Revisiting aid dependency for HIV programs in Sub-Saharan Africa

Olakunde, Babayemi O; Adeyinka, Daniel A; Ozigbu, Chamberline E; Ogundipe, Temitayo; Menson, William Nii Ayitey; Olawepo, John Olajide; Olakunde, Olubunmi A; Ezeanolue, Echezona E.

doi:10.1016/j.puhe.2019.02.016

Cited by 12 publications

(8 citation statements)

References 8 publications

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“…In 2016, the UNAIDS set an annual target of 5 million VMMCs to reach 25 million men in SSA by 2021. However, many VMMC-priority countries face persistent healthcare resource constraints, characterized by low healthcare expenditures [6] personnel shortages [7] and an overdependence on donors for financing HIV prevention and treatment interventions [8]. These healthcare resource constraints threaten the quality and pace of VMMC scale-up [9,10].…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of two-way texting for post-operative follow-up in Zimbabwe’s voluntary medical male circumcision program

et al. 2020

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Objective Although adverse events (AEs) following voluntary medical male circumcision (VMMC) are rare, their prompt ascertainment and management is a marker of quality care. The use of two-way text messaging (2wT) for client follow-up after VMMC reduces the need for clinic visits (standard of care (SoC)) without compromising safety. We compared the cost-effectiveness of 2wT to SoC for post-VMMC follow-up in two, high-volume, public VMMC sites in Zimbabwe. Materials and methods We developed a decision-analytic (decision tree) model of post-VMMC client follow-up at two high-volume sites. We parameterized the model using data from both a randomized controlled study of 2wT vs. SoC and from the routine VMMC program. The perspective of analysis was the Zimbabwe government (payer). The time horizon covered the time from VMMC to wound healing. Costs included text messaging; both in-person and outreach follow-up; and AE management. Costs were estimated in 2018 U.S. dollars. The outcome of analysis was AE yield relative to the globally accepted safety standard of a 2% AE rate. We estimated the incremental cost per percentage increase in AE ascertainment and the incremental cost per additional AE identified. We conducted univariate and probabilistic sensitivity analyses.

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Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of two-way texting for post-operative follow-up in Zimbabwe’s voluntary medical male circumcision program

et al. 2020

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“…The low-income status prevalent in this region likely restricted existing private facilities to level 1. The regulated status of HIV services provided to clients by the government (through donor funds) free at the point of service in public and private not-for-profit facilities also characterizes many HIV programs in Africa [30]. This likely explains why the majority of PLHIV accessed care in public facilities [31,32].…”

Section: Discussionmentioning

confidence: 99%

The Shinyanga Patient: A Patient’s Journey through HIV Treatment Cascade in Rural Tanzania

Okere

Sambu²,

Ndungile³

et al. 2021

IJERPH

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The 2016–2017 Tanzania HIV Impact Survey (THIS) reported the accomplishments towards the 90-90-90 global HIV targets at 61-94-87, affirming the need to focus on the first 90 (i.e., getting 90% of people living with HIV (PLHIV) tested). We conducted a patient-pathway analysis to understand the gap observed, by assessing the alignment between where PLHIV seek healthcare and where HIV services are available in the Shinyanga region, Tanzania. We used existing and publicly available data from the National AIDS Control program, national surveys, registries, and relevant national reports. Region-wide, the majority (n = 458/722, 64%) of THIS respondents accessed their last HIV test at public sector facilities. There were 65.9%, 45.1%, and 74.1% who could also access antiretroviral therapy (ART), CD4 testing, and HIV viral load testing at the location of their last HIV test, respectively. In 2019, the viral suppression rate estimated among PLHIV on ART in the Shinyanga region was 91.5%. PLHIV access HIV testing mostly in public health facilities; our research shows that synergies can be achieved to improve access to services further down the cascade in this sector. Furthermore, effective engagement with the private sector (not-for-profit and for-profit) will help to achieve the last mile toward ending the HIV epidemic.

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“…In Uganda, 3.77% of PLHIV are on second-line ART [4] which is composed of a PI-based regimen of boosted lopinavir or atazanavir, and a recycled NRTI [9]. Moreover, the rising number of patients on second-line ART presents limited options to providers of HIV/AIDS care, more so those in developing Africa whose health systems are still dependent on foreign aid to provide ART [10,11]. Beyond the high cost of second-line regimens, failure on rst-line ART has been mostly associated with poor adherence [12,13], which, if not addressed, means that patients initiated on second-line ART are also likely to fail on this regimen.…”

Section: Second-line Antiretroviral Therapymentioning

confidence: 99%

Predictors of Failure on Second-line Antiretroviral Therapy with Protease Inhibitor Mutations in Uganda

Musana

Ssensamba

Nakafeero

et al. 2020

Preprint

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Introduction Failure on second-line antiretroviral therapy (ART) with protease inhibitor (PI) mutations is on the rise. However, there is a paucity of information on the factors associated with this observation in the context of low-income countries. Knowledge of underlying factors is key if we are to minimize the number of PLHIV switched to costly third-line ART. Our study investigated the factors associated with failure on second-line ART with PI mutations. Methods We conducted a matched case-control analysis of patients' records kept at the Joint Clinical Research Center, starting from January 2008 to May 2018. We matched records of patients who failed the second-line ART with major PI mutations (cases) with records of patients who were virologically suppressed (controls) by a ratio of 1:3. Data analysis was conducted using STATA Version 14, and descriptive statistics comparing cases and controls were generated. Categorical variables were compared with the outcome, failure on second line ART with PI mutations using the Chi-square and Fisher's exact tests where appropriate. Conditional logistic regression for paired data was used to assess the association between the outcome and exposure variables, employing the backward model building procedure was done. Results Of the 340 reviewed patients' records, 53% were women, and 6.2% had previous Tuberculosis treatment. Males (aOR 2.64 CI: 1.0-4.64), type of second-line ART (aOR 3.92 CI: 1.15-13.38), and Tuberculosis treatment while on second-line ART (aOR7.08 CI: 2.35-21.29) highly predicted failure on second-line ART with PI mutations. Conclusion Males and patients concomitantly on Tuberculosis treatment while on second-line ART are at a higher risk of failing on second-line ART with PI mutations. HIV/AIDS response programs should give special attention to this group of people if we are to minimize the need for expensive third-line ART. More extensive explorative studies to ascertain underlying factors are recommended.

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Revisiting aid dependency for HIV programs in Sub-Saharan Africa

Cited by 12 publications

References 8 publications

Cost-effectiveness analysis of two-way texting for post-operative follow-up in Zimbabwe’s voluntary medical male circumcision program

Cost-effectiveness analysis of two-way texting for post-operative follow-up in Zimbabwe’s voluntary medical male circumcision program

The Shinyanga Patient: A Patient’s Journey through HIV Treatment Cascade in Rural Tanzania

Predictors of Failure on Second-line Antiretroviral Therapy with Protease Inhibitor Mutations in Uganda

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