Successes and gaps in the HIV cascade of care of a high HIV prevalence setting in Zimbabwe: a population‐based survey

Conan, Nolwenn; Coulborn, Rebecca M.; Simons, Erica; Mapfumo, Abraham; Apollo, Tsitsi; Garone, Daniela; Casas, Esther C.; Puren, Adrian; Chihana, Menard; Maman, David

doi:10.1002/jia2.25613

Cited by 13 publications

(32 citation statements)

References 22 publications

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“…When restricting to the age group 15-64 years, HIV prevalence was 13% in our survey versus 16% in the southwest zone where Nsanje District is located [1]. As documented in other settings, women were more likely to be infected with HIV than men [14][15][16][17].…”

Section: Discussionmentioning

confidence: 76%

What gaps remain in the HIV cascade of care? Results of a population-based survey in Nsanje District, Malawi

Conan¹,

Paye²,

Ortuno

et al. 2021

PLoS ONE

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Introduction The Malawi Ministry of Health (MoH) has been in collaboration with Médecins sans Frontières (MSF) to increase access to quality HIV care through decentralization of antiretroviral therapy (ART) diagnosis and treatment from hospital to clinics in Nsanje District since 2011. A population-based household survey was implemented to provide information on HIV prevalence and cascade of care to inform and prioritize community-based HIV interventions in the district. Methods A cross-sectional survey was conducted between September 2016 and January 2017. Using two-stage cluster sampling, eligible adult individuals aged ≥15 years living in the selected households were asked to participate. Participants were interviewed and tested for HIV at home. Those tested HIV-positive had their HIV-RNA viral load (VL) measured, regardless of their ART status. All participants tested HIV-positive at the time of the survey were advised to report their HIV test result to the health facility of their choice that MSF was supported in the district. HIV-RNA VL results were made available in this health facility. Results Among 5,315 eligible individuals, 91.1% were included in the survey and accepted an HIV test. The overall prevalence was 12.1% (95% Confidence Interval (CI): 11.2–13.0) and was higher in women than in men: 14.0% versus 9.5%, P<0.001. Overall HIV-positive status awareness was 80.0% (95%CI: 76.4–83.1) and was associated with sex (P<0.05). Linkage to care was 78.0% (95%CI: 74.3–81.2) and participants in care 76.2% (95%CI: 72.4–79.5). ART coverage among participants aware of their HIV-positive status was 95.3% (95%CI: 92.9–96.9) and was not associated with sex (P = 0.55). Viral load suppression among participants on ART was 89.9% (95%CI: 86.6–92.4) and was not statistically different by sex (p = 0.40). Conclusions Despite encouraging results in HIV testing coverage, cascade of care, and UNAIDS targets in Nsanje District, some gap remains in the first 90, specifically among men and young adults. Enhanced community engagement and new strategies of testing, such as index testing, could be implemented to identify those who are still undiagnosed, particularly men and young adults.

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Section: Discussionmentioning

confidence: 76%

What gaps remain in the HIV cascade of care? Results of a population-based survey in Nsanje District, Malawi

Conan¹,

Paye²,

Ortuno

et al. 2021

PLoS ONE

Self Cite

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“…Thirty‐nine studies reported on initiation of ART [2,21,23,28,33,34,37,40‐42,44‐47,49‐54,23,55‐62,64,66,67‐75], with 25 (64%) defining numerators and denominators. Thirty‐two were longitudinal, four of mixed design and three were cross‐sectional.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 52 studies reported numbers or percentages of patients retained at this step [8,20‐32,34,36,40‐43,46,56,58,65,68,69,72‐74,76‐93,95‐99]. The majority of studies (32 studies, 62%) covering this step were longitudinal studies.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-eight studies reported on this step [20,23,24,[26][27][28]31,[33][34][35][37][38][39]41,44,45,[47][48][49][50][51][52][53][54][55][56][57][58]: 15 cohort studies, 10 crosssectional and three of mixed design. Twenty-four studies (86%) provided a clear definition of the step (Table 2).…”

Section: Linkage To Pre-art Carementioning

confidence: 99%

“…A total of 52 studies reported numbers or percentages of patients retained at this step [8,[20][21][22][23][24][25][26][27][28][29][30][31][32]34,36,[40][41][42][43]46,56,58,65,68,69,[72][73][74][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][95][96][97][98][99]. The majority of studies (32 studies, 62%) covering this step were longitudinal studies.…”

