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Author: Daisy Krakowiak
Publisher:
ISBN:
Category :
Languages : en
Pages : 71
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Book Description
Male partner involvement has been recognized as an important component of prevention-of-mother-to-child transmission of HIV (PMTCT); however, male antenatal attendance has been difficult to achieve. Home-based testing among pregnant couples may be an effective strategy to test men. Women attending their first antenatal visit at Kisumu District Hospital in Kenya were screened for eligibility and randomized to home-based education and HIV testing (HOPE) or to written invitations for male partners to attend clinic (INVITE). Of 1101 women screened, 620 were eligible and 601 were randomized either to HOPE (n=306) or INVITE (n=295). At 6 months postpartum, male partners were more than twice as likely (RR=2.10; 95% CI: 1.81-2.42) to have been HIV tested in the HOPE arm (n=233, 87%) compared to the INVITE arm (n=108, 39%). Couples in the HOPE arm (n=192, 77%) were three times more likely (RR=3.17; 95% CI: 2.53-3.98) to have been tested as a couple than the INVITE arm (n=62, 24%) and women in the HOPE arm (n=217, 88%) were also twice as likely (RR=2.27; 95% CI: 1.93-2.67) to know their partner’s HIV status as the INVITE arm (n=98, 39%). More serodiscordant couples (RR=3.38; 95% CI: 1.70-6.71) were identified in the HOPE arm (n=33, 13%) than in the INVITE arm (n=10, 4%). In qualitative interviews with participants, it was found that home-based couple HIV testing and counseling facilitated partner testing and disclosure, was preferable due to privacy and quality time, and helped participants overcome their fear of testing. Couples also appreciated the efficiency and appropriateness of partner involvement and joint education, and spoke of intervention influence on partner support in pregnancy and postpartum as well as improved relationship due to disclosure. Couples overwhelmingly had positive feedback for the intervention, although had preferences in terms of health advisors, especially having non-local advisors. Home-based HIV testing among pregnant couples resulted in higher uptake of male testing and couple testing as well as rates of disclosure and identification of serodiscordant couples. This intervention not only has implications for PMTCT, but also for testing men as part of overall HIV testing strategies to reach the UNAIDS 90-90-90 targets by 2020.
Author: Daisy Krakowiak
Publisher:
ISBN:
Category :
Languages : en
Pages : 71
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Book Description
Male partner involvement has been recognized as an important component of prevention-of-mother-to-child transmission of HIV (PMTCT); however, male antenatal attendance has been difficult to achieve. Home-based testing among pregnant couples may be an effective strategy to test men. Women attending their first antenatal visit at Kisumu District Hospital in Kenya were screened for eligibility and randomized to home-based education and HIV testing (HOPE) or to written invitations for male partners to attend clinic (INVITE). Of 1101 women screened, 620 were eligible and 601 were randomized either to HOPE (n=306) or INVITE (n=295). At 6 months postpartum, male partners were more than twice as likely (RR=2.10; 95% CI: 1.81-2.42) to have been HIV tested in the HOPE arm (n=233, 87%) compared to the INVITE arm (n=108, 39%). Couples in the HOPE arm (n=192, 77%) were three times more likely (RR=3.17; 95% CI: 2.53-3.98) to have been tested as a couple than the INVITE arm (n=62, 24%) and women in the HOPE arm (n=217, 88%) were also twice as likely (RR=2.27; 95% CI: 1.93-2.67) to know their partner’s HIV status as the INVITE arm (n=98, 39%). More serodiscordant couples (RR=3.38; 95% CI: 1.70-6.71) were identified in the HOPE arm (n=33, 13%) than in the INVITE arm (n=10, 4%). In qualitative interviews with participants, it was found that home-based couple HIV testing and counseling facilitated partner testing and disclosure, was preferable due to privacy and quality time, and helped participants overcome their fear of testing. Couples also appreciated the efficiency and appropriateness of partner involvement and joint education, and spoke of intervention influence on partner support in pregnancy and postpartum as well as improved relationship due to disclosure. Couples overwhelmingly had positive feedback for the intervention, although had preferences in terms of health advisors, especially having non-local advisors. Home-based HIV testing among pregnant couples resulted in higher uptake of male testing and couple testing as well as rates of disclosure and identification of serodiscordant couples. This intervention not only has implications for PMTCT, but also for testing men as part of overall HIV testing strategies to reach the UNAIDS 90-90-90 targets by 2020.
