Understanding Specific Contexts of Antiretroviral Therapy Adherence in Rural South Africa: A Thematic Analysis of Digital Stories from a Community with High HIV Prevalence

Near-perfect adherence to antiretroviral therapy (ART) is required to achieve the best possible prevention and treatment outcomes. Yet, there have been particular concerns about the challenges of adherence among patients living in resource-limited settings in sub-Saharan Africa. 

The primary objective of this study was to explore adherence in a low-resourced, rural community of high HIV prevalence in South Africa and to identify specific individual and structural factors that can either challenge or support adherence in this context. We applied digital stories as a qualitative research tool to gain insights into personal contexts of HIV and ART adherence. Through an inductive thematic analysis of twenty story texts, soundtracks and drawings, we explored experiences, understandings, and contexts of the participants and identified potential barriers and facilitators for those on lifelong treatment. 

We found that many of the stories reflected a growing confidence in the effectiveness of ART, which should be viewed as a key facilitator to successful adherence since this attitude can promote disclosure and boost access to social support. Nevertheless, stories also highlighted the complexity of the issues that individuals and households face as they deal with HIV and ART in this setting and it is clear that an overburdened local healthcare system has often struggled to meet the demands of a rapidly expanding epidemic and to provide the necessary medical and emotional support. 

Our analysis suggests several opportunities for further research and the design of novel health interventions to support optimal adherence. Firstly, future health promotion campaigns should encourage individuals to test together, or at least accompany each other for testing, to encourage social support from the outset. 

Additionally, home-based testing and ART club interventions might be recommended to make it easier for individuals to adhere to their treatment regimens and to provide a sense of support and solidarity.

Below: Participant drawing depicting the pain of disclosure

Full article at:   http://goo.gl/th5yAY

By:  

Astrid Treffry-Goatley, Richard Lessells, Till Bärnighausen, Tulio de Oliveira, Janet Seeley 

Africa Centre for Population Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa

Astrid Treffry-Goatley, Relebohile Moletsane 

School of Education, University of KwaZulu-Natal, Durban, KwaZulu Natal, South Africa

Richard Lessells 

Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom

Pam Sykes 

Independent digital storytelling practitioner and researcher, Digital storytelling South Africa, Cape Town, South Africa

Till Bärnighausen 

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America

Tulio de Oliveira 

School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

Tulio de Oliveira 

Honorary, Research Department of Infection, University College London (UCL), London, United Kingdom

Tulio de Oliveira 

Research Department of Infection, University College London (UCL), London, United Kingdom

Janet Seeley 

Anthropology and Health, London School of Hygiene and Tropical Medicine, London, United Kingdom 

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Recruiting a U.S. National Sample of HIV-Negative Gay & Bisexual Men to Complete At-Home Self-Administered HIV/STI Testing & Surveys: Challenges & Opportunities

We describe enrollment for the One Thousand Strong panel, present characteristics of the panel relative to other large U.S. national studies of gay and bisexual men (GBM), and examine demographic and behavioral characteristics that were associated with passing enrollment milestones. 

A U.S. national sample of HIV-negative men were enrolled via an established online panel of over 22,000 GBM. Participants (n = 1071) passed three milestones to join our panel. Milestone 1 was screening eligible and providing informed consent. Milestone 2 involved completing an hour-long at-home computer-assisted self-interview (CASI) survey. Milestone 3 involved completing at-home self-administered rapid HIV testing and collecting/returning urine and rectal samples for gonorrhea and chlamydia testing. 

Compared to those who completed milestones: those not passing milestone 1 were more likely to be non-White and older; those not passing milestone 2 were less likely to have insurance or a primary care physician; and those not passing milestone 3 were less educated, more likely to be bisexual as opposed to gay, more likely to live in the Midwest, had fewer male partners in the past year, and less likely to have tested for HIV in the past year. Effect sizes for significant findings were small. 

We successfully enrolled a national sample of HIV-negative GBM who completed at-home CASI assessments and at-home self-administered HIV and urine and rectal STI testing. This indicates high feasibility and acceptability of incorporating self-administered biological assays into otherwise fully online studies. 

Differences in completion of study milestones indicate a need for further investigation into the reasons for lower engagement by certain groups.

Purchase full article at:   http://goo.gl/HXeiS1

By:  Grov C, Cain D, Whitfield TH, Rendina HJ, Pawson M, Ventuneac A, Parsons JT.

Sex Res Social Policy. 2016 Mar 1;13(1):1-21.

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HIV Prevalence and Antenatal Care Attendance among Pregnant Women in a Large Home-Based HIV Counseling and Testing Program in Western Kenya

OBJECTIVE:

To describe the uptake of and factors associated with HIV prevalence among pregnant women in a large-scale home-based HIV counseling and testing (HBCT) program in western Kenya.

METHODS:

In 2007, the Academic Model Providing Access to Healthcare Program (AMPATH) initiated HBCT to all individuals aged ≥13 years and high-risk children <13 years. Included in this analysis were females aged 13-50 years, from 6 catchment areas (11/08-01/12). We used descriptive statistics and logistic regression to describe factors associated with HIV prevalence.

RESULTS:

There were 119,678 women eligible for analysis; median age 25 (interquartile range, IQR: 18-34) years. Of these, 7,396 (6.2%) were pregnant at the time of HBCT; 4,599 (62%) had ever previously tested for HIV and 2,995 (40.5%) had not yet attended ANC for their current pregnancy. Testing uptake among pregnant women was high (97%). HBCT newly identified 241 (3.3%) pregnant HIV-positive women and overall HIV prevalence among all pregnant women was 6.9%. HIV prevalence among those who had attended ANC in this pregnancy was 5.4% compared to 9.0% among those who had not. Pregnant women were more likely to newly test HIV-positive in HBCT if they had not attended ANC in the current pregnancy (AOR: 6.85, 95% CI: 4.49-10.44).

CONCLUSIONS:

Pregnant women who had never attended ANC were about 6 times more likely to newly test HIV-positive compared to those who had attended ANC, suggesting that the cascade of services for prevention of mother-to-child HIV transmission should optimally begin at the home and village level if elimination of perinatal HIV transmission is to be achieved.

Full article at: http://goo.gl/pRbjCk

By:  Ndege S1,2, Washington S3, Kaaria A1,4, Prudhomme-O'Meara W1,2,5, Were E1,6, Nyambura M1, Keter AK1, Wachira J1,6, Braitstein P1,6,7,8,9.

• 1Academic Model Providing Access to Healthcare (AMPATH) Program, Eldoret, Kenya.
• 2Moi University, College of Health Sciences, School of Public Health, Eldoret, Kenya.
• 3Indiana University, School of Medicine, Indianapolis, Indiana, United States of America.
• 4Moi Teaching and Referral Hospital, Eldoret, Kenya.
• 5Duke University, School of Medicine and Duke Global Health Institute, Durham, North Carolina, United States of America.
• 6Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya.
• 7University of Toronto, Dalla Lana School of Public Health, Toronto, Canada.
• 8Indiana University, Fairbanks School of Public Health, Indianapolis, Indiana, United States of America.
• 9Regenstrief Institute, Inc. Indianapolis, Indiana, United States of America. 
• PLoS One. 2016 Jan 19;11(1):e0144618. doi: 10.1371/journal.pone.0144618. eCollection 2016.

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Factors Associated with Access to HIV Care Services in Eastern Uganda: The Kumi Home Based HIV Counseling & Testing Program Experience

The HIV/AIDS health challenge continues to ravage many resource-constrained countries of the world. Approximately 75 % of all the global HIV/AIDS related deaths totaling 1.6 (1.4–1.9) million in 2012 occurred in sub-Saharan Africa, Uganda contributed 63,000 (52,000–81,000) to these deaths. 

Most of the morbidity and mortality associated with HIV/AIDS can be averted if individuals with HIV/AIDS have improved access to HIV care and treatment. The aim of this study therefore, was to explore the factors associated with access to HIV care services among HIV seropositive clients identified by a home based HIV counseling and testing program in Kumi district, eastern Uganda.

In a cross sectional study conducted in February 2009, we explored predictor variables: socio-demographics, health facility and community factors related to access to HIV care and treatment. The main outcome measure was reported receipt of cotrimoxazole for prophylaxis.

The majority [81.1 %] of respondents received cotrimoxazole prophylaxis (indicating access to HIV care). The main factors associated with access to HIV care include; age 25–34 years, male sex, urban residence and lack of family support.

There was relatively high access to HIV care and treatment services at health facilities for HIV positive clients referred from the Kumi home based HIV counseling and testing program. The factors associated with access to HIV care services include; age group, sex, residence and having a supportive family. Stakeholders involved in providing HIV care and treatment services in similar settings should therefore consider these socio-demographic variables as they formulate interventions to improve access to HIV care services.

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By: David Lubogo^1*, John Bosco Ddamulira², Raymond Tweheyo³ and Henry Wamani¹

¹Department of Community Health and Behavioural Sciences, Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda

²Department of Disease Control and Environmental Health, Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda

³Department of Health Policy Planning and Management, Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda

  

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Correlates of Requesting Home HIV Self-Testing Kits on Online Social Networks among African-American & Latino Men Who Have Sex With Men

High levels of HIV stigma are one of the main difficulties in engaging African-American and Latino men who have sex with men (MSM) in HIV testing. The availability of home HIV test and the possibility of self-testing in private may improve uptake and counteract stigma. This paper sought to determine the correlates of requesting home HIV test kits among a sample of MSM social media users. 

The odds of participants requesting a test kit were significantly associated with using social networks to seek sexual partners (aOR: 2.47, 95% CI: 1.07-6.06) and thinking it is easier to use social networks for seeking sexual partners (1.87, 1.2-3.12), uncertain HIV status (4.29, 1.37-14.4), and having sex under the influence of alcohol (2.46, 1.06-5.77). Participants who had not been tested for more than 6 months were more likely to request a test kit than those who were tested in the past 6 months (2.53, 1.02-6.37). Participants who frequently talked to others about having sex with men online were less likely to request a test kit (0.73, 0.56-0.92). 

By reaching people over social media and offering them access to test kits, we were able to reach at-risk individuals who were uncertain about their HIV status and had not been regularly tested. The findings of the study will help to inform future HIV testing interventions.

Purchase full article at: http://goo.gl/mcgzgM

By: Chiu CJ1, Young SD1.

1a Department of Family Medicine , University of California, Los Angeles (UCLA) , Los Angeles , CA , USA

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Entry into Care Following Universal Home-Based HIV Testing in Rural KwaZulu-Natal, South Africa: the ANRS TasP 12249 Cluster-Randomised Trial

Via:   http://ht.ly/QUVxt HT @IAS_conference 

Home-Testing and Initiation of ART in Africa

Via:   http://ht.ly/QUTTo MT @IAS_conference 

Targeted HIV Testing in Home or Clinic for Older Children of HIV-Infected Adults in Care Increases Pediatric HIV Testing Rates and Reveals High Prevalence of Previously Undiagnosed HIV Infection

Via:   http://ht.ly/QRiFL HT @IAS_conference 

HIV Self-Testing in Men Who Have Sex with Men

Via:  http://ht.ly/QRgD6 MT @IAS_conference 

A Household Food Voucher Increases Consent to Home-Based HIV Testing in Rural KwaZulu-Natal

Below:  Consent to Test for HIV, 2009 - 2011 by Intervention Group

Allocation of the voucher to a household in 2010 increased the probability of household members consenting to test in 2010 by 29 percentage points (risk difference 95% CI 23 - 35; p<.001). We also find an attenuated effect of treatment on consent rates in 2011. Rates of consent to test by intervention group (being a member of a household which received the voucher in 2010) are shown in figure 1. We estimate the cost of the program at 7 USD per additional HIV test obtained.

The provision of gift vouchers to surveillance participants is likely to be a cost-effective tool for raising consent rates for home-based HIV testing. In addition, by persuading respondents who would ordinarily refuse to test in the absence of the voucher effect, this approach can potentially be used to assess the extent of selection bias in the population.

Via:  http://ht.ly/KvZkA HT @Harvard