Journal of the International Association of Providers of AIDS Care最新文献

{"title":"Metabolic Syndrome Among People Living With HIV on Dolutegravir and Efavirenz-Based Antiretroviral Therapy in Ethiopia: A Comparative Cross-Sectional Study.","authors":"Mohammed Jemal, Baye Ashenef, Deresse Sinamaw, Adane Adugna, Mamaru Getinet, Temesgen Baylie, Nuredin Chura Waritu","doi":"10.1177/23259582241303305","DOIUrl":"10.1177/23259582241303305","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to assess the burden of metabolic syndrome among people living with HIV (PLWH) on dolutegravir (DTG)- and efavirenz (EFV)-based regimens.</p><p><strong>Methods: </strong>A hospital-based comparative cross-sectional study design was implemented from May 5, 2022, to August 5, 2022.</p><p><strong>Results: </strong>The overall prevalence of metabolic syndrome was 18.6% (32/172) for all regimens, with 25.6% (22/86) for the DTG- and 11.6% (10/86) for the EFV-based regimens (<i>P</i> = .019). Body mass index ≥ 25 kg/m² (adjusted odds ratio [AOR] = 3.04; 95% confidence interval [CI]: 1.13-8.14), CD4 count ≥ 500 cells/mm³ (AOR = 3.01; 95% CI: 1.09-8.28), insufficient physical activity (AOR = 2.60; 95% CI: 1.00-6.72), and DTG-based regimen (AOR = .86; 95% CI: 1.14-7.20) were associated with metabolic syndrome.</p><p><strong>Conclusion: </strong>The prevalence of metabolic syndrome was significantly higher among PLWH on DTG-based regimens. This signifies that DTG-treated patients should be advised on lifestyle adjustments to prevent the development of metabolic syndrome.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241303305"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stakeholder Perspectives on Research Consent and Reconsent for Procedures Involving Biological Samples and Biobanking of Children and Adolescents Living With HIV in Kenya.","authors":"Josephine Aluoch, Ashley Chory, Michael Scanlon, Emma Gillette, Hillary Koros, Dennis Munyoro, Celestine Ashimosi, Whitney Beigon, Janet Lidweye, Jack Nyagaya, Allison DeLong, Rami Kantor, Rachel Christine Vreeman, Violet Naanyu, Winstone M Nyandiko","doi":"10.1177/23259582241305424","DOIUrl":"10.1177/23259582241305424","url":null,"abstract":"<p><strong>Objective: </strong>To explore the perspectives of stakeholders on consenting and reconsenting children and adolescents living with HIV (CALWH) to participate in research involving biological sampling and biobanking. Stakeholders included CALWH, their caregivers, subject matter experts (SMEs) such as Institutional Review Board (IRB) members, Community Advisory Board (CAB) members, Healthcare Providers, researchers, and community leaders.</p><p><strong>Study design: </strong>This qualitative study was conducted at the Academic Model Providing Access to Healthcare (AMPATH) in Kenya. Semi-structured interviews were conducted with CALWH, their caregivers, and SMEs. Audio recordings were transcribed, thematically analyzed, and emerging themes derived.</p><p><strong>Results: </strong>In total, 99 participants were interviewed, of which the majority (52%) were female; 50% of CALWH were female with a median age of 17.5 years (range 11-24); 70% of caregivers and 44% of SMEs were female. All SMEs, CALWH, and caregivers emphasized that recontacting and reconsenting were their strong preferences for the use of biospecimens and also an essential procedure to address legal and ethical considerations and confidentiality. All CALWH wanted consent to detail how they will be informed about research findings and emphasized making their results available to them. Caregivers highlighted the importance of trust in the use of the stored samples to be maintained as per the consents.</p><p><strong>Conclusion: </strong>Our findings revealed that CALWH and their caregivers want researchers to go beyond the typical information provided about biospecimen storage and use. They desire to be recontacted and reconsented as well as maintain ongoing communication with the research team about the research findings.