Equity and HIV/AIDS

ARVs alone won't save HIV infected mothers
Skosana I and Malan M: Mail and Guardian, 19 April 2013

In April 2013, the South African government announced that it will offer all HIV-infected pregnant and breastfeeding women antiretroviral (ARV) treatment, regardless of the state of their health. Previously, only pregnant women with significantly weakened immune systems qualified for the drugs. The government is also now supplying HIV-infected pregnant women with a convenient once-a-day tablet. A department of health spokesperson said an increase in access to ARVs will lead to a decline in maternal mortality. Almost half of all maternal deaths in South Africa are caused by HIV-related complications. However, the former director of maternal health at the department of health, Eddie Mhlanga, disagreed, arguing that there is no evidence yet that the government's antiretroviral drug programme has led to a lower chance of pregnant women infected with the virus dying during pregnancy, childbirth or within 42 days thereafter. He said negligence, substandard care and mismanagement in maternal wards would first need to be addressed.

ARVs reduce mortality in Malawi
Health-e, 9 May 2008

In a rare study of mortality before and after ARVs, researchers have found a drop in deaths of 10 percent. Free antiretroviral therapy has significantly reduced mortality in rural Malawi. The researchers investigated the mortality in a population before and after the introduction of free ARVs, in turn measuring the effects of such programmes on survival rates in the population. Researchers measured the mortality in a population of 32,000 in northern Malawi, from August 2002 when free ARV therapy was not available in the district, until February 2006, eight months after an ARV clinic was opened. Comparisons revealed that overall mortality rates among adults had declined by 10 percent. This equalled nine deaths averted in an eight-month observation period after the introduction of ARVs. Mortality decreased by 35 percent in adults near the district’s main road, where death rates before antiretroviral therapy were highest.

Assessing the quality of data aggregated by antiretroviral treatment clinics in Malawi
Makombe SD, Hochgesang M, Jahn A, et al: Bulletin of the World Health Organization 86 (4):241-320, April 2008

By 31 December 2006, Malawi had enrolled 82 000 patients in its free national antiretroviral treatment (ART) programme. Each quarter, data from all ART clinics are aggregated for national reporting on ART scale-up. This information is essential to monitoring site performance, guiding national planning and supporting sustained funding. Despite increasing reliance on sites to aggregate data, the completeness and accuracy of sites’ reports was unknown. The authors therefore conducted an operational study during regular supervisory visits to assess the quality of data in the site reports. Specific objectives were to: i) determine the completeness and accuracy of key case registration and outcome data compiled by ART clinics, ii) compare national data summarized from site reports versus supervision reports, and iii) analyse characteristics associated with sites’ capacity to compile quality data.

Assessment of awareness, attitudes and perceptions of students on HIV vaccine trials at the University of Dar es Salaam, Tanzania
Haraka F and Bakari M: Tanzania Medical Journal 23(2):5-8, 2008

The objective of this paper was to assess the awareness, attitude and perceptions on HIV AND AIDS vaccine trials among students at the University of Dar es Salaam, Tanzania. This was a descriptive cross-sectional study. A total of 384 students were recruited in the study. Out of these, 41.7% reported that HIV vaccine can not prevent the spread of HIV. One hundred-and-four (26.8%) were of the opinion that an HIV vaccine can cause infection to the person vaccinated. The perceptions and attitudes of University of Dar es Salaam students towards HIV vaccine trials were generally positive. However misconceptions were common. The community should be educated more on HIV vaccine trials, and more socio-behavioral studies need to be done among different social groups on HIV vaccine trials.

Assessment of the World Health Organisation’s HIV Drug Resistance Early Warning Indicators in Main and Decentralised Outreach Antiretroviral Therapy Sites in Namibia
Mutenda N; Bukowski A; Nitschke A; et al.: PLoS ONE 11(12): e0166649, 2016, doi:10.1371/journal.pone.0166649

The World Health Organization early warning indicators (EWIs) of HIV drug resistance (HIVDR) assess factors at individual ART sites that are known to create situations favourable to the emergence of HIVDR. In 2014, the Namibia HIV care and treatment program abstracted adult and paediatric EWIs from all public ART sites (50 main sites and 143 outreach sites) related to on-time pill pick-up, retention in care, pharmacy stock-outs, dispensing practices, and viral load suppression. Comparisons were made between main and outreach sites and between 2014 and 2012. The national estimates were: On-time pill pick-up 81.9% for adults and 82.4% for paediatrics, Retention in care 79% retained on ART after 12 months for adults and 82% for paediatrics, Pharmacy stock-outs 94% of months without a stock-out for adults and 88% for paediatrics. Viral load suppression was significantly affected by low rates of viral load completion. Main sites had higher on-time pill pick-up than outreach sites for adults and paediatrics and no difference between main and outreach sites for retention in care for adults or paediatrics. From 2012 to 2014 in adult and paediatric sites, on-time pill pick-up, retention in care and pharmacy stock-outs worsened. Results of EWIs monitoring in Namibia provide evidence about ART programmatic functioning and contextualise results from national surveys of HIVDR. These results are worrisome as they show a decline in program performance over time. The national ART program is taking steps to minimise the emergence of HIVDR by strengthening adherence and retention of patients on ART, reducing stock-outs, and strengthening ART data quality.