Author: Monisha Sharma
Publisher:
ISBN:
Category :
Languages : en
Pages : 208
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Book Description
Knowledge of one’s HIV status is vital to accessing treatment and prevention yet only a fraction of individuals in sub-Saharan Africa are regularly tested for HIV. Community-based HIV testing and counseling (HTC), defined as HTC conducted outside of a healthcare facility, has the potential to achieve high population testing coverage and linkage to care. The studies within this dissertation describe effectiveness and efficiency (cost-effectiveness) of various modalities of community-based HTC. Aim 1 presents a systematic review of community and facility-based HTC strategies in sub-Saharan Africa. Aims 2 and 3 evaluate the cost-effectiveness of two types of community HTC interventions in western Kenya by incorporating primary cost and effectiveness data from randomized clinical trials into an HIV mathematical model. Specifically, Aim 2 assesses the health and economic impact of implementing a home-based partner education and HIV testing (HOPE) intervention for pregnant women and their male partners. Aim 3 evaluates the cost-effectiveness of scaling up provider notification services for sexual partners of recently diagnosed HIV-positive persons. In Aim 1, we found that community HTC (including home, mobile, partner notification, key populations, campaign, workplace and self-testing) successfully reached target groups (men, young adults and first-time testers) with higher coverage than facility HTC. Community HTC also identifies HIV-positive individuals at higher CD4 counts who were likely to be earlier in their disease course. Combined with the potential of community HTC with facilitated linkage to achieve high linkage to treatment with similar retention rates as facility HTC, this suggests that scaling up community interventions can reduce the morbidity, mortality and transmission associated with late or non-initiation of ART. Of all modalities examined, home HTC attained the highest population coverage (70%, 95% CI = 58–79) while mobile HTC reached the highest proportion of men (50%, 95% CI = 47–54%). Self-testing reached the highest proportion of young adults (66%, 95% CI = 65–67%). As each HTC modality reaches distinct sub-populations, a combination of modalities (differing by setting) will likely be needed to achieve high ART coverage. In Aim 2, we found that the incremental cost of adding the HOPE intervention to standard antenatal care was $31-37 USD per couple tested; task shifting intervention responsibilities to community health workers lowered the cost to $14-16 USD per couple tested. At 60% coverage of male partners, HOPE was projected to avert 6,987 HIV infections and 2,603 deaths in Nyanza province over 10 years with an incremental cost-effectiveness ratio (ICER) of $886 and $615 per DALY averted for the program and task-shifting scenario, respectively. The ICERs are below the threshold of Kenya’s per capita gross domestic product ($1,358) and are therefore considered cost-effective. We conclude that the HOPE intervention can cost-effectively decrease HIV-associated morbidity and mortality in western Kenya by linking HIV-positive male partners to care. In Aim 3, we found that implementing assisted partner services (aPS) or active tracing, exposure notification, and home HTC for sexual partners of newly diagnosed HIV-positive persons in western Kenya is projected to achieve 12% population coverage and reduce HIV infections by by 2.8% and HIV-related deaths by 1.5%. The incremental cost-effectiveness ratio (ICER) of implementing aPS is $1,703 USD (range $1,198-2,887) per disability-adjusted life year (DALY) averted. Task-shifting intervention activities from healthcare professionals to community health workers decreases the ICER to $1,302 (range $955-2,789) per DALY averted. The task-shifting scenario falls below Kenya’s per capita gross domestic product (GDP) and is therefore considered very cost-effective while the full program cost scenario is considered cost-effective under the higher threshold of 3-times Kenya’s per capita GDP. Intervention cost-effectiveness and HIV-related deaths averted among aPS partners increased with expanded ART initiation criteria. We hope that this dissertation work will be useful in forming policy deliberations regarding implementation of community HTC in countries of sub-Saharan Africa.