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241305424"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Location Preferences for Accessing Long-Acting Injectable Pre-Exposure Prophylaxis (LA-PrEP) Among Men Who Have Sex With Men (MSM) Currently on Daily Oral PrEP.","authors":"Jennifer L Glick, Danielle F Nestadt, Travis Sanchez, Kevin Li, Marissa Hannah, M Keith Rawlings, Alex R Rinehart, Supriya Sarkar, Vani Vannappagari","doi":"10.1177/23259582241293336","DOIUrl":"10.1177/23259582241293336","url":null,"abstract":"<p><p>We investigated men who have sex with men's (MSM) location preferences for long-acting injectable pre-exposure prophylaxis (LA-PrEP). MSM (<i>n</i> = 1076) who completed the 2021 American Men's Internet Survey, were currently prescribed oral PrEP, and expressed LA-PrEP interest reported location preferences for receiving LA-PrEP: healthcare provider (HCP) setting, pharmacy, or at-home. HCP settings were preferred by 60% of participants; 26% preferred home and 14% preferred pharmacy. In adjusted models, high healthcare stigma was associated with preferring pharmacy and at-home versus HCP, while high friends/family stigma was associated with preferring HCP settings versus pharmacy. Healthcare access history was associated with preference for HCP setting versus home. Being 25 to 29 or 30 to 29 years old versus 40+ was associated with preferring HCP versus home. Private insurance was associated with location preferences. Findings support the need for multiple LA-PrEP service locations to best reach MSM and highlight multiple complex factors that influence such preferences.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241293336"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Depression Among Middle-Aged to Older People Living With HIV in Lima, Peru.","authors":"Virgilio E Failoc-Rojas, Dan Tong Jia, Marcela Gil-Zacarias, Alana Latorre, Robinson Cabello, Patricia J Garcia, Monica M Diaz","doi":"10.1177/23259582241273452","DOIUrl":"10.1177/23259582241273452","url":null,"abstract":"<p><strong>Introduction: </strong>Depression is prevalent among aging people living with HIV (PLWH) worldwide. We sought to identify depression risk factors among a group of middle-aged and older PLWH in Lima, Peru.</p><p><strong>Materials and methods: </strong>We assessed risk factors for depression among PLWH over age 40 receiving care in an HIV clinic in Lima, Peru. The Patient Health Questionnaire-9 (PHQ-9) was administered. We performed descriptive statistics and logistic regression analyses.</p><p><strong>Results: </strong>Mean age was 51.7 ± 7.7 years with 15.3% females. One-quarter of participants had depression with higher frequency in females. Risk factors that significantly increased the risk of depression included female sex (adjusted prevalence ratio [aPR] = 2.19 [95%CI 1.07-4.49]), currently smoking (aPR = 2.25 [95%CI 1.15-4.43]), and prior opportunistic infection (aPR = 2.24 [95%CI 1.05-4.76]).</p><p><strong>Discussion: </strong>Our study demonstrates that PLWH who are female, current smokers, or had an opportunistic infection have higher risk of depression. Identifying PLWH at-risk for depression is key to early mental health interventions.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241273452"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11325335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatitis B and C Virus Co-Infection and Their Association With Liver Disease in Persons With HIV in Nigeria.","authors":"Emuobor Odeghe, Ganiyat Oyeleke, Mayowa Odofin, Mary Duguru, Pantong Davwar, David Nyam, Olufunmilayo Lesi, Edith Okeke, Hameed Adelabu, Oluwakemi Odukoya, Alani Akanmu, Wasiu Adeyemo, Fatimah Abdulkareem, Godwin Imade, Brian Joyce, Imran Khan, Ariel Chandler, Atiene Sagay, Robert Murphy, Lifang Hou, Claudia Hawkins","doi":"10.1177/23259582241292511","DOIUrl":"10.1177/23259582241292511","url":null,"abstract":"<p><strong>Plain language summary: </strong><b><i>Hepatitis B and C infection and liver disease in people with HIV infection in Nigeria</i></b>People living with human immunodeficiency virus (HIV) infection who have hepatitis B or C infection have a higher chance of developing advanced liver disease than those who do not have either of the hepatitis infections. This finding highlights the importance of awareness, screening, and treatment of the hepatitis viruses in HIV programs in order to reduce the risk of liver disease in this population.