Assessment of voluntary counseling and testing service utilisation and associated factors among Debre Markos University Students, North West Ethiopia: a cross-sectional survey in 2011
Tsegay G, Edris M and Meseret S: BMC Public Health 13(243), 19 March 2013

This cross-sectional study design was conducted among 753 students drawn from selected departments in Debre Markos University, Ethiopia, using multi-stage sampling technique. A self-administered questionnaire was used to estimate the prevalence of voluntary counseling and testing (VCT) service utilisation and to assess associated factors. A total of 711 students participated in the study, of whom 81.4% had heard about the government’s confidential VCT service, identifying their major sources of information as mass media (73.3%) and health workers (71.1%). Just over half (58.5%) of the study participants had undergone VCT. The researchers identified the major factors for increased VCT service utilisation as knowledge about the availability of antiretrovirals in the VCT site, information about confidentiality, absence of perceived stigma, higher risk perception and knowledge about HIV. Therefore, they argue, actions targeting on these predictors are necessary to effectively enhance the use of the VCT services utilisation.

Assessment of water, sanitation, and hygiene practice and associated factors among people living with HIV/AIDS home based care services in Gondar city, Ethiopia
Yallew WW, Terefe MW, Herchline TE, Sharma HR, Bitew BD, Kifle MW, Tetemke DM et al: BMC Public Health 12(1057), 7 December 2012

This cross-sectional study was carried during 2009 to assess water, sanitation status and hygiene practices and associated factors among People Living with HIV and AIDS (PLWHAs) in home-based care services in Gondar City, Ethiopia. Researchers collected data from 294 PLWHAs in the form of in-depth interviews (72.8% females and 27.2% males). They found that 42.9% of the households had “unimproved” water status, 67% had “unimproved” sanitation status, and 51.7% had poor hygienic practice. Diarrhoea with associated with water status, while educational status and latrine availability were associated with sanitation status. Lack of hand washing devices and the unaffordable cost of soap reduced hygienic practices. In conclusion, the authors found a high burden of water, sanitation and hygiene problems in home-based care services for PLWHAs. They recommend hygiene education and additional support for the provision of water, sanitation and hygiene services.

Assessment study on mobile and migrant populations’ access to HIV prevention and treatment and care services in Zimbabwe
National AIDS Council: March 2009

This study is one of Zimbabwe's national efforts to assess specific HIV and AIDS needs of mobile and migrant populations (MMPs) in the country and the barriers to accessing HIV and AIDS prevention, treatment and care services by these groups. The study also sought to identify the gaps that exist in meeting the HIV and AIDS needs for MMPs. The study was conducted in all major corridors in Zimbabwe, targeting a range of groups of MMPs. It found that the rising poverty levels (and in some cases absolute poverty levels) emanating from the rapid socio-economic decline and political uncertainty in the country, have provided a basis upon which vulnerability to HIV infection of MMPs, as well as that of the general population is premised. The study calls for improved coordination and strategic partnerships, modification of art access regulations, inclusive programming, awareness raising and creating regional approaches.

Associations between health systems capacity and mother-to-child HIV prevention program outcomes in Zambia
Price J; Chi B; Phiri W: PLOS ONE 13(9), doi: https://doi.org/10.1371/journal.pone.0202889, 2018

In this study, the authors investigated the association between health system capacity and use of prevention of mother-to-child HIV transmission (PMTCT) services in Zambia. They analyzed data from two studies conducted in rural and semi-urban Lusaka Province in 2014–2015. Among 29 facilities, the median overall facility score was 72. Median domain scores were: patient satisfaction 75; human resources 85; finance 50; governance 82; service capacity 77; service provision 60. The programmatic outcome was measured from 804 HIV-infected mothers. Median community-level antiretroviral use at 12 months was 81%. Patient satisfaction was the only domain score significantly associated with 12-month maternal antiretroviral use. When the authors excluded the human resources and finance domains, a positive association between composite 4-domain facility score and 12-month maternal antiretroviral use in peri-urban but not rural facilities was found. In these Zambian health facilities, patient satisfaction was positively associated with maternal antiretroviral 12 months postpartum. The association between overall health system capacity and maternal antiretroviral drug use was stronger in peri-urban versus rural facilities.

Audience segmentation as a social-marketing tool in health promotion: Use of the Risk Perception Attitude Framework in HIV prevention in Malawi
Rimal RN, Brown J, Mkandawire G, Folda L, Böse K and Creel AH: American Journal of Public Health 99(9), September 2009

This paper sought to determine whether individuals’ risk perceptions and efficacy beliefs could be used to meaningfully segment audiences to assist interventions that seek to change HIV-related behaviours. A household-level survey of 968 individuals was conducted in four districts in Malawi. Cluster analysis was used to create four groups within the risk perception attitude framework: responsive, avoidant, proactive, and indifferent. The researchers ran analysis of covariance models (controlling for known predictors) to determine how membership in the risk perception attitude framework groups would affect three variables: knowledge about HIV, HIV-testing uptake and condom use. A significant association was found between membership in one or more of the four Risk Perception Attitude Framework groups and the three variables. In conclusion, the Risk Perception Attitude Framework can serve as a theoretically sound audience segmentation technique to determine whether messages should augment perceptions of risk, beliefs about personal efficacy or both.