Extending beyond Policy: Reaching UNAIDS’ Three “90”s in Malawi

Chirwa, Zengani; Kayambo, Florence; Oseni, Lolade; Plotkin, Marya; Hiner, Cyndi; Chitsulo, Chimwemwe; Curran, Kelly; Kalua, Thokozani; Stender, Stacie C.

doi:10.3389/fpubh.2018.00069

Cited by 14 publications

(11 citation statements)

References 12 publications

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“…Male and female prisoners are strictly separated to different sections of the prison but have access to the same prison clinic. The current study took place in 6 prisons in southern Malawi, which contain more than 50% of the prison population in Malawi [ 17 ]. Two of the six are central prisons that often house more than 1200 prisoners despite having a capacity of 800.…”

Section: Methodsmentioning

confidence: 99%

Prisoners’ access to HIV services in southern Malawi: a cross-sectional mixed methods study

et al. 2021

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Background The prevalence of Human Immunodeficiency Virus (HIV) among prisoners remains high in many countries, especially in Africa, despite a global decrease in HIV incidence. Programs to reach incarcerated populations with HIV services have been implemented in Malawi, but the success of these initiatives is uncertain. We explored which challenges prisoners face in receiving essential HIV services and whether HIV risk behavior is prevalent in prisons. Methods We conducted a mixed-methods (qualitative and quantitative), cross-sectional study in 2018 in six prisons in Southern Malawi, two large central prisons with on-site, non-governmental organization (NGO) supported clinics and 4 smaller rural prisons. Four hundred twelve prisoners were randomly selected and completed a structured questionnaire. We conducted in-depth interviews with 39 prisoners living with HIV, which we recorded, transcribed and translated. We used descriptive statistics and logistic regression to analyze quantitative data and content analysis for qualitative data. Results The majority of prisoners (93.2%) were male, 61.4% were married and 63.1% were incarcerated for 1–5 years. Comprehensive services were reported to be available in the two large, urban prisons. Female prisoners reported having less access to general medical services than males. HIV risk behavior was reported infrequently and was associated with incarceration in urban prisons (adjusted odds ratio [aOR] 18.43; 95% confidence interval [95%-CI] 7.59–44.74; p = < 0.001) and not being married (aOR 17.71; 95%-CI 6.95–45.13; p = < 0.001). In-depth interviews revealed that prisoners living with HIV experienced delays in referrals for more severe illnesses. Prisoners emphasized the detrimental impact of poor living conditions on their personal health and their ability to adhere to antiretroviral therapy (ART). Conclusions Malawian prisoners reported adequate knowledge about HIV services albeit with gaps in specific areas. Prisoners from smaller, rural prisons had suboptimal access to comprehensive HIV services and female prisoners reported having less access to health care than males. Prisoners have great concern about their poor living conditions affecting general health and adherence to ART. These findings provide guidance for improvement of HIV services and general health care in Malawian institutionalized populations such as prisoners.

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Section: Methodsmentioning

confidence: 99%

Prisoners’ access to HIV services in southern Malawi: a cross-sectional mixed methods study

et al. 2021

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“…The prevalence of HIV in sub-Saharan countries such as Malawi are among the highest in the world [1,2]. Like many other countries in the region, Malawi, has adopted a "public health approach" to HIV scale-up in order to meet the UNAIDS 90-90-90 goals (diagnosing 90% of all people living with HIV, providing antiretroviral therapy [ART] to 90% of those diagnosed, and achieving viral suppression for 90% of those treated) [3][4][5]. Great strides have been made towards achieving these goals and engaging people living with HIV in care across the region [6,7]; in 2018 in Malawi, 90% of those living with HIV were estimated to be aware of their status, 87% were on treatment and 89% were virally suppressed [1].…”

Section: Introductionmentioning

confidence: 99%

Association Between Depression and HIV Care Engagement Outcomes Among Patients Newly Initiating ART in Lilongwe, Malawi

et al. 2020

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As in other sub-Saharan countries, the burden of depression is high among people living with HIV in Malawi. However, the association between depression at ART initiation and two critical outcomes—retention in HIV care and viral suppression—is not well understood. Prior to the launch of an integrated depression treatment program, adult patients were screened for depression at ART initiation at two clinics in Lilongwe, Malawi. We compared retention in HIV care and viral suppression at 6 months between patients with and without depression at ART initiation using tabular comparison and regression models. The prevalence of depression among this population of adults newly initiating ART was 27%. Those with depression had similar HIV care outcomes at 6 months to those without depression. Retention metrics were generally poor for those with and without depression. However, among those completing viral load testing, nearly all achieved viral suppression. Depression at ART initiation was not associated with either retention or viral suppression. Further investigation of the relationship between depression and HIV is needed to understand the ways depression impacts the different aspects of HIV care engagement.

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“…A risk score to identify who has a greater likelihood of no prior tests may help the established lay cadre of HIV diagnostic assistants augment their established HIV testing promotion success. 1 Multiple initiatives exist to increase HIV testing among men, 8,26 yet some men perceive health services as female spaces, 8 view testing as an accusation of infidelity, 27 or believe that they have tested "by proxy" if their wives have tested for HIV. 28 However, we observed higher testing among men whose partners had ever tested for HIV, which may point to partner notification and other testing initiatives, or to shared values and health-seeking behaviors among our participants compared to previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…Malawi may be on target to reach the UNAIDS 90-90-90 goals by 2020, 1 in which 90% of people living with HIV (PLWH) know their status, 90% of those aware of their positive status receive sustained antiretroviral treatment (ART), and 90% of those on treatment are virally suppressed. 2 Between 2004 and 2015, Malawi increased the proportion of adults who have ever tested for HIV from 13% to 83% among women and 15% to 70% among men.…”

Section: Introductionmentioning

confidence: 99%

Who Has Yet to Test? A Risk Score for Predicting Never Having Tested for Human Immunodeficiency Virus Among Women and Men in Rural Malawi

Harrington¹,

Turner²,

Chemey

et al. 2019

Sexual Trans Dis

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Background: HIV status awareness is important for preventing onward HIV transmission, and is one of the UNAIDS 90-90-90 goals. Efforts to scale up HIV testing have generally been successful, but identifying at risk individuals who have never tested for HIV-a population necessary to reach to improve HIV status awareness-remains challenging. Methods: Using data from a community-based cohort of people living in rural central Malawi, we identified demographic, socioeconomic, and sexual health correlates of never having tested for HIV. Correlates were assigned values from the logistic regression model to develop a risk score that identified who had never tested for HIV. Results: Among 1,310 ever sexually active participants, 7% of women and 13% of men had never tested for HIV. Of those who had tested for HIV, about 30% had tested more than 12 months ago. For women, younger age and poorer sexual health knowledge were correlated with never having tested for HIV, and the c-statistic for the risk score was 0.83. For men, their partner having not tested for HIV, low socioeconomic status, and poor sexual health knowledge were correlated with never testing for HIV (c-statistic 0.81). Among those with a score of 3, the sensitivity and specificity for never having tested for HIV were 81% and 77% for women, and 82% and 66% for men, respectively. Conclusions: About 10% of participants had never tested for HIV. This risk score could help health professionals to identify never-testers to increase HIV status awareness in line with 90-90-90 goals.

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Extending beyond Policy: Reaching UNAIDS’ Three “90”s in Malawi

Cited by 14 publications

References 12 publications

Prisoners’ access to HIV services in southern Malawi: a cross-sectional mixed methods study

Prisoners’ access to HIV services in southern Malawi: a cross-sectional mixed methods study

Association Between Depression and HIV Care Engagement Outcomes Among Patients Newly Initiating ART in Lilongwe, Malawi

Who Has Yet to Test? A Risk Score for Predicting Never Having Tested for Human Immunodeficiency Virus Among Women and Men in Rural Malawi

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