Equity and HIV/AIDS

Utility of HIV support groups in advancing implementation research in resource-limited settings: experiences from an urban-setting HIV support group in Zimbabwe
Mazambara F; Chagwena D; Mudzviti T; et al: AIDS Research and Therapy 19(7), 2022

This paper describes how an adult HIV peer-support group in urban Zimbabwe enabled implementation research, and client recruitment and retention, with successes, challenges and lessons documented over eight years. The interventions involved psychosocial support, nutrition care and support, adherence education and income generating projects. More than 900 people participated in peer-support group activities every month and 400 were engaged in income generating activities. The support group provided a platform for identification of research priorities, patient recruitment and retention and for dissemination of research findings.

Feasibility and acceptability of a peer youth led curriculum to improve HIV knowledge in Northern Tanzania: resilience and intervention experience from the perspective of peer leaders
Hosaka K R J; Mmbaga B T; Gallis J A; Dow D E: BMC Public Health 21:1925, 1-9, 2021

The authors describe the change in 12-24 year old peer leaders' knowledge and leadership of a peer youth led HIV curriculum applied during monthly Saturday adolescent HIV clinics at two clinical sites in Moshi, Tanzania. Peer leaders previously participated in a mental health and life skills intervention called Sauti ya Vijana and were recommended for leadership by Sauti ya Vijana facilitators and clinic staff. Peer leaders demonstrated high fidelity to activities in each lesson and participant feedback was positive for curriculum delivery. Participants’ knowledge improved in nine of ten sessions. Peer leaders reported improved leadership confidence and resilience, and their perception was that the curriculum helped normalize the HIV experience for Youth Living with HIV attending clinic. Nevertheless, anticipated stigma, difficulty disclosing HIV status, and teaching ability remained barriers. This study provides evidence to support efforts to scale and sustain peer youth led interventions for Youth Living with HIV.

Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe
Sande L; Matsimela K; Mwenge L: et al: BMJ Global Health, doi:10.1136/bmjgh-2021-005191, 2021

As countries approach the UNAIDS 95-95-95 targets, there is a need for innovative and cost-saving HIV testing approaches that can increase testing coverage in hard-to-reach populations. The HIV Self-Testing Africa-Initiative distributed HIV self-test (HIVST) kits using unincentivised HIV testing counsellors across 31 public facilities in Malawi, South Africa, Zambia and Zimbabwe. HIVST was distributed either through secondary (partner’s use) distribution alone or primary (own use) and secondary distribution approaches. The authors evaluated the costs of adding HIVST to existing HIV testing from the providers’ perspective in the 31 public health facilities across the four countries between 2018 and 2019 using expenditure analysis and bottom-up costing approaches. They found that costs of integrating HIV self-testing in the public health facilities ranged from US$4.27-US$13.42 per kit distributed. Personnel and cost of test kits were important cost drivers.

Dispensing antiretrovirals during Covid-19 lockdown: re-discovering community-based ART delivery models in Uganda
Zakumumpa H; Tumwine C; Milliam K; et al: BMC Health Services Research 21(692), 1-11, 2021

This paper explored the health-system resilience at the sub-national level in Uganda with regard to strategies for dispensing antiretrovirals during Covid-19 lockdown. The authors conducted a qualitative case-study of eight districts purposively selected from Eastern and Western Uganda. Between June and September 2020, through interviews with district health team leaders, ART clinic managers, representatives of PEPFAR implementing organizations and focus group discussions with recipients of HIV care. Five broad strategies for distributing antiretrovirals during ‘lockdown’ emerged: (i) accelerating home-based delivery of antiretrovirals; (ii) extending multi-month dispensing from three to six months for stable patients; (iii) leveraging the Community Drug Distribution Points model for ART refill pick-ups at outreach sites in the community; (iv) increasing reliance on health information systems, including geospatial technologies, to support ART refill distribution in unmapped rural settings and (v) leveraging Covid-19 outbreak response funding to deliver ART refills to rural homesteads. While Covid-19 ‘lockdown’ restrictions undoubtedly impeded access to facility-based HIV services, they revived interest by providers and demand by patients for community-based ART delivery models in case-study districts in Uganda.

Integration of non-communicable disease and HIV/AIDS management: a review of healthcare policies and plans in East Africa
Adeyemi O; Lyons M; Njim T; Okebe J; et al: BMJ Global Health6:e004669, 1-9, 2021

This paper assessed the extent in East Africa to which policies reflect calls for HIV-NCD service integration, through document review. Integrated delivery of HIV and NCD care is recommended in high level health policies and treatment guidelines in four countries in the East African region; Kenya, Rwanda, Tanzania and Uganda, mostly relating to integrating NCD care into HIV programmes, in response both to increasing levels of NCDs and more person-centred services for people living with HIV. Other countries, however, have no reported plans for HIV and NCD care integration.

