models During the Coronavirus Disease 2019 (COVID-19) Era.

The COVID-19 pandemic is an unprecedented global challenge that substantially risks reversing the progress in ending HIV. At the same time, it may offer the opportunity for a new era of HIV management. This viewpoint presents the impact of COVID-19 on HIV care, including the Joint United Nations Programme on HIV/AIDS (UNAIDS) “three 90s” targets. It outlines how to enhance a patient-centered care approach, now known as the "fourth 90,” by integrating face-to-face patient–physician and telemedicine encounters. It suggests a framework for prevention and treatment of multimorbidity and frailty, to achieve a good health-related quality of life and preserve intrinsic capacity in all people living with HIV.

Wheeling out HIV elimination

HIV Several sub-Saharan countries have been prioritized by the Joint United Nations Programme on HIV/AIDS (UNAIDS) for HIV elimination. This will require 90% treatment coverage by the end of 2030, but poor transport infrastructure means incomplete access to medication in some countries. Palk et al. developed a geospatial model for understanding the difficulties of reaching health care facilities in Malawi, a country severely affected by HIV. They mapped health care facilities with the density of HIV prevalence and quantified the difficulty of travel across Malawi's landscape by a friction surface raster map. If bicycles are used, then the catchment size for a health care facility is substantially larger than if people walk, and the required 90% treatment coverage for elimination becomes achievable. Bicycles are already used as “ambulances” in rural areas, but Malawi's bicycle fleet is small and in poor repair. One straightforward route for beating HIV (and many other health conditions) here and in similar countries could lie simply in boosting the supply of bicycles, an established and well-tested technology. Lancet Glob. Health 8 , E1555 (2020).

Advances and challenges in antiretroviral therapy for acquired immunodeficiency syndrome.

Advances and challenges in antiretroviral therapy for acquired immunodeficiency syndrome.

High variability in the measurement of HIV primary prevention activities and outcomes.

IntroductionWhile there is a global consensus on monitoring Human Immunodeficiency Virus (HIV) treatment progress, there has been less attention to the degree of consistency of the measurement of HIV prevention programmes—and the global prevention response is not on‐track to achieve 2020 goals. In this paper, we assess the degree of variability in primary prevention indicators selected by national strategic plans (NSPs) and global stakeholder monitoring and evaluation (M&E) strategies.MethodsWe obtained the most recent NSPs from low and middle income Joint United Nations Programme on HIV/AIDS (UNAIDS) Fast‐Track countries, and M&E documents from The Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund), President’s Emergency Plan for AIDS Relief (PEPFAR), UNAIDS, the Global HIV Prevention Coalition and the World Health Organization (WHO). We extracted HIV primary prevention indicators from each document, standardized and aggregated them by age/ sex, categorized indicators by topic, and evaluated the frequency of matched indicators between countries and stakeholders. Data were collected between February and April of 2019.ResultsTwenty‐one NSPs and five global stakeholder documents were assessed; 736 primary prevention indicators were identified; 284 remained following standardization and aggregation. NSPs contained from 3 to 48 primary prevention indicators, with an average of 23; categories included: HIV education and outreach (17.6%), testing (17.3%) and condom use (16.2%). Of unique national indicators, only 34% was shared between two or more countries. Sixty‐nine per cent was applied in a single country only. 56% of NSP indicators did not appear in any global stakeholder document. Conversely, 42% of global indicators did not appear in any surveyed NSPs. Within global indicators, 63% was only measured by one global body, and no single indicator was measured by all five.ConclusionsThese analyses reveal a lack of consensus both between and within countries’ and global stakeholders' measurement of HIV prevention. Though some variability is expected, these findings point to a need to refocus attention on achieving greater consensus on a global measurement framework for HIV prevention.