Author: Alfred Onyango Osoti
Publisher:
ISBN:
Category :
Languages : en
Pages : 21
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Book Description
HIV testing of male partners of pregnant women is important to decrease HIV transmission to women and to support HIV-infected women in taking prevention of mother-to-child HIV transmission (PMTCT) interventions. However, it has been difficult to access male partners in antenatal care (ANC) settings. We hypothesized that home visits to male partners of women attending ANC would be feasible and would increase HIV testing of partners. Pregnant women attending ANC were enrolled, interviewed using smartphone audio-computer assisted self-interviews (ACASI), and randomized to home visits or written invitations for male partners to come to clinic. Enrolled men were interviewed (ACASI) and offered couples HIV counseling and testing (CHCT). Participants underwent follow-up ACASI six weeks post-enrollment. Prevalence of CHCT, male HIV, couple discordance, intimate partner violence were compared using intent-to-treat analysis. Results Among 495 women screened, 312 (63.0%) were eligible, of whom 300 were randomized to clinic-based or home-based HCT. Median age was 22 years [interquartile range (IQR) 20,26]; most were monogamous (87%) and 11% reported condom use and did not differ between trial arms. Male CHCT was substantially and significantly higher in the home-visit than the clinic-invitation arm (87% vs. 36%, p
Author: Jennifer Mark
Publisher:
ISBN:
Category :
Languages : en
Pages :
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Book Description
For HIV and other sexually transmitted infections (STIs), men seek care at more advanced stages of disease and are less likely to initiate treatment.1-4 Male partner participation in antenatal care (ANC) has been shown to increase male and female HIV testing,5,6 identification of HIV-discordant couples,7,8 female participation in ANC and uptake of PMTCT services1,9 as well as reduce infant HIV acquisition and mortality.10 Despite these significant benefits, rates of male attendance to clinic-based antenatal services remain very low.1,2,11 in part because efforts to engage men have focused on reducing HIV transmission risks to mothers and children without directly addressing the sexual health needs of men. Advocating for the health of fathers as equally important and reframing men as positive contributors to the health of the family shifts the balance from a maternal and child health approach to a family health approach that addresses HIV and STI control within the larger community.12 The advent of rapid and inexpensive point-of-care (POC) tests for syphilis and HIV has greatly expanded test coverage, especially in areas with difficult-to-reach populations or without access to laboratory diagnostics.19,20 POC tests also enabled the development of home-based education and testing (HBT), a novel approach utilizing trained counselors to deliver individualized sexual and reproductive education and testing to couples in the privacy of their homes.21 Engaging men by providing HBT for syphilis and HIV during pregnancy can have synergistic and cost-saving effects on reducing HIV and syphilis transmission and adverse pregnancy outcomes. HBT has been shown to increase HIV test uptake by men and identify more serodiscordant couples who can be targeted for high-yield HIV prevention, 7,8,21,22 but less is known about the effects of HBT on linking individuals to care and treatment. Within a randomized control trial of pregnant women attending a first antenatal visit in Western Kenya, women and their male partners received either: (1) a home-based couple education and testing (HBT) intervention, or (2) an invitation letter for clinic-based couple HIV testing. We assessed the uptake of home-based POC syphilis and HIV testing during pregnancy and at 6 months postpartum and assessed whether introduction of syphilis testing affected HIV testing. At 6 months postpartum, we examined whether HBT affected male partner utilization of STI and HIV prevention and care services (i.e. STI consultation, medical male circumcision and HIV care and treatment) and female partner HIV viral suppression. Syphilis testing was highly acceptable to male partners during early pregnancy (93% of 80 men) and 6 months postpartum (98% of 230 men). Therefore, uptake of paired syphilis and HIV testing uptake was also high (91% during pregnancy and 96% postpartum). Introducing syphilis testing did not adversely affect HIV testing as uptake remained high before (96%) and after (95%) syphilis testing was introduced. After receiving home-based education and testing during their partners0́9 pregnancy, 75 of 80 (94%) men intended to seek clinic-based services for STI consultation if testing was positive. By 6 months postpartum, among 525 women exiting the study, we reached 487 (93%) of their male partners in the intervention (n=247) and control arms (n=240). Men who received home-based couple education and testing were 59% more likely to have sought STI consultation during the study period than men in the control arm (n=47 of 247 vs. 16 of 240, respectively; RR=1.59; 95% CI: 0.50-0.96). However, at 6 months postpartum, one-time home-based education and testing did not have an impact on HIV prevention or treatment as medical circumcision among eligible uncircumcised men and linkage to HIV care among newly diagnosed HIV-positive men remained low in both intervention and control arms. Similarly, home-based couple education and testing did not affect HIV viral suppression in HIV-positive pregnant women in the intervention or control arms at 6 months postpartum. Despite women commencing lifelong antiretroviral therapy, 22 (30%) of 73 HIV-positive women who provided dried blood spots were not virally suppressed at 6 months postpartum. Of these women with unsuppressed HIV, 17 (81%) of 22 were breastfeeding and 8 (38%) of 22 had HIV-negative male partners. These findings indicate continued risk of HIV transmission to young infants and male partners and highlight continuing gaps in the HIV care and treatment cascade. These results show that syphilis testing is as acceptable as HIV testing and that home-based couple education and testing can be effective in increasing male partners seeking STI consultation and treatment. However, one-time home-based education and testing for HIV appeared insufficient to convince men to obtain medical circumcision or to increase linkage to HIV care among newly diagnosed HIV-positive male partners. HBT also did not have an effect on HIV viral suppression of women at 6 months postpartum. The inherent and social differences between STIs such as syphilis (short-term curative treatment, less stigma) and HIV (long-term non-curative treatment, high stigma) necessitate a recurrent and longer-term approach for linkage and continued engagement in HIV care and treatment. Providing home-based education and POC testing for HIV and other STIs to men and women as equal and contributing members of a family can help make a family health approach to sexual and reproductive health more holistic, accessible and sustainable.