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241292511"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Index Case HIV Testing Uptake and its Associated Factors at Oromia, Ethiopia.","authors":"Mustefa Adem Hussen, Dawud Kadire, Bilisumamulifna Tefera Kefeni, Zakir Abdu, Eshetu Chilo","doi":"10.1177/23259582241274028","DOIUrl":"10.1177/23259582241274028","url":null,"abstract":"<p><strong>Background: </strong>Lack of index case testing increased the risk of contracting HIV among the families of index clients, partners, and biological children. The aim of this study was to determine the prevalence of index case HIV testing uptake and its associated factors at Oromia, Ethiopia.</p><p><strong>Methods: </strong>An institutional-based cross-sectional study was conducted. A face-to-face interviewer administered structured questionnaire and chart review checklist were used to collect data. The data were analyzed using SPSS version 25. Logistic regressions were executed and statistical significance was declared at <i>P</i> < .05.</p><p><strong>Results: </strong>The prevalence of index case testing was 80.2%. Factors associated with index case HIV testing uptake included HIV status disclosure (AOR = 5.4, 95% CI: 2.1, 14.0), discussed about HIV with family (AOR = 3.1, 95% CI: 1.2, 7.5), counseling of the index case (AOR = 3.3, 95% CI: 1.7, 10.6), perceived benefit of the index case tested (AOR = 3.2, 95% CI: 1.5, 8.7), being on ART 12 months or more (AOR = 2.6, 95% CI: 1.1, 6.1), and maintained privacy (AOR = 3.1, 95% CI: 1.3, 7.1).</p><p><strong>Conclusions: </strong>The uptake of index case HIV testing was moderately high. Additionally, factors such as HIV status disclosure, discussion of HIV with family, counseling of the index case, perception of the benefits of HIV testing for the index case, duration of clients on ART, and privacy maintenance during service delivery were significantly associated with index case HIV testing. To enhance index case testing, it is crucial to raise awareness and ensure client privacy during the initial HTC visit. Encouraging HIV status disclosure through discussion and promoting adherence to HIV medication is also recommended.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241274028"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Policy and Programming Towards Addressing Treatment Gaps in Adolescents Living with HIV: A Content Analysis of Policy and Programme Documents in Namibia.","authors":"Farai K Munyayi, Brian E van Wyk","doi":"10.1177/23259582241236061","DOIUrl":"10.1177/23259582241236061","url":null,"abstract":"<p><p>Adolescents living with HIV (ALHIV) face unique challenges resulting in persistent treatment gaps, particularly viral non-suppression. Country programs adopt policies, guidelines, and innovations, based on WHO recommendations and best practices from elsewhere. However, it is unclear to what extent these tools address the management of adolescents with viral non-suppression. We report on a review of guidelines for the provision of HIV services to ALHIV in Namibia. We conducted a systematic document review using Content Analysis and Thematic Analysis methodology, and the READ approach. We identified seven relevant policy documents, four of which somewhat addressed viral non-suppression (treatment gap) in ALHIV and outlined interventions to improve treatment outcomes in adolescents considering their lived experience and unique challenges. The persistent treatment gap may reflect policy implementation gaps in specifically addressing viral non-suppression. It may be worthwhile to leverage existing documents to develop specific operational guidance for ALHIV with unsuppressed viral loads.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241236061"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10916493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140039740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma Viral Load of 200 Copies/mL is a Suitable Threshold to Define Viral Suppression and HIV Drug Resistance Testing in Low- and Middle-Income Countries: Evidence From a Facility-Based Study in Cameroon.","authors":"Collins Ambe Chenwi, Rachel Audrey Nayang Mundo, Alex Durand Nka, Ezechiel Ngoufack Jagni Semengue, Grâce Angong Beloumou, Aude Christelle Ka'e, Willy Leroi Togna Pabo, Désiré Takou, Aissatou Abba, Sandrine Claire Djupsa, Evariste Molimbou, Naomi-Karell Etame, Aurelie Minelle Kengni Ngueko, David Kob Same, Jolle Nounouce Bouba Pamen, Aristide Stephane Abah Abah, Serge Clotaire Billong, Rogers Ajeh Awoh, Gregory Edie Halle-Ekane, Giulia Cappelli, Anne-Esther Njom-Nlend, Anne-Cecile Zk Bissek, Elvis Temfack, Maria Mercedes Santoro, Francesca Ceccherini-Silberstein, Vittorio Colizzi, Jean Kaseya, Nicaise Ndembi, Alexis Ndjolo, Carlo Federico Perno, Joseph Fokam","doi":"10.1177/23259582241306484","DOIUrl":"10.1177/23259582241306484","url":null,"abstract":"<p><strong>Introduction: </strong>In low-and-middle-income-countries (LMIC), viral suppression is defined as plasma viral load (PVL) below 1000 copies/mL (low-level viremia [LLV]) and threshold for HIV drug resistance (HIVDR) testing. However, there is evidence that drug resistance mutations (DRMs) may emerge at LLV, thus compromising antiretroviral treatment (ART) response<b>.