Journal Article > ResearchFull Text
PLOS One. 2019 May 2; Volume 14 (Issue 5); e0215454.; DOI:10.1371/journal.pone.0215454
Moore HA, Metcalf CJ, Cassidy T, Hacking D, Shroufi A, et al.
PLOS One. 2019 May 2; Volume 14 (Issue 5); e0215454.; DOI:10.1371/journal.pone.0215454
INTRODUCTION:
HIV self-testing (HIVST) offers a useful addition to HIV testing services and enables individuals to test privately. Despite recommendations to the contrary, repeat HIV testing is frequent among people already on anti-retroviral treatment (ART) and there are concerns that oral self-testing might lead to false negative results. A study was conducted in Khayelitsha, South Africa, to assess feasibility and uptake of HIVST and linkage-to-care following HIVST.
METHODS:
Participants were recruited at two health facilities from 1 March 2016 to 31 March 2017. People under 18 years, or with self-reported previously-diagnosed HIV infection, were excluded. Participants received an OraQuick Rapid HIV-1/2 Antibody kit, and reported their HIVST results by pre-paid text message (SMS) or by returning to the facility. Those not reporting within 7 days were contacted by phone. Electronic and paper-based clinical and laboratory records were retrospectively examined for all participants to identify known HIV outcomes, after matching for name, date of birth, and sex. These findings were compared with self-reported HIVST results where available.
RESULTS:
Of 639 participants, 401 (62.8%) self-reported a negative HIVST result, 27 (4.2%) a positive result, and 211 (33.0%) did not report. The record search identified that of the 401 participants self-reporting a negative HIVST result, 19 (4.7%) were already known to be HIV positive; of the 27 self-reporting positive, 12 (44%) were known HIV positive. Overall, records showed 57/639 (8.9%) were HIV positive of whom 39/57 (68.4%) had previously-diagnosed infection and 18/57 (31.6%) newly-diagnosed infection. Of the 428 participants who self-reported a result, 366 (85.5%) reported by SMS.
CONCLUSIONS:
HIVST can improve HIV testing uptake and linkage to care. SMS is acceptable for reporting HIVST results but negative self-reports by participants may be unreliable. Use of HIVST by individuals on ART is frequent despite recommendations to the contrary and its implications need further consideration.
HIV self-testing (HIVST) offers a useful addition to HIV testing services and enables individuals to test privately. Despite recommendations to the contrary, repeat HIV testing is frequent among people already on anti-retroviral treatment (ART) and there are concerns that oral self-testing might lead to false negative results. A study was conducted in Khayelitsha, South Africa, to assess feasibility and uptake of HIVST and linkage-to-care following HIVST.
METHODS:
Participants were recruited at two health facilities from 1 March 2016 to 31 March 2017. People under 18 years, or with self-reported previously-diagnosed HIV infection, were excluded. Participants received an OraQuick Rapid HIV-1/2 Antibody kit, and reported their HIVST results by pre-paid text message (SMS) or by returning to the facility. Those not reporting within 7 days were contacted by phone. Electronic and paper-based clinical and laboratory records were retrospectively examined for all participants to identify known HIV outcomes, after matching for name, date of birth, and sex. These findings were compared with self-reported HIVST results where available.
RESULTS:
Of 639 participants, 401 (62.8%) self-reported a negative HIVST result, 27 (4.2%) a positive result, and 211 (33.0%) did not report. The record search identified that of the 401 participants self-reporting a negative HIVST result, 19 (4.7%) were already known to be HIV positive; of the 27 self-reporting positive, 12 (44%) were known HIV positive. Overall, records showed 57/639 (8.9%) were HIV positive of whom 39/57 (68.4%) had previously-diagnosed infection and 18/57 (31.6%) newly-diagnosed infection. Of the 428 participants who self-reported a result, 366 (85.5%) reported by SMS.
CONCLUSIONS:
HIVST can improve HIV testing uptake and linkage to care. SMS is acceptable for reporting HIVST results but negative self-reports by participants may be unreliable. Use of HIVST by individuals on ART is frequent despite recommendations to the contrary and its implications need further consideration.
Journal Article > ResearchFull Text
AIDS Behav. 2022 March 2; Online ahead of print; DOI:10.1007/s10461-022-03586-9
Hacking D, Cassidy T, Ellman T, Steele SJ, Moore HA, et al.
AIDS Behav. 2022 March 2; Online ahead of print; DOI:10.1007/s10461-022-03586-9
In South Africa, where an estimated 34% of nearly 7-million HIV-positive people were not on antiretroviral therapy (ART) in 2019, innovative strategies to diagnose and link people to care are needed. HIV self-testing (HIVST) is one such strategy. However, there is concern that access to HIVST might result in re-testing among people on ART, with a risk of false negative results and disengagement from care. Between November 2017 and December 2018, HIVST kits were distributed at a private pharmacy and at HIV testing outreach events. Each participant was instructed to report their result via SMS and those who did not were followed-up telephonically 10 days later. Electronic medical records of participants were searched for evidence of HIV services 6 months before and after enrollment. Of 1482 participants, 163 (11%) were previously diagnosed HIV-positive prior to taking the test. Of these, 123 reported a result, however 87% reported a negative result. Of the 163 previously diagnosed, 84 were not in ART care prior to the test, with 15 (18%) linking to care post-test. Of 79 who were in ART care prior to the test, 76 (96%) remained in care, even though 51 (67%) had reported a negative result. Overall, 29% of participants reported their result via SMS, and 48% when telephoned. Despite efforts to dissuade them, some previously diagnosed HIV-positive utilised HIVST. For those disengaged from care this may facilitate re-engagement. Self-testing among those already in care, regardless of the reported result, did not disrupt their treatment, and their reasons for doing the test remain unclear.
Journal Article > ResearchFull Text
J Med Internet Res. 2019 October 12; Volume 21 (Issue 12); DOI:10.2196/14012
Hacking D, Mgengwana-Mbakaza Z, Cassidy T, Runeyi P, Duran LT, et al.
J Med