PIN38 Cost-Effectiveness of Expanded HIV Screening Among Adult Population in Italy

The global targets set out by the Joint United Nations Programme on HIV/AIDS (UNAIDS) for 2020 are to diagnose 90% of all HIV-positive people, provide antiretroviral therapy for 90% of those diagnosed, and achieve viral suppression for 90% of those treated (known as 90-90-90 targets). In Italy, there is no uniform HIV screening strategy across the country. Our study aimed to assess the cost-effectiveness of expanded HIV screening among adult population (25-50 years). A decision tree was combined with a previously published Markov model for evaluate the management of HIV-infected patients in Italy. The model was informed by epidemiological and cost estimates taken from different sources (literature and real-world data). The cohort of new HIV diagnosed patients effectively linked to care in Italy (2,847 patients) was followed over a 30-year time horizon evaluating different scenarios for new HIV diagnoses due to the expanded HIV screening. The analysis was conducted from the National Health Service perspective and both costs and QALYs were discounted at an annual rate of 3%. Deterministic and probabilistic sensitivity analysis were conducted to evaluate parameter uncertainty. Our preliminary analysis showed that with an increase of 10% of new HIV linked to care patients, HIV screening strategy resulted in an increment of about 2,466 QALYs and in an increment of about € 73.8 million compared to the status quo from the Italian NHS perspective. The ICER was equal to € 29,943/QALY. Probabilistic sensitivity analysis confirmed that the expanded HIV screening would be cost-effective for > 51% of simulations at a minimum willingness-to-pay threshold of € 30,000 per QALY gained. In Italy there is an urgent need to apply HIV screening strategies to increase awareness of the risks of the disease. Our analysis indicates that the expanded HIV screening in adult population would be cost-effective.

THE INTERNATIONAL GOVERNMENT ORGANIZATIONS ROLE IN GLOBAL HEALTH

International government organizations with a global outreach are working on global health issues to achieve the objective of Health for All. The key actors in global health working on global health problems are the United Nations Educational, Scientific and Cultural Organization (UNESCO) and the Joint United Nations Program on HIV/AIDS (UNAIDS) (Johnson, Stotskopt, & Shi, 2018). These international organizations participate in generating and sharing knowledge, engage in advocacy,provide global funds for health efforts. Our paper will analyze the structure, goals, and processes of global health organizations, UNESCO and UNAIDS.

Availability and Quality of Surveillance and Survey Data on HIV Prevalence Among Sex Workers, Men Who Have Sex With Men, People Who Inject Drugs, and Transgender Women in Low- and Middle-Income Countries: Review of Available Data (2001-2017).

BackgroundIn 2019, 62% of new HIV infections occurred among key populations (KPs) and their sexual partners. The World Health Organization (WHO) recommends implementation of bio-behavioral surveys every 2-3 years to obtain HIV prevalence data for all KPs. However, the collection of these data is often less frequent and geographically limited.ObjectiveThis study intended to assess the availability and quality of HIV prevalence data among sex workers (SWs), men who have sex with men (MSM), people who inject drugs, and transgender women (transwomen) in low- and middle-income countries.MethodsData were obtained from survey reports, national reports, journal articles, and other grey literature available to the Global Fund, Joint United Nations Programme on HIV/AIDS, and WHO or from other open sources. Elements reviewed included names of subnational units, HIV prevalence, sampling method, and size. Based on geographical coverage, availability of trends over time, and recency of estimates, data were categorized by country and grouped as follows: nationally adequate, locally adequate but nationally inadequate, no recent data, no trends available, and no data.ResultsAmong the 123 countries assessed, 91.9% (113/123) presented at least 1 HIV prevalence data point for any KP; 78.0% (96/123) presented data for at least 2 groups; and 51.2% (63/123), for at least 3 groups. Data on all 4 groups were available for only 14.6% (18/123) of the countries. HIV prevalence data for SWs, MSM, people who inject drugs, and transwomen were available in 86.2% (106/123), 80.5% (99/123), 45.5% (56/123), and 23.6% (29/123) of the countries, respectively. Only 10.6% (13/123) of the countries presented nationally adequate data for any KP between 2001 and 2017; 6 for SWs; 2 for MSM; and 5 for people who inject drugs. Moreover, 26.8% (33/123) of the countries were categorized as locally adequate but nationally inadequate, mostly for SWs and MSM. No trend data on SWs and MSM were available for 38.2% (47/123) and 43.9% (54/123) of the countries, respectively, while no data on people who inject drugs and transwomen were available for 76.4% (94/123) and 54.5% (67/123) of the countries, respectively. An increase in the number of data points was observed for MSM and transwomen. Overall increases were noted in the number and proportions of data points, especially for MSM, people who inject drugs, and transwomen, with sample sizes exceeding 100.ConclusionsDespite general improvements in health data availability and quality, the availability of HIV prevalence data among the most vulnerable populations in low- and middle-income countries remains insufficient. Data collection should be expanded to include behavioral, clinical, and epidemiologic data through context-specific differentiated survey approaches while emphasizing data use for program improvements. Ending the HIV epidemic by 2030 is possible only if the epidemic is controlled among KPs.

