Impact of a community-wide combination HIV prevention intervention on knowledge of HIV status among adolescents

Shanaube, Kwame; Schaap, Ab; Hoddinott, Graeme; Mubekapi-Musadaidzwa, Constance; Floyd, Sian; Böck, Peter; Hayes, Richard; Fidler, Sarah; Ayles, Helen; Team, Hptn Study

doi:10.1097/qad.0000000000002722

Cited by 8 publications

(9 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We found that advanced HIV disease [WHO stage III/IV] and management in a large HIV care center were associated with higher risk of attrition. Regarding age, it has been previously shown that adolescents are a group at risk for poor outcomes [40][41][42] and that adolescent-friendly screening interventions are needed to increase adolescents' access to ART programs [43][44][45]. We observed similar results in the univariate models but the impact of age was lost in the multivariate analysis.…”

Section: Plos Global Public Healthsupporting

confidence: 73%

Retention in care and predictors of attrition among HIV-infected patients who started antiretroviral therapy in Kinshasa, DRC, before and after the implementation of the ‘treat-all’ strategy

Mayasi

Situakibanza

Mbula

et al. 2022

PLOS Glob Public Health

View full text Add to dashboard Cite

The retention of patients in care is a key pillar of the continuum of HIV care. It has been suggested that the implementation of a “treat-all” strategy may favor attrition (death or lost to follow-up, as opposed to retention), specifically in the subgroup of asymptomatic people living with HIV (PLWH) with high CD4 counts. Attrition in HIV care could mitigate the success of universal antiretroviral therapy (ART) in resource-limited settings. We performed a retrospective study of PLWH at least 15 years old initiating ART in 85 HIV care centers in Kinshasa, Democratic Republic of Congo (DRC), between 2010 and 2019, with the objective of measuring attrition and to define factors associated with it. Sociodemographic and clinical characteristics recorded at ART initiation included sex, age, weight, height, WHO HIV stage, pregnancy, baseline CD4 cell count, start date of ART, and baseline and last ART regimen. Attrition was defined as death or loss to follow-up (LTFU). LTFU was defined as “not presenting to an HIV care center for at least 180 days after the date of a last missed visit, without a notification of death or transfer”. Kaplan–Meier curves were used to present attrition data, and mixed effects Cox regression models determined factors associated with attrition. The results compared were before and after the implementation of the “treat-all” strategy. A total of 15,762 PLWH were included in the study. Overall, retention in HIV care was 83% at twelve months and 77% after two years of follow-up. The risk of attrition increased with advanced HIV disease and the size of the HIV care center. Time to ART initiation greater than seven days after diagnosis and Cotrimoxazole prophylaxis was associated with a reduced risk of attrition. The implementation of the “treat-all” strategy modified the clinical characteristics of PLWH toward higher CD4 cell counts and a greater proportion of patients at WHO stages I and II at treatment initiation. Initiation of ART after the implementation of the ‘treat all” strategy was associated with higher attrition (p<0.0001) and higher LTFU (p<0.0001). Attrition has remained high in recent years. The implementation of the “treat-all” strategy was associated with higher attrition and LTFU in our study. Interventions to improve early and ongoing commitment to care are needed, with specific attention to high-risk groups to improve ART coverage and limit HIV transmission.

show abstract

Section: Plos Global Public Healthsupporting

confidence: 73%

Retention in care and predictors of attrition among HIV-infected patients who started antiretroviral therapy in Kinshasa, DRC, before and after the implementation of the ‘treat-all’ strategy

Mayasi

Situakibanza

Mbula

et al. 2022

PLOS Glob Public Health

View full text Add to dashboard Cite

show abstract

“…Adaptation, defined as a “process of making modifications or changes to the design or implementation of an intervention”, is important for optimizing implementation [ 10 , 11 ]. Adaptations are important for meeting a specific target group needs or as a response to a contextual stimulant, such as disease outbreaks [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Adapting community-based sexual and reproductive health services for adolescents and young people aged 15-24 years in response to COVID-19 in Lusaka, Zambia: the implications on the uptake of HIV testing services

Phiri

Hensen

Schaap

et al. 2022

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

Background Across Sub-Saharan Africa, adolescents and young people (AYP) aged 15-24 have limited access to sexual and reproductive health (SRH) services, including HIV testing services (HTS). In response, the Yathu Yathu study was implemented in two high-density communities in Lusaka, Zambia. Yathu Yathu provides comprehensive, community-based, peer-led SRH services, including differentiated HTS (finger-prick and HIV self-testing) and comprehensive sexuality education (CSE). We describe adaptations to the Yathu Yathu intervention in response to the COVID-19 epidemic, and implications on uptake of HTS among AYP. Methods Yathu Yathu provides SRH services through community-based peer-led spaces. AYP in study communities were offered prevention points cards (PPC), which incentivizes and tracks service use. Social media (WhatsApp©/Facebook©) is used to engage and inform AYP about SRH. Due to COVID-19, hubs closed from April-June 2020. We describe adaptations in response to COVID-19 and, using routinely collected PPC data, describe uptake of HTS before (September 2019-March 2020) and after (July-December 2020) adaptations in response to COVID-19. We describe reach of the Yathu Yathu Facebook page and use qualitative data to describe AYP experiences of SRH service access. Results During hub closures, CSE was delivered via video on social media, resulting in an increase in Facebook page followers from 539(April) to 891(June). WhatsApp groups evolved as a platform to deliver CSE and COVID-19 information, with higher participation among young people aged 20-24. Key service delivery adaptations included: reducing the number of participants in hubs, mandatory handwashing before entry, use of personal protective equipment by staff and provision of facemasks to AYP. HTS were provided as normal. Adaptations led to fewer AYP attending hubs. Uptake of HTS among AYP visiting hubs for the first time after COVID-19-related closures was higher (73.2%) compared to uptake before adaptations (65.9%; adjOR=1.24 95%CI 0.99, 1.56, p=0.06). Despite disappointments with some aspects of service delivery, AYP expressed happiness that hubs had reopened. Conclusions Social media can be a useful additional platform to reach AYP with HIV prevention information during COVID-19. With proper infection control in place, HTS can safely be provided to, accessed and accepted by AYP in community-based settings during COVID-19. Trial Registration National Clinical Trials NCT04060420,19th August 2019. Current Controlled Trials ISRCTN75609016, 14th September 2021, retrospectively registered.

