Quantifying the gender gap in the HIV care cascade in southern Mozambique: We are missing the men

López-Varela, Elisa; Augusto, Orvalho; Fuente-Soro, Laura; Sacoor, Charfudin; Nhacolo, Ariel; Casavant, Isabelle; Karajeanes, Esmeralda; Naniche, Denise

doi:10.1371/journal.pone.0245461

Cited by 16 publications

(15 citation statements)

References 32 publications

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“…Innovative testing models, such as HIV self-testing, which target specific populations not sufficiently engaged in the public health services (e.g., men, adolescents, and other key and vulnerable populations in Tanzania) [9,34,35] also show promise for potentially improving efficiencies and optimizing HIV testing access. The achievement of the first 90 [36][37][38][39] will, however, benefit from more engagement of private sector level 1a facilities through the provision of training or other incentives, such as the provision of self-testing or ART refill. The effective coordination of community HIV-testing strategies in Uganda showed an increasing number of PLHIV tested [40].…”

Section: Discussionmentioning

confidence: 99%

The Shinyanga Patient: A Patient’s Journey through HIV Treatment Cascade in Rural Tanzania

Okere

Sambu²,

Ndungile³

et al. 2021

IJERPH

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The 2016–2017 Tanzania HIV Impact Survey (THIS) reported the accomplishments towards the 90-90-90 global HIV targets at 61-94-87, affirming the need to focus on the first 90 (i.e., getting 90% of people living with HIV (PLHIV) tested). We conducted a patient-pathway analysis to understand the gap observed, by assessing the alignment between where PLHIV seek healthcare and where HIV services are available in the Shinyanga region, Tanzania. We used existing and publicly available data from the National AIDS Control program, national surveys, registries, and relevant national reports. Region-wide, the majority (n = 458/722, 64%) of THIS respondents accessed their last HIV test at public sector facilities. There were 65.9%, 45.1%, and 74.1% who could also access antiretroviral therapy (ART), CD4 testing, and HIV viral load testing at the location of their last HIV test, respectively. In 2019, the viral suppression rate estimated among PLHIV on ART in the Shinyanga region was 91.5%. PLHIV access HIV testing mostly in public health facilities; our research shows that synergies can be achieved to improve access to services further down the cascade in this sector. Furthermore, effective engagement with the private sector (not-for-profit and for-profit) will help to achieve the last mile toward ending the HIV epidemic.

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Section: Discussionmentioning

confidence: 99%

The Shinyanga Patient: A Patient’s Journey through HIV Treatment Cascade in Rural Tanzania

Okere

Sambu²,

Ndungile³

et al. 2021

IJERPH

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“…We conducted a single-group pre-post study involving healthcare providers between November 2018 and November 2019 in the four highest-volume healthcare facilities of Manhiça District (MD) ─MD hospital, Xinavane rural hospital, and Palmeira and Maragra health units. MD is a semi-rural area in the Maputo province, southern Mozambique, with an overall community HIV-prevalence of 36.6% in 2015 [14,15]. The Mozambican national HIV testing strategy recommends targeted PITC in the high-volume entry points of healthcare facilities where universal PITC is not feasible to be applied, such as the triage and ED [16,17] [see Additional file 1].…”

Section: Methodsmentioning

confidence: 99%

Enhancing HIV testing yield in southern Mozambique: the effect of a Ministry of Health training module in targeted provider-initiated testing and counselling