</b> We evaluated sequencing success rates (SSR) at LLV, described HIVDR profiles and adequacy with potential efficacy of tenofovir-lamivudine-dolutegravir (TLD).</p><p><strong>Methods: </strong>A cross-sectional study was conducted among individuals with LLV at the Chantal BIYA International Reference Centre, Yaoundé, Cameroon from January 2020 through August 2021. HIV-1 sequencing was performed on protease/reverse-transcriptase, and sequences analysed using Stanford HIVdbv9.5. SSR and HIVDR rates were assessed according to viral-load ranges, with <i>P</i> < .05 considered statistically significant.</p><p><strong>Results: </strong>In total, 131 individuals were enrolled (median [IQR] age = 41 [30-49] years; 67.9% female; 54.7% at WHO clinical-stage I/II; median ART-duration 7 [4-11] years; median CD4-count 221 [103-402] cells/mm³ and median PVL 222 [96-436] copies/mL). Overall, SSR at LLV was 34.4% (45/131) and increased significantly with decreasing-age (<i>P = </i>.002) and increasing-PVL (<i>P </i>= .017). SSR were doubled at PVL≥150 copies/mL (21.8% at [40-150] vs. 43.3% at [150-1000]; OR = 2.8, <i>P = </i>.01). Of the 45 sequences obtained, 75.6% were recombinant strains (CRF02_AG, CRF09_cpx, CRF11_cpx) and 24.4% pure-subtypes (A1, D, F2, G). Overall, HIVDR prevalence at LLV was 82.2% (37/45), with 74.6% and 15.6% resistance to reverse-transcriptase inhibitors (RTIs) and ritonavir-boosted protease inhibitors (PI/r) respectively. Interestingly, HIVDR rates were similar at PVLs [50-200] versus [200-1000] copies/mL (<i>P = </i>.69). The most frequent DRMs were M184 V (73.3%) and K103N (40.0%) for RTIs and M46I (6.7%) for PIs/r. Overall 55.6% (25/45) of individuals were on suboptimal ART (needing ART-optimisation), with 48.9% (22/45) having suboptimal TLD predictive efficacy. Optimisation need was higher in first-line (81.8%, <i>P = </i>.03), but similar across viral clades and PVL-ranges (<i>P = </i>.6).</p><p><strong>Conclusion: </strong>In this LMIC context, sequencing for HIVDR is feasible at LLV even with broad HIV-1 diversity, with significantly higher SSR above 150 copies/mL and/or in paediatrics. About 80% of individuals with LLV harbour HIVDR strains, with half of them needing ART optimisations to limit HIVDR emergence and prevent treatment failure. Our findings underscore the clinical benefits of HIVDR during persisting LLV and the need to reconsider the threshold for viral suppression around 200copies/mL in LMICs.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241306484"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic Syndrome and Associated Factors Among People Living With HIV on Dolutegravir-Based Antiretroviral Therapy in Northern Tanzania.","authors":"Tumaini E Mirai, Kajiru G Kilonzo, Abid M Sadiq, Ibrahim Ali Ibrahim Muhina, Norman J Kyala, Annette A Marandu, Sarah K Gharib, Andrea R Costantine, Elifuraha W Mkwizu, William P Howlett, Elichilia R Shao, Gissela B Nyakunga, Huda F Akrabi, Vibhu R Kshettry, Venance P Maro, Nyasatu G Chamba, Furaha S Lyamuya","doi":"10.1177/23259582241306492","DOIUrl":"10.1177/23259582241306492","url":null,"abstract":"<p><strong>Purpose: </strong>Chronic systemic inflammation from human immunodeficiency virus (HIV) may cause metabolic abnormalities in lipid metabolism. Additionally, the development of metabolic syndrome has been associated with specific anti-retroviral therapy, particularly dolutegravir. This study aimed to determine the prevalence and associated factors of metabolic syndrome among people living with HIV on dolutegravir-based anti-retroviral therapy.