Section: Viral Suppressionmentioning

confidence: 99%

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The HIV care cascade in sub‐Saharan Africa: systematic review of published criteria and definitions

et al. 2021

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Introduction:The HIV care cascade examines the attrition of people living with HIV from diagnosis to the use of antiretroviral therapy (ART) and suppression of viral replication. We reviewed the literature from sub-Saharan Africa to assess the definitions used for the different steps in the HIV care cascade. Methods: We searched PubMed, Embase and CINAHL for articles published from January 2004 to December 2020. Longitudinal and cross-sectional studies were included if they reported on at least one step of the UNAIDS 90-90-90 cascade or two steps of an extended 7-step cascade. A step was clearly defined if authors reported definitions for numerator and denominator, including the description of the eligible population and methods of assessment or measurement. The review protocol has been published and registered in Prospero. Results and discussion: Overall, 3364 articles were screened, and 82 studies from 19 countries met the inclusion criteria. Most studies were from Southern (38 studies, 34 from South Africa) and East Africa (29 studies). Fifty-eight studies (71.6%) were longitudinal, with a median follow-up of three years. The medium number of steps covered out of 7 steps was 3 (interquartile range [IQR] 2 to 4); the median year of publication was 2015 (IQR 2013(IQR to 2019. The number of different definitions for the numerators ranged from four definitions (for step "People living with HIV") to 21 (step "Viral suppression"). For the denominators, it ranged from three definitions ("Diagnosed and aware of HIV status") to 14 ("Viral suppression"). Only 12 studies assessed all three of the 90-90-90 steps. Most studies used longitudinal data, but denominator-denominator or denominator-numerator linkages over several steps were rare. Also, cascade data are lacking for many countries. Our review covers the academic literature but did not consider other data, such as government reports on the HIV care cascade. Also, it did not examine disengagement and reengagement in care. Conclusions: The proportions of patients retained at each step of the HIV care cascade cannot be compared between studies, countries and time periods, nor meta-analysed, due to the many different definitions used for numerators and denominators. There is a need for standardization of methods and definitions.

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Men missing from the HIV care continuum in sub‐Saharan Africa: a meta‐analysis and meta‐synthesis

et al. 2022

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Introduction:Men are missing along the HIV care continuum. However, the estimated proportions of men in sub-Saharan Africa meeting the UNAIDS 95-95-95 goals vary substantially between studies. We sought to estimate proportions of men meeting each of the 95-95-95 goals across studies in sub-Saharan Africa, describe heterogeneity, and summarize qualitative evidence on factors influencing care engagement. Methods: We systematically searched PubMed and Embase for peer-reviewed articles published between 1 January 2014 and 16 October 2020. We included studies involving men ≥15 years old, with data from 2009 onward, reporting on at least one 95-95-95 goal in sub-Saharan Africa. We estimated pooled proportions of men meeting these goals using DerSimonion-Laird random effects models, stratifying by study population (e.g. studies focusing exclusively on men who have sex with men vs. studies that did not), facility setting (healthcare vs. community site), region (eastern/southern Africa vs. western/central Africa), outcome measurement (e.g. threshold for viral load suppression), median year of data collection (before vs. during or after 2017) and quality criteria. Data from qualitative studies exploring barriers to men's HIV care engagement were summarized using meta-synthesis. Results and discussion: We screened 14,896 studies and included 129 studies in the meta-analysis, compiling data over the data collection period. Forty-seven studies reported data on knowledge of serostatus, 43 studies reported on antiretroviral therapy use and 74 studies reported on viral suppression. Approximately half of men with HIV reported not knowing their status (0.49 [95% CI, 0.41-0.58; range, 0.09-0.97]) or not being on treatment (0.58 [95% CI, 0.51-0.65; range, 0.07-0.97]), while over three-quarters of men achieved viral suppression on treatment (0.79 [95% CI, 0.77-0.81; range, 0.39-0.97]. Heterogeneity was high, with variation in estimates across study populations, settings and outcomes. The meta-synthesis of 40 studies identified three primary domains in which men described risks associated with engagement in HIV care: perceived social norms, health system challenges and poverty. Conclusions: Psychosocial and systems-level interventions that change men's perceptions of social norms, improve trust in and accessibility of the health system, and address costs of accessing care are needed to better engage men, especially in HIV testing and treatment.

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Successes and gaps in the HIV cascade of care of a high HIV prevalence setting in Zimbabwe: a population‐based survey

Cited by 13 publications

References 22 publications

What gaps remain in the HIV cascade of care? Results of a population-based survey in Nsanje District, Malawi

What gaps remain in the HIV cascade of care? Results of a population-based survey in Nsanje District, Malawi

The HIV care cascade in sub‐Saharan Africa: systematic review of published criteria and definitions

Men missing from the HIV care continuum in sub‐Saharan Africa: a meta‐analysis and meta‐synthesis

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