show abstract

“…The PopART for Youth (P-ART-Y) study aimed to determine the acceptability and uptake of HIV testing among adolescents and young adults aged 10-24 years (young people) and was implemented from October 2015 to December 2017, the main findings from the study have been published elsewhere (13,18,19). The P-ART-Y study was nested within the HPTN071 (PopART) trial, a three-arm cluster-randomized trial conducted in 12 communities in Zambia and nine communities in South Africa which was implemented from November 2013 to December 2017 (13).…”

Section: Trial Design and Settingmentioning

confidence: 99%

“…In Africa, HIV/AIDS is now the leading cause of death among adolescents, notably among girls, and is ranked second globally next to unintentional injuries (1,2). Furthermore, an estimated 250,000 adolescents aged [15][16][17][18][19] become newly HIV-positive annually (3). Compared to adults, older adolescents, and children/infants, little is known about the burden of HIV and AIDS among young adolescents (aged 10-14 years) as data on them are rarely collected, and the statistics that are reported aggregate them with older youth.…”

Section: Introductionmentioning

confidence: 99%

A screening tool enhances home-based identification of adolescents (aged 10-14) living with HIV in Zambia and South Africa: HPTN 071 (PopART) Study

Chaila

McLeod

Vermund³

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

Introduction: The HPTN071 (PopART) for Youth (P-ART-Y) study evaluated the acceptability and uptake of a community-level combination HIV prevention package including universal testing and treatment (UTT) among young people in Zambia and South Africa (SA). We determined whether a four-question primary care level screening tool, validated for use in clinical settings, could enhance community (door-to-door) identification of undiagnosed HIV-positive younger adolescents (aged 10-14) who are frequently left out of HIV interventions. Method : Community HIV-care Providers (CHiPs) contacted and consented adolescents in their homes and offered them participation in the PopART intervention. CHiPs used a four question-screening tool, which included: history of hospital admission; recurring skin problems; poor health in last 3 months; and death of at least one parent. A "yes" response to one or more questions was classified as being "at risk" of being HIV-positive. The data were captured through an electronic data capturing device from August 2016 to December 2017. Proportions of adolescents who were deemed "at risk" were calculated and the association of screening "at risk" with age, sex and community was tested using a chi-squared test. The adjusted odds ratio (OR) comparing the odds of testing HIV-positive if "at risk" with the odds of testing positive if "not at risk" was estimated using logistic regression. Results : In our 14 study sites, 33,283 adolescents aged 10-14 in Zambia and 8,610 in SA participated in the study. About 1.3% (427/33,710) and 1.2% (106/8,610) self-reported to be HIV positive. Excluding the self-reported HIV-positive, we classified 11.3% (3,746/33,283) of adolescents in Zambia and 17.5% (1,491/8,504) in SA as "at risk". In Zambia and SA, the "at risk" adolescents were 4.6 and nearly 16.7 times more likely to test HIV-positive compared to the "not at risk", respectively (both p<0.001). Using the screening tool, one-third of HIV-positive adolescents could be diagnosed using just a tenth of the number of HIV tests compared to universal testing. Conclusion: The screening tool may be of some value where UTT is not possible and limited resources must be prioritised toward adolescents who are more likely to be living with HIV. Further, the tool is of greater value in settings where there are more adolescents living with HIV who are undiagnosed. However, given our goal is to identify and treat all ALHIV, as well as link all HIV uninfected young people to prevention services, this screening tool should not be a substitute for UTT in community settings.

show abstract

Impact of a community-wide combination HIV prevention intervention on knowledge of HIV status among adolescents

Cited by 8 publications

References 14 publications

Retention in care and predictors of attrition among HIV-infected patients who started antiretroviral therapy in Kinshasa, DRC, before and after the implementation of the ‘treat-all’ strategy

Retention in care and predictors of attrition among HIV-infected patients who started antiretroviral therapy in Kinshasa, DRC, before and after the implementation of the ‘treat-all’ strategy

Adapting community-based sexual and reproductive health services for adolescents and young people aged 15-24 years in response to COVID-19 in Lusaka, Zambia: the implications on the uptake of HIV testing services

A screening tool enhances home-based identification of adolescents (aged 10-14) living with HIV in Zambia and South Africa: HPTN 071 (PopART) Study

Contact Info

Product

Resources

About