Assessing barriers to treatment for all: an analysis of resources for PLHA in Cayo and Stann Creek Districts of Belize

Background The Joint United Nations Programme on HIV/AIDS (UNAIDS) launched a global campaign, 90:90:90, which aims to ensure that by 2030: 90% of the people living with HIV will know their HIV status, 90% of those diagnosed with HIV will receive sustained ART, and 90% of those on ART will have durable viral suppression. Belize is striving towards completing this goal and contributing to international efforts for eliminating HIV globally. In order to successfully reach 90% of the population receiving sustained ART, barriers to care that decrease retention rates must be addressed. To combat barriers to care for Persons Living with HIV/AIDS (PLHA), resources must serve to eliminate the obstacles negatively affecting adherence to treatment. Methods This study aimed to (a) assess treatment and care resources in Cayo and Stann Creek districts and (b) pose questions to key informants to gain deeper understanding of HIV services and patient utilization. The study was conducted from May to July 2016 and focused in Belmopan, San Ignacio, and Dangriga to produce an HIV services inventory for the Cayo and Stann Creek districts. Results Our participants composed of 50% civil society and 50% government organizations. 50% of the locations worked less than 45 hours per week and most commonly served the community by providing training, health fairs, and posters. Resources with the lowest number of facility participation were directly observed therapy (DOT), HIV support group (HSG), and prescriptions. The emerging themes from the key informants were (a) concern with patients’ needs, (b) unsustainable resources, and (c) inadequate quality of treatment and care beyond the provider’s control. Results convey the gap between the needs of PLHA and what is being offered by the organizations in the community. In addition, key informants note the unsustainable resources that may contribute to the current climate. Conclusions The final product of this study included a report based on the data produced, a patient-friendly brochure in English listing resources available, and an infographic summarizing the findings of this study.

Written at the closing year of the "three 90%" strategic goal for AIDS prevention and treatment

In 2014, Joint United Nations Programme on HIV/AIDS (UNAIDS) put forward the goal of ending HIV epidemic by 2030 at the International AIDS Conference and proposed the strategic goal of achieving "three 90%" by 2020. This year is the closing year of this strategic goal, and all regions have begun to evaluate the progress of implementing the goal. This article discussed the progress of the implementation of the "three 90%", and scientifically interpreted the strategic goal. It is proposed that the goal is a relative and dynamic concept, and only if we sieze the opportunity to achieve the strategic goal and continuously enhance comprehensive prevention and control, can the HIV epidemic be better controlled.

Time for HIV self-testing in Canada: a vision and an action plan

KEY POINTS In 2020, compared against the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets for HIV elimination (95% tested for HIV, 95% treated and 95% retained in treatment), Canada stands at 86% tested, 81% treated, 91% retained in treatment.[1][1] Despite the availability of

Determinants of Virological Failure Among Adult Clients on First-Line Antiretroviral Therapy in Amhara Regional State, Northeast Ethiopia. A Case -Control Study.

BackgroundVirological failure is defined as having viral load measurement greater or equal to 1000 copies/mm3 after at least six-month exposure to antiretroviral therapy. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS-2018) report, globally nearly one in five patients on first-line antiretroviral therapy had experienced virological failure. In line with this, Ethiopia federal ministry of health also reported that one in four patients had experienced virological failure in the year 2016. To date, very little is known about the predictors of virological failure in the local context. Therefore, this study intended to address the determinants of virological failure among patients on a first-line antiretroviral regimen.MethodsA case–control study was conducted among clients on first-line antiretroviral therapy in Amhara regional state, January 2019 with a sample of 257 clients; of these, 86 clients were cases. Data were collected via patient interview and chart extraction for clinical profiles using standardized tools. Binary logistic regression was computed to identify the determinants of virological failure using Stata version 14 and the result was displayed using adjusted odds ratio with a 95% confidence interval.ResultsOut of the proposed samples, 255 clients were considered for final analysis. The odds of virological failure are higher among poor medication adherence (AOR: 10.2:95% CI [4.1–25.8]), age<35 years (AOR: 3.07 95% CI 1.4–6.8), low baseline CD4 (AOR 3.9: 95% CI 1.6–9.6), and Khat chewers (AOR: 9.5:95% CI 2.8–32.4) as compared with their counterparts.ConclusionBeing a young age, poor immunity at the initiation of antiretroviral, Khat chewer, and poor medication adherence significantly associated with virological failure.

