Reimagining the Future of HIV Service Implementation in the Philippines Based on Lessons from COVID-19

Quilantang, Ma Irene; Bermudez, Amiel Nazer C.; Operario, Don

doi:10.1007/s10461-020-02934-x

Cited by 20 publications

(21 citation statements)

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“…Participants welcome the clinic step at COVID-19 for telephone consultations, delivery of medicine for a longer duration (up to 6 months), and appreciated the courier delivery of ART to remote patients. Similar actions have been reported by Quilantang et al (2020) in the Philippines. Although the world has been struggling to contain the pandemic of COVID-19, millions of people are living with HIV and need constant medical supervision.…”

Section: Discussionsupporting

confidence: 87%

Barriers and Enablers for Adherence to Antiretroviral Therapy Among People Living With HIV/AIDS in the Era of COVID-19: A Qualitative Study From Pakistan

et al. 2022

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Background: With the increased availability of safe antiretroviral therapy (ART) in recent years, achieving optimal adherence and patient retention is becoming the biggest challenge for people living with HIV (PLWH). Care retention is influenced by several socioeconomic, socio-cultural, and government policies during the COVID-19 pandemic. Therefore, we aim to explore barriers and facilitators to adherence to ART among PLWH in Pakistan in general and COVID-19 pandemic related in particular.Methods: Semi-structured interviews were conducted among 25 PLWH from December 2020 to April 2021 in the local language (Urdu) at the ART centre of Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Interviews were audio-recorded in the local Urdu language, and bilingual expert (English, Urdu) transcribed verbatim, coded for themes and sub-themes, and analyzed using a phenomenological approach for thematic content analysis.Results: Stigma and discrimination, fear of HIV disclosure, economic constraints, forgetfulness, religion (Ramadan, spiritual healing), adverse drug reactions, lack of social support, alternative therapies, and COVID-19-related lock-down and fear of lesser COVID-19 care due to HIV associated stigma were identified as barriers affecting the retention in HIV care. At the same time, positive social support, family responsibilities, use of reminders, the beneficial impact of ART, and initiation of telephone consultations, courier delivery, and long-term delivery of antiretrovirals during COVID-19 were identified as facilitators of HIV retention.Conclusion: Improving adherence and retention is even more challenging due to COVID-19; therefore, it requires the integration of enhanced access to treatment with improved employment and social support. HIV care providers must understand these reported factors comprehensively and treat patients accordingly to ensure the continuum of HIV care. A coordinated approach including different stakeholders is required to facilitate patient retention in HIV care and consequently improve the clinical outcomes of PLWH.

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Section: Discussionsupporting

confidence: 87%

Barriers and Enablers for Adherence to Antiretroviral Therapy Among People Living With HIV/AIDS in the Era of COVID-19: A Qualitative Study From Pakistan

et al. 2022

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“…Our findings are therefore limited by the small sample size. As healthcare evolves post‐COVID‐19, telemedicine is likely to play a greater role in the management of many chronic medical conditions, including HIV [14]. Future work to assess the utility of short frailty screening tests via video consultation, which require no specific tools or investigations, will be required.…”

Section: Discussionmentioning

confidence: 99%

Objective and subjective rapid frailty screening tools in people with HIV

et al. 2020

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ObjectivesAs people with HIV (PWH) age, the prevalence of frailty increases. Rapid screening tests to identify frailty within HIV outpatient settings are required to identify at‐risk individuals. We undertook a service evaluation to assess three short frailty assessments in PWH.MethodsWe assessed two objective [gait speed (GS), timed‐up‐and‐go test (TUGT)] and one subjective [the self‐reported health questionnaire (SRH)] frailty screening tools in PWH aged > 40 years attending a single HIV outpatient department. Factors associated with positive frailty screening tests (defined as GS < 0.8 m/s, TUGT ≥ 10 s and SRH score < 6) were assessed using logistic regression models.Ethical considerationsThis was a service evaluation and was approved as a service evaluation by the Imperial College Healthcare NHS trust HIV clinical research committee (February 2020). All participants were given verbal information and were able to terminate the screening tests at any time.ResultsOf 84 PWH approached, 80 individuals completed all screening tests (median age = 56 years, range: 40–80) with a positive frailty screening prevalence in 19%, 33% and 20% for GS, TUGT and SRH, respectively. All tests were considered acceptable to participants. Factors statistically significantly associated with frailty included age (GS and TUGT), detectable HIV RNA (TUGT), number of comorbidities (GS and TUGT), presence of polypharmacy (GS and TUGT) and total number of concomitant medication (GS and SRH).ConclusionsRates of positive screening tests for frailty are dependent on screening tool used, with all three tools being acceptable to participants. Objective measures of frailty screening (GS and TUGT) are more closely associated with clinical parameters than is a subjective measure of frailty screening (SRH).

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“…Additionally, interest was also stronger among those who were currently based outside of Metro Manila, suggesting the geographic appeal of this long-acting modality among those who might not have proximity to the nation’s HIV most resourced hospital and public health settings. Leveraging innovative strategies and lessons learned from the Philippines’ local community-based organizations’ responses to delivering HIV services in light of the recent COVID-19 pandemic could be promising to integrate into future LAI-PrEP programming [46]; this includes improving logistics and protocols such as online remote service delivery (e.g., counseling, referrals, refill appointments), a continuance of supply chain of medications, and app-based strategies to reach individuals who may be remote or experience travel difficulties to clinics.…”

Section: Discussionmentioning

confidence: 99%

High interest in Long-Acting Injectable PrEP among Filipina Transfeminine Adults

Restar

Quilantang

Wickersham

et al. 2022

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Transfeminine adults are impacted by the HIV epidemic in the Philippines, and newly approved modalities of pre-exposure prophylaxis (PrEP), including long-acting injectable (LAI-PrEP), could be beneficial for this group. We utilized secondary data from the #ParaSaAtin survey that sampled Filipina transfeminine adults (n=139) and conducted a series of multivariable logistic regressions with lasso selection to explore factors independently associated with PrEP outcomes, including awareness, discussion with trans friends, and interest in LAI-PrEP. Overall, 53% of Filipina transfeminine respondents were aware of PrEP, 39% had discussed PrEP with their trans friends, and 73% were interested in LAI-PrEP. PrEP awareness was associated with being non-Catholic, having previously been HIV tested, discussing HIV services with a provider, and having high HIV knowledge (p<0.05). Discussing PrEP with friends was associated with older age, having experienced healthcare discrimination due to transgender identity, having HIV tested, and having discussed HIV services with a provider (p<0.05). Interest in LAI-PrEP was associated with living in Central Visayas, having discussed HIV services with a provider, and having discussed HIV services with a sexual partner were associated (p<0.05). Implementing LAI-PrEP in the Philippines requires addressing systemic improvements across personal, interpersonal, social, and structural levels in healthcare access, including efforts to create healthcare settings and environments with providers who are trained and competent in transgender health and can address the social and structural drivers of trans health inequities, including HIV and barriers to LAI-PrEP.

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Reimagining the Future of HIV Service Implementation in the Philippines Based on Lessons from COVID-19

Cited by 20 publications

References 1 publication

Barriers and Enablers for Adherence to Antiretroviral Therapy Among People Living With HIV/AIDS in the Era of COVID-19: A Qualitative Study From Pakistan

Barriers and Enablers for Adherence to Antiretroviral Therapy Among People Living With HIV/AIDS in the Era of COVID-19: A Qualitative Study From Pakistan

Objective and subjective rapid frailty screening tools in people with HIV

High interest in Long-Acting Injectable PrEP among Filipina Transfeminine Adults

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