Saura-Lázaro,

Fernández-Luis,

Nhampossa

et al. 2023

Preprint

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BackgroundIn Mozambique, targeted provider-initiated HIV testing and counselling (PITC) is recommended to increase HIV testing yield where universal PITC is not feasible. However, its effectiveness depends on healthcare providers’ training. We evaluated the effect of a Ministry of Health training module in targeted PITC on the HIV testing yield.MethodsWe conducted a single-group pre-post study between November 2018 and November 2019 in the triage and emergency departments of four healthcare facilities in Manhiça District. It consisted of two two-month phases split by a one-week targeted PITC training module (“observation phases”). During both phases, providers reported their recommendation to test or not for individuals ≥15 years, and study HIV counsellors performed universal testing. We calculated HIV testing yield of targeted PITC as the proportion of HIV-positive individuals among those provider-recommended and tested. We compared pre- and post-training yields using two-proportion z-test. Additionally, we extracted aggregated health information system data over the four months preceding and following the observation phases to compare yield in real-world conditions (“routine phases”). We used logistic regression to identify predictors of HIV test positivity.ResultsAmong 7,102 participants in the pre- and post-training observation phases (58.5% and 41.5% respectively), 68% were women, and 96% were recruited at triage. While HIV testing yield between pre- and post-training observation phases was similar, we observed an increase in yield in the post-training routine phase for women in triage (Yield ratio=1.54; 95%CI: 1.11-2.14). Age (25-49 years) (OR=2.43; 95%CI: 1.37-4.33), working in industry/mining (OR=4.94; 95%CI: 2.17-11.23), unawareness of partner’s HIV status (OR=2.50; 95%CI: 1.91-3.27), and visiting a healer (OR=1.74; 95%CI: 1.03-2.93) were factors associated with HIV test positivity. Including these factors in the targeted PITC algorithm could increase new HIV diagnoses by 2.6%. Furthermore, testing individuals with ≥1 HIV risk factor/symptom and a negative HIV test within the past three months revealed an additional 3.5% of undiagnosed PLHIV.ConclusionsWe found over 50% increase in the HIV testing yield of targeted PITC among women in the four months following the training and observation phases. Including additional sociodemographic and risk factors in the targeted PITC algorithm could help identify undiagnosed PLHIV.

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“… 22 The community prevalence of HIV was estimated to be 36.6% in 2015 and 25% in pregnant women in 2021 (Nhampossa et al, unpublished). 23 , 24 Pregnant women attending the first ANC clinic visit were routinely tested for HIV and syphilis infection using rapid diagnostic tests (Determine, Abbott Laboratories-USA, and Uni-Gold HIV, Trinity Biotech-Ireland for HIV, and SD Bioline Syphilis 3.0, Standard Diagnostics-Korea for syphilis). Following national guidelines, after diagnosis all HIV-infected women are scheduled to receive life-long antiretroviral therapy (ART).…”

Section: Methodsmentioning

confidence: 99%

SARS-CoV-2 Seropositivity and HIV Viral Load Among Mozambican Pregnant Women

González

Nhampossa

Figueroa-Romero

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction: Prevalence estimates of SARS-CoV-2 infection in Africa are limited, particularly among pregnant women and in those living with HIV. This study assessed the seroprevalence of SARS-CoV-2 antibodies among Mozambican HIV-infected pregnant women during the first year of the pandemic, before COVID-19 vaccines were deployed in the country. Setting: The study was conducted in Manhiça district, a semirural area in southern Mozambique. Methods: A prospective cohort study including pregnant women living with HIV was conducted from November 2019 to June 2021. Women were enrolled at the first antenatal care clinic visit and followed until postpartum. HIV viral load and IgM/IgG antibodies against SARS-CoV-2 were determined in blood samples at first antenatal care clinic visit and at delivery. Associations between SARS-CoV-2 serostatus and maternal characteristics at enrolment were analyzed. Results: A total of 397 women were enrolled. SARS-CoV-2 IgG/IgM antibodies were detected in 7.1% of women at enrolment and in 8.5% of women at delivery. Overall, SARS-CoV-2 antibodies were detected in 45 women (11.3%; 95% confidence interval 8.4 to 14.9%) during the study period; the first seropositive sample was identified in September 2020. Having undetectable HIV viral load was associated with seropositivity of SARS-CoV-2 IgG/IgM [odds ratio 3.35 (1.10 to 11.29); P = 0.039]. Conclusion: Seroprevalence of SARS-CoV-2 antibodies in this cohort of Mozambican unvaccinated pregnant women was similar to reported global estimates of approximately 10% in pregnancy for 2021. The findings also suggest that pregnant women with high HIV viral load may have an impaired immune response against SARS-CoV-2 and might need to be carefully managed in case of COVID-19.

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Quantifying the gender gap in the HIV care cascade in southern Mozambique: We are missing the men

Cited by 16 publications

References 32 publications

The Shinyanga Patient: A Patient’s Journey through HIV Treatment Cascade in Rural Tanzania

The Shinyanga Patient: A Patient’s Journey through HIV Treatment Cascade in Rural Tanzania

Enhancing HIV testing yield in southern Mozambique: the effect of a Ministry of Health training module in targeted provider-initiated testing and counselling

SARS-CoV-2 Seropositivity and HIV Viral Load Among Mozambican Pregnant Women

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