HIV Stigma and Viral Suppression Among People Living With HIV in the Context of Universal Test and Treat: Analysis of Data From the HPTN 071 (PopART) Trial in Zambia and South Africa

Hargreaves, James; Pliakas, Triantafyllos; Hoddinott, Graeme; Mainga, Tila; Mubekapi-Musadaidzwa, Constance; Donnell, Deborah; Piwowar‐Manning, Estelle; Agyei, Yaw; Mandla, Nomhle F; Dunbar, Rory; Macleod, David; Floyd, Sian; Böck, Peter; Fidler, Sarah; Hayes, Richard; Seeley, Janet; Stangl, Anne; Bond, Virginia; Ayles, Helen; Team, Hptn Study

doi:10.1097/qai.0000000000002504

Cited by 28 publications

(28 citation statements)

References 27 publications

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“…HIV stigma remains an ever-present issue affecting progress toward the 95-95-95 targets in sub-Saharan Africa [ 37 , 38 ]. Similar to prior research on decentralized ART delivery [ 39 ], our study indicates that CCMDD may help to decrease HIV stigma concerns, because CCMDD integrates medication refills across chronic conditions.…”

Section: Discussionmentioning

confidence: 99%

Implementation of South Africa’s Central Chronic Medicine Dispensing and Distribution Program for HIV Treatment: A Qualitative Evaluation

et al. 2022

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We used the Practical, Robust Implementation and Sustainability Model to evaluate implementation of South Africa’s Central Chronic Medicine Dispensing and Distribution (CCMDD) program, a differentiated service delivery program which allows clinically stable HIV-positive patients to receive antiretroviral therapy refills at clinic- or community-based pick-up points. Across ten clinics, we conducted 109 semi-structured interviews with stakeholders (pick-up point staff, CCMDD service providers and administrators) and 16 focus groups with 138 patients. Participants had highly favorable attitudes and said CCMDD decreased stigma concerns. Patient-level barriers included inadequate education about CCMDD and inability to get refills on designated dates. Organizational-level barriers included challenges with communication and transportation, errors in medication packaging and tracking, rigid CCMDD rules, and inadequate infrastructure. Recommendations included: (1) provide patient education and improve communication around refills (at the patient level); (2) provide dedicated space and staff, and ongoing training (at the organizational/clinic level); and (3) allow for prescription renewal at pick-up points and less frequent refills, and provide feedback to clinics (at the CCMDD program level).

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Section: Discussionmentioning

confidence: 99%

Implementation of South Africa’s Central Chronic Medicine Dispensing and Distribution Program for HIV Treatment: A Qualitative Evaluation

et al. 2022

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“…Reduction and elimination of HIV-related stigma and discrimination (i.e., directed to PLHIV or to key populations at risk of HIV or held by service providers) refers to at least 3 different manifestations: community level discrimination, healthcare provider discrimination, and internalized stigma. Studies have measured the effects of internalized stigma on access to care and treatment and found that it leads to reduced likelihood of testing for HIV [ 19 ], late linkage to care [ 20 , 21 ], lower levels of adherence to treatment [ 22 ], and lower levels of viral suppression among those on treatment [ 23 ]. We have used these studies to estimate the effects of internalized stigma on the treatment cascade: knowledge of status on treatment and viral suppression.…”

Section: Methodsmentioning

confidence: 99%

Modeling the epidemiological impact of the UNAIDS 2025 targets to end AIDS as a public health threat by 2030

et al. 2021

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Background UNAIDS has established new program targets for 2025 to achieve the goal of eliminating AIDS as a public health threat by 2030. This study reports on efforts to use mathematical models to estimate the impact of achieving those targets. Methods and findings We simulated the impact of achieving the targets at country level using the Goals model, a mathematical simulation model of HIV epidemic dynamics that includes the impact of prevention and treatment interventions. For 77 high-burden countries, we fit the model to surveillance and survey data for 1970 to 2020 and then projected the impact of achieving the targets for the period 2019 to 2030. Results from these 77 countries were extrapolated to produce estimates for 96 others. Goals model results were checked by comparing against projections done with the Optima HIV model and the AIDS Epidemic Model (AEM) for selected countries. We included estimates of the impact of societal enablers (access to justice and law reform, stigma and discrimination elimination, and gender equality) and the impact of Coronavirus Disease 2019 (COVID-19). Results show that achieving the 2025 targets would reduce new annual infections by 83% (71% to 86% across regions) and AIDS-related deaths by 78% (67% to 81% across regions) by 2025 compared to 2010. Lack of progress on societal enablers could endanger these achievements and result in as many as 2.6 million (44%) cumulative additional new HIV infections and 440,000 (54%) more AIDS-related deaths between 2020 and 2030 compared to full achievement of all targets. COVID-19–related disruptions could increase new HIV infections and AIDS-related deaths by 10% in the next 2 years, but targets could still be achieved by 2025. Study limitations include the reliance on self-reports for most data on behaviors, the use of intervention effect sizes from published studies that may overstate intervention impacts outside of controlled study settings, and the use of proxy countries to estimate the impact in countries with fewer than 4,000 annual HIV infections. Conclusions The new targets for 2025 build on the progress made since 2010 and represent ambitious short-term goals. Achieving these targets would bring us close to the goals of reducing new HIV infections and AIDS-related deaths by 90% between 2010 and 2030. By 2025, global new infections and AIDS deaths would drop to 4.4 and 3.9 per 100,000 population, and the number of people living with HIV (PLHIV) would be declining. There would be 32 million people on treatment, and they would need continuing support for their lifetime. Incidence for the total global population would be below 0.15% everywhere. The number of PLHIV would start declining by 2023.

