Leaving No Man Behind: How Differentiated Service Delivery Models Increase Men’s Engagement in HIV Care

Mukumbang, Ferdinand C.

doi:10.34172/ijhpm.2020.32

Cited by 34 publications

(37 citation statements)

References 58 publications

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“…Although the designathon ideas were not gender-specific the high percentage of boys and young men (48.5%) in the development of HIV services using this participatory approach is noteworthy. While previous literature shows low male involvement in the delivery and uptake of HIV preventive and care services [ 32–34 ], this designathon underscores the capabilities of young men to develop promising proposals for youth-friendly health services. This participatory approach is comparable to other open challenge contests that have been successful in engaging men in developing interventions to promote health care utilization [ 35 ].…”

Section: Discussionmentioning

confidence: 86%

Tailoring youth-friendly health services in Nigeria: a mixed-methods analysis of a designathon approach

Nwaozuru

Tahlil

Obiezu-Umeh

et al. 2021

Global Health Action

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Background Young people in low- and middle-income countries are often neglected in designing youth-friendly health services, especially HIV testing and preventive services. Designathons, which are time-bounded co-creation events where individuals gather in teams to develop solutions to a problem, could promote youth participation and ownership of health services. Objective The purpose of this study is to examine youth participation in a designathon to create youth-friendly health services in Nigeria. Methods Our designathon was based on crowdsourcing principles and informed by a human-centered design approach. The designathon included an open call for Nigerian youths between 14 and 24 years to share ideas on how to promote uptake of HIV self-testing services and a three-day sprint event that brought together diverse teams to develop strategies enhancing linkage to care. Teams pitched their solutions to a panel of five independent experts who scored ideas based on the desirability, feasibility, potential impact, and teamwork. We used descriptive statistics to summarize participants’ demographics and conducted a content analysis to synthesize themes from youth proposals. Results Nine hundred seventy-six youth across Nigeria applied to join the designathon. Forty-eight youth in 13 teams participated in the designathon with a median age of 20 years (IQR: 17–22]. Boys and young men were 48.5% (446/919) of the total applicants, 62.5% (30/48) of the designathon participants, and 63.6% (7/11) of the finalists. Students, from all educational levels, represented 91.2% (841/922) of the total applicants, 88.4% (38/43) of the designathon participants, and 90.0% (9/10) of the finalists. About twenty-three percent (3/13) of the final proposals were top ranked. The three finalist approaches to optimize youth-friendly health services centered on decentralizing service delivery to young people through mobile health technologies, use of mobile tents, or peer support services. Conclusions Our open call engaged diverse groups of Nigerian youth, including young women and students. Our data suggest that designathons may be useful for developing tailored youth-friendly health services. Further research is needed to understand the designathon process and the effectiveness of the finalist submissions.

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Section: Discussionmentioning

confidence: 86%

Tailoring youth-friendly health services in Nigeria: a mixed-methods analysis of a designathon approach

Nwaozuru

Tahlil

Obiezu-Umeh

et al. 2021

Global Health Action

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“…The majority of the population of Khayelitsha relies on government social grants, especially child support grants (Seekings, 2013). Our case study clinic was selected because it is one of the facilities in the sub-structure with the highest HIV cohort and one of the few public health facilities implementing all three models (Mukumbang, 2021). With most of the patients on antiretroviral treatment at the facility being stable patients, the facility adherence clubs reached maximum capacity as determined by the available resources.…”

Section: Study Settingmentioning

confidence: 99%

Comparing Patients’ Experiences in Three Differentiated Service Delivery Models for HIV Treatment in South Africa

2021

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Differentiated service delivery for HIV treatment seeks to enhance medication adherence while respecting the preferences of people living with HIV. Nevertheless, patients’ experiences of using these differentiated service delivery models or approaches have not been qualitatively compared. Underpinned by the tenets of descriptive phenomenology, we explored and compared the experiences of patients in three differentiated service delivery models using the National Health Services’ Patient Experience Framework. Data were collected from 68 purposively selected people living with HIV receiving care in facility adherence clubs, community adherence clubs, and quick pharmacy pick-up. Using the constant comparative thematic analysis approach, we compared themes identified across the different participant groups. Compared to facility adherence clubs and community adherence clubs, patients in the quick pharmacy pick-up model experienced less information sharing; communication and education; and emotional/psychological support. Patients’ positive experience with a differentiated service delivery model is based on how well the model fits into their HIV disease self-management goals.

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“…The poor treatment outcome reported among males have been attributed to strong gender norms and practices speci cally the perception of masculinity inherent within societies. In addition, lack of male friendly services inhibits males from seeking health care services [26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Determinants of Viral Suppression Among Adolescents on Antiretroviral Therapy in Ehlanzeni District, South Africa: A Retrospective Cohort Analysis

Okonji¹,

Wyk²,

Mukumbang³

et al. 2021

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Background Achieving undetectable viral loads is crucial for the reduction of HIV transmissions, AIDS related illnesses and death. Adolescents living with HIV on antiretroviral therapy (ART) have worse treatment adherence and lower viral suppression rates compared to adults. We report on the clinical factors associated with viral suppression among adolescents 10–19 years living with HIV in the Ehlanzeni district, Mpumalanga in South Africa. Methods A retrospective cohort analysis was conducted with 9,543 adolescents living with HIV, aged 10–19 years, who were enrolled in 136 ART clinics in the Ehlanzeni district. Clinical and immunological data were obtained from electronic medical records (Tier.net). Adolescents were categorized as having achieved viral suppression if their latest viral load count was < 1000 ribonucleic acid (RNA) copies/mL. Using a backward stepwise approach, a multivariate logistic regression analysis was performed to identify factors independently associated with viral suppression. Results The mean age of the participants was 14.75 years (SD = 2.8), and 55.43% were female. Mean duration on ART was 72.26 (SD = 42.3) months. Of the 9,543 adolescents with viral load results recorded, 74% had achieved viral suppression. After adjusting for other covariates, the likelihood of achieving viral suppression remained significantly higher among adolescents who were: female (AOR = 1.21, 95% CI 1.05–1.38), had CD4 count > 200 (AOR = 2.29, 95% CI 1.89–2.79), and on ART for more than 6 months (AOR = 2.75, 95% CI 1.74–4.34). Furthermore, the likelihood of having viral suppression was lower among adolescents with CD4 count < 200 at baseline (AOR = 0.76, 95% CI 0.64–0.90), and who were switched to second line regimen (AOR = 0.42, 95% CI 0.35–0.49). Conclusions Viral suppression amongst adolescents at 74% is considerably lower than the WHO target of 90%. Of particular concern for intervention is the lower rates of viral suppression amongst male adolescents. Greater emphasis should be placed to enrol adolescents on ART earlier before CD4 counts are depleted (< 200) and keeping them engaged in care (beyond 6 months). Furthermore, improved viral load monitoring may prevent unnecessary switching to second line treatment, which are costly and is a risk factor for viral non suppression.

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Leaving No Man Behind: How Differentiated Service Delivery Models Increase Men’s Engagement in HIV Care

Cited by 34 publications

References 58 publications

Tailoring youth-friendly health services in Nigeria: a mixed-methods analysis of a designathon approach

Tailoring youth-friendly health services in Nigeria: a mixed-methods analysis of a designathon approach

Comparing Patients’ Experiences in Three Differentiated Service Delivery Models for HIV Treatment in South Africa

Determinants of Viral Suppression Among Adolescents on Antiretroviral Therapy in Ehlanzeni District, South Africa: A Retrospective Cohort Analysis

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