It’s a secret between us: a qualitative study on children and care-giver experiences of HIV disclosure in Kinshasa, Democratic Republic of Congo
Sumbi E; Venables E; Harrison R; Garcia M: et al: BMC Public Health 21(313), 1-9, 2021

This paper explored child and care-giver experiences of the process of disclosing HIV statuses to children, including reasons for delay, through 22 in-depth interviews with care-givers and 11 in-depth interviews with HIV positive children in Kinshasa. Care-givers included biological parents, grandmothers, siblings and community members and 86% of them were female. Many care-givers had lost family members due to HIV and several were HIV positive themselves. Reasons for non-disclosure included fear of stigmatisation; wanting to protect the child and not having enough knowledge about HIV or the status of the child to disclose. Several children had multiple care-givers, which also delayed disclosure, as responsibility for the child was shared. In addition, some care-givers were struggling to accept their own HIV status and did not want their child to blame them for their own positive status by disclosing to them. The authors identify that child disclosure is a complex process for care-givers, health-care workers and the children themselves.

COVID-19’s impact on HIV treatment less severe than feared
UNAIDS: UNAIDS New York, 2020

Recent data has shown that the COVID-19 pandemic has had an impact on HIV testing services, but the impact on HIV treatment is less than originally feared. As of August 2020, the UNAIDS, World Health Organization and United Nations Children's Fund data collection exercise to identify national, regional and global disruptions of routine HIV services caused by COVID-19 had collected treatment data from 85 countries. Of these, 22 countries reported data over a sufficient number of months to enable the identification of trends. Only five countries reported monthly declines in the number of people on treatment after April—these include Zimbabwe in June, Peru and Guyana in July, the Dominican Republic in April, and Sierra Leone in May through to July. The remaining 18 countries did not show a decline and some countries showed a steady increase (e.g. Kenya, Ukraine, Togo and Tajikistan). However, among the 22 countries with trend data on numbers newly initiating treatment, all countries except Jamaica showed declines for at least one month or more relative to January. Only around eight of those countries showed a rebound in the number of people newly initiating treatment between January and July.

COVID-19 Pandemic Disrupts HIV Continuum of Care and Prevention: Implications for Research and Practice Concerning Community-Based Organizations and Frontline Providers
Pinto R; Park S: AIDS and Behaviour 24(286-2489) doi: https://doi.org/10.1007/s10461-020-02893-3, 2020

More quickly than they could have anticipated, people living with (PLWH) and those at-risk for HIV felt the impact of the COVID-19 pandemic, as they were asked to shelter in place and distance themselves from others. In March and April 2020, community-based organizations (CBOs) closed, medical offices cut hours, and medical personnel shifted from primary care to COVID-19 hospital units, affecting the HIV Continuum of Care and Prevention—that is, testing, pre-exposure prophylaxis (PrEP), and primary care. The authors call for further research, review and monitoring to provide evidence on referral practices and links that could help clients access the HIV services to which they are referred (“referral completion”).

Sociodemographic Predictors of HIV Infection among Pregnant Women in Botswana: Cross-Sectional Study at 7 Health Facilities
Hamda S; Tshikuka J; Joel D: Journal of the International Association of Providers of AIDS Care (19) doi: https://doi.org/10.1177/2325958220925659, 2020

The authors determined the prevalence and sociodemographic predictors of HIV among pregnant women in Botswana through a cross-sectional study of 407 randomly enrolled women aged 18 to 49 years, attending 7 health facilities between November 2017 and March 2018. The HIV prevalence was 17%. Women aged 35 to 49 years had higher HIV prevalence than those 18 to 24 years. Illiterate and elementary school educated women had higher HIV prevalence than those with a tertiary education. Those with a history of alcohol intake had a higher HIV prevalence than those without. While HIV prevalence was lower than it was in 2011 the authors call for targeted interventions that integrate these identified dimensions of susceptibility.

Estimates of the Potential Impact of the COVID-19 Pandemic on Sexual and Reproductive Health in Low- and Middle-Income Countries
Riley T; Sully E; Ahmed Z; Biddlecom Z: International Perspectives on Sexual and Reproductive Health 46, 73-76, 2020

The strain that the COVID-19 outbreak imposes on health systems will undoubtedly impact the sexual and reproductive health of individuals living in low- and middle-income countries (LMICs); however, sexual and reproductive health will also be affected by societal responses to the pandemic, such as when local or national lockdowns close services not deemed to be essential, as well as from consequences of travel restrictions and economic slowdowns. Previous public health emergencies have shown that the impact of an epidemic on sexual and reproductive health often goes unrecognized, because the effects relate to indirect consequences of strained health care systems, disruptions in care and redirected resources. The authors argue for the learning from prior epidemics to be used to put in place critical resources and systems, and ensuring the provision of essential sexual and reproductive health services to avoid health system disruptions that would have devastating, lasting effects on individuals and communities.