</p><p><strong>Methods: </strong>This was an analytical cross-sectional study conducted between October 1, 2022, and March 31, 2023, among 312 people living with HIV. A structured questionnaire was used to collect socio-demographic and clinical characteristics including anthropometric indices and a blood pressure reading. A blood sample was collected to measure plasma glucose levels and serum lipid levels. The outcome being metabolic syndrome, odds ratios were evaluated using logistic regression analysis, and a <i>P</i>-value of <.05 was considered statistically significant.</p><p><strong>Results: </strong>The prevalence of metabolic syndrome was 42.3%. Waist circumference (73%) and reduced high-density lipoprotein cholesterol (59.9%) were the most prevalent components. Factors associated with metabolic syndrome were patients aged 18-44 years (aOR: 3.10; 95% CI: 1.24-7.79; <i>P</i> = .016), female gender (aOR: 5.40; 95% CI: 2.07-14.13; <i>P</i> = .001), no physical activity (aOR: 4.00; 95% CI: 1.05-15.10; <i>P</i> = .042), and patients who earned >300 000 Tanzanian shillings per month (aOR: 2.15; 95% CI: 1.07-4.32; <i>P</i> = .032).</p><p><strong>Conclusion: </strong>The prevalence of metabolic syndrome among patients on dolutegravir-based therapy is high. There is a need to adhere to routine screening of metabolic syndrome among people living with HIV on dolutegravir-based anti-retroviral therapy.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241306492"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring Patient Adherence and Follow-up in Option B+ Program: Understanding Healthcare Workers' Practices, Challenges, and Facilitators in Lilongwe, Malawi.","authors":"Wiza Kumwenda, Angela M Bengtson, Shaphil Wallie, Agatha K Bula, Jimmy Ba Villiera, Edith Ngoma, Mina C Hosseinipour, Victor Mwapasa","doi":"10.1177/23259582241299006","DOIUrl":"10.1177/23259582241299006","url":null,"abstract":"<p><strong>Background: </strong>Option B+ aims to prevent mother-to-child transmission of HIV by providing lifelong antiretroviral therapy (ART) to pregnant and breastfeeding women living with HIV (PBWHIV). Identifying and reengaging PBWHIV who disengage or fail to initiate ART is essential for the success of Option B+. However, the process is often suboptimal, leading to challenges such as misclassification of patients as lost to follow-up. Healthcare workers (HCWs) are pivotal for monitoring engagement, but little is known about their monitoring practices. This study aimed to explore how HCWs monitor women's engagement in Option B+ services.</p><p><strong>Methods: </strong>A qualitative study was conducted in five high-volume health facilities in Lilongwe, Malawi. Thirty HCWs responsible for monitoring women in Option B+ were purposively selected as key informants. Semistructured interviews were conducted between March and June 2021. Thematic analysis employing deductive and inductive coding methods was utilized. The Consolidated Framework for Implementation Research was used to map gaps, strategies, barriers, and facilitators of monitoring.</p><p><strong>Results: </strong>Monitoring was described as tracking a PBWHIV from HIV diagnosis to initiation of ART to subsequent ART visits for up to 2 years postpartum. <i>The gaps</i> included timing variations in tracing. No procedures to follow up formal transfer-outs or management of silent transfers during emergency ART refills were identified. <i>Strategies</i> identified included interfacility collaboration, record review, tracing, escorting women during initial visits, and self-reports. Technological innovations, such as WhatsApp groups, were highlighted as game changers in interfacility collaboration when tracking women's movements. <i>Barriers</i> included resource constraints (human and operational), poor work attitudes, and challenges faced by women (partner support, stigma, and HCW rapport). <i>The facilitators</i> included implementing partner support, leadership, and strategies such as education and tracing.</p><p><strong>Conclusion: </strong>Addressing resource constraints, women's relationship dynamics for self-management, HCWs' attitudes, and standardizing tracing protocols are crucial for effective monitoring. Leveraging instant messaging for clinic coordination may enhance tracing. Further research and interventions should target identified gaps to promote effective monitoring in similar settings.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":"23 ","pages":"23259582241299006"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}