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“…Only two studies examined the link between key population specific stigma and discrimination and HIV outcomes, one with female sex workers [ 43 ] and one with gay men and other men who have sex with men [ 32 ]. The evidence reviewed from 12 studies and 3 systematic reviews found a negative impact of HIV and key population stigma and discrimination on linkage to HIV care [ 33 , 41 ], HIV testing among the general population [ 30 , 42 ], HIV testing among the lesbian, gay, bisexual, and transgender community [ 32 , 34 ], viral suppression [ 31 , 35 , 37 , 38 , 44 ], treatment adherence [ 29 , 36 , 39 ] and treatment initiation [ 41 ]. Experienced stigma in the healthcare setting was also linked with avoiding or delaying care seeking for HIV [ 40 ].…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, people living with HIV who perceived high HIV stigma were twice as likely to delay enrolment in HIV care than those who perceived low HIV stigma [ 33 ] and men who have sex with men who reported stigma related to being gay had reduced odds of HIV testing [ 32 ]. Internalized stigma also impedes ART adherence among people living with HIV and key populations by compromising social support and adaptive coping [ 39 , 43 ], and has been linked to poorer viral suppression among people living with HIV who are taking antiretroviral therapy (ART) [ 35 , 37 , 38 , 44 ]. Among female sex workers living with HIV, experienced discrimination related to being a sex worker was associated with higher odds of ART interruption [ 43 ].…”

Section: Resultsmentioning

confidence: 99%

“…Our review demonstrated that anticipated and experienced discrimination [29] and anticipated, perceived and internalized stigma are key domains of stigma that must be addressed. While the negative influence of HIV stigma and discrimination on HIV prevention, care and treatment outcomes is well documented, only recently has evidence emerged linking internalized stigma with poorer viral suppression [31,35,37,38]. While previous research has found associations between stigma related to being gay or transgender with poorer access to HIV services [59][60][61][62], more research is needed to examine the link between key population-specific stigma and other HIV outcomes to inform appropriate mitigation strategies that can address intersectional stigma [63].…”

Section: Plos Onementioning

confidence: 99%

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Removing the societal and legal impediments to the HIV response: An evidence-based framework for 2025 and beyond

et al. 2022

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Societal and legal impediments inhibit quality HIV prevention, care, treatment and support services and need to be removed. The political declaration adopted by UN member countries at the high-level meeting on HIV and AIDS in June 2021, included new societal enabler global targets for achievement by 2025 that will address this gap. Our paper describes how and why UNAIDS arrived at the societal enabler targets adopted. We conducted a scoping review and led a participatory process between January 2019 and June 2020 to develop an evidence-based framework for action, propose global societal enabler targets, and identify indicators for monitoring progress. A re-envisioned framework called the ‘3 S’s of the HIV response: Society, Systems and Services’ was defined. In the framework, societal enablers enhance the effectiveness of HIV programmes by removing impediments to service availability, access and uptake at the societal level, while service and system enablers improve efficiencies in and expand the reach of HIV services and systems. Investments in societal enabling approaches that remove legal barriers, shift harmful social and gender norms, reduce inequalities and improve institutional and community structures are needed to progressively realize four overarching societal enablers, the first three of which fall within the purview of the HIV sector: (i) societies with supportive legal environments and access to justice, (ii) gender equal societies, (iii) societies free from stigma and discrimination, and (iv) co-action across development sectors to reduce exclusion and poverty. Three top-line and 15 detailed targets were recommended for monitoring progress towards their achievement. The clear articulation of societal enablers in the re-envisioned framework should have a substantial impact on improving the effectiveness of core HIV programmes if implemented. Together with the new global targets, the framework will also galvanize advocacy to scale up societal enabling approaches with proven impact on HIV outcomes.

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HIV Stigma and Viral Suppression Among People Living With HIV in the Context of Universal Test and Treat: Analysis of Data From the HPTN 071 (PopART) Trial in Zambia and South Africa

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 28 publications

References 27 publications

Implementation of South Africa’s Central Chronic Medicine Dispensing and Distribution Program for HIV Treatment: A Qualitative Evaluation

Implementation of South Africa’s Central Chronic Medicine Dispensing and Distribution Program for HIV Treatment: A Qualitative Evaluation

Modeling the epidemiological impact of the UNAIDS 2025 targets to end AIDS as a public health threat by 2030

Removing the societal and legal impediments to the HIV response: An evidence-based framework for 2025 and beyond

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