Not yet 90-90-90: A quality improvement approach to human immunodeficiency virus viral suppression in paediatric patients in the rural Eastern Cape, South Africa.

BackgroundA strategy implemented by the South African Department of Health to manage the high burden of human immunodeficiency virus (HIV) has been to task-shift services to primary health care clinics. Outcomes of paediatric patients with HIV are poorer than those of adults, particularly in rural areas. Viral suppression in paediatric patients at the feeder clinics of a rural South African hospital was anecdotally far below the aim of the Joint United Nations Programme on HIV/AIDS (UNAIDS) of 90%.MethodsA quality improvement approach was used to conduct a baseline assessment of HIV viral suppression in paediatric patients and other process measures, implement a clinical mentorship intervention and evaluate its effectiveness.ResultsAn initial audit of 235 clinical folders of paediatric patients with HIV revealed a viral suppression of 55.3%. Other poor measures included prescription accuracy, viral loads performed within schedule and response to successive high viral loads. A clinical mentorship intervention using dedicated doctor outreach was implemented and the audit repeated after 12 months (263 folders). Viral suppression improved to 67.4%, as did most other process measures.ConclusionThe quality improvement approach regarding the aim to significantly improve viral suppression in paediatric patients through the implementation of clinical mentorship was successful.

Non-uptake of viral load testing among people receiving HIV treatment in Gomba district, rural Uganda

BackgroundViral load (VL) testing is the gold-standard approach for monitoring human immunodeficiency virus (HIV) treatment success and virologic failure, but uptake is suboptimal in resource-limited and rural settings. We conducted a cross-sectional study of risk factors for non-uptake of VL testing in rural Uganda.MethodsWe conducted a cross-sectional analysis of uptake of VL testing among randomly selected people with HIV (PWH) receiving anti-retroviral treatment (ART) for at least 6 months at all eight primary health centers in Gomba district, rural Uganda. Socio-demographic and clinical data were extracted from medical records for the period January to December 2017. VL testing was routinely performed 6 months after ART initiation and 12 months thereafter for PWH stable on ART. We used descriptive statistics and multivariable logistic regression to evaluate factors associated with non-uptake of VL testing (the primary outcome).ResultsOf 414 PWH, 60% were female, and the median age was 40 years (interquartile range [IQR] 31–48). Most (62.3%) had been on ART > 2 years, and the median duration of treatment was 34 months (IQR 14–55). Thirty three percent did not receive VL testing: 36% of women and 30% of men. Shorter duration of ART (≤2 years) (adjusted odds ratio [AOR] 2.38; 95% CI:1.37–4.12; p = 0.002), younger age 16–30 years (AOR 2.74; 95% CI:1.44–5.24; p = 0.002) and 31–45 years (AOR 1.92; 95% CI 1.12–3.27; p = 0.017), and receipt of ART at Health Center IV (AOR 2.85; 95% CI: 1.78–4.56; p < 0.001) were significantly associated with non-uptake of VL testing.ConclusionsOne-in-three PWH on ART missed VL testing in rural Uganda. Strategies to improve coverage of VL testing, such as VL focal persons to flag missed tests, patient education and demand creation for VL testing are needed, particularly for recent ART initiates and younger persons on treatment, in order to attain the third Joint United Nations Program on HIV/AIDS (UNAIDS) 95–95-95 target – virologic suppression for 95% of PWH on ART.

Effect of female sex work-targeted community-based interventions along the HIV treatment cascade in sub-Saharan Africa: a systematic review protocol

IntroductionFemale sex workers (FSWs) are a known high-risk group that are at increased risk of HIV transmission due to exposure to multiple sexual partners and inability to negotiate safe sex...