Author: King K. Holmes
Publisher: World Bank Publications
ISBN: 1464805253
Category : Medical
Languages : en
Pages : 1027
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Book Description
Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.
Author: Joint United Nations Programme on HIV/AIDS.
Publisher: World Health Organization
ISBN: 9291735426
Category : Medical
Languages : en
Pages : 97
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Book Description
This annual update reports on developments in the global HIV/AIDS epidemic and draws on the most recent data available to give global and regional estimates of its scope and human toll. Despite promising developments in global efforts to address the AIDS epidemic, including increased access to effective treatment and prevention programmes, the number of people living with HIV continues to grow, as does the number of deaths due to AIDS. Findings for 2006 include: the total number of people living with HIV is estimated at 39.5 million, 4.3 million new cases during the year and an estimated 2.9 million deaths. Sub-Saharan Africa continues to bear the brunt of the global epidemic with 63 per cent of all adults and children with HIV globally and with its epicentre in southern Africa. In the past two years, the number of people living with HIV increased in every region in the world, with the most striking increases in East Asia, Eastern Europe and Central Asia, where the number of people living with HIV in 2006 was over 21 per cent higher than in 2004.
Author: Shiza Farid
Publisher:
ISBN:
Category :
Languages : en
Pages : 31
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Kenya has aims to achieve the 95-95-95 goals for prevention of mother-to-child HIV transmission (PMTCT) by 2030; yet, each year there are 13,000 new infant HIV infections. Repeat testing in the third trimester and in the postpartum period, when risk of HIV acquisition is high, can help detect and treat incident maternal infections and reduce mother-to-child HIV transmission. Current data on the timing, frequency, and utility of repeat testing are lacking. We assessed the cost-effectiveness of repeat HIV testing during pregnancy and the postpartum period, comparing various repeat testing scenarios to inform more targeted policies on PMTCT programs, and maximize HIV prevention resources in Kenya. We assessed the cost-effectiveness of 5 repeat testing scenarios, varying the number and timing of repeat testing, in averting infant HIV infections. We constructed a separate decision analytic model for each scenario to estimate the number of infant infections averted, the incremental cost-effectiveness ratio in terms of infections averted (ICER-IA), and the total cost to the Kenyan health care system. As a conservative estimate, repeat testing scenarios were considered to be cost-effective if the ICER-IA was less than 3 times Kenya’s gross domestic product (GDP) per capita ($4365 USD in 2016) and highly cost-effective if less than Kenya’s GDP per capita ($1455 USD in 2016). All repeat testing strategies are cost-effective in averting infant infections. Repeat testing at delivery; at 6 weeks postpartum; at both 6 weeks postpartum and 6 months postpartum; and in the third trimester/at delivery, at 6 weeks postpartum, and at 6 months postpartum (complete repeat testing) are all also considered highly-cost-effective. The most cost-effective strategy is conducting complete repeat maternal HIV testing, which averts a 12,023 infant infections with an ICER-IA of $1,189. The second most cost-effective scenario is repeat testing at 6 weeks postpartum and 6 months postpartum, which averts 8,403 infections at the ICER-IA of $1,249. Repeat testing at 6 weeks postpartum averts 5,160 infections at the ICER-IA of $1,426. Among all the repeat testing scenarios, complete retesting averts the most infant infections and is highly cost-effective. Data on implementation of repeat testing guidelines will be useful to measure health and economic impact of scaling up repeat maternal testing in Kenya.
Author: National Research Council (U.S.). Panel on Data and Research Priorities for Arresting AIDS in Sub-Saharan Africa
Publisher: National Academies
ISBN:
Category : Medical
Languages : en
Pages : 36
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Book Description
The AIDS epidemic in Sub-Saharan Africa continues to affect all facets of life throughout the subcontinent. Deaths related to AIDS have driven down the life expectancy rate of residents in Zambia, Kenya, and Uganda with far-reaching implications. This book details the current state of the AIDS epidemic in Africa and what is known about the behaviors that contribute to the transmission of the HIV infection. It lays out what research is needed and what is necessary to design more effective prevention programs.
Author:
Publisher:
ISBN:
Category : Electronic book
Languages : en
Pages :
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Author: Suzanne Maman
Publisher:
ISBN: 9789241590730
Category :
Languages : en
Pages : 65
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Book Description
This review paper synthesizes the current information available on HIV status disclosure in terms of rates barriers and outcomes of HIV status disclosure among HIV-infected individuals. Particular emphasis is placed on women's experiences with disclosure to sexual partners. The report also aims to identify major barriers and describe programmatic and policy strategies that have been adopted to address these barriers and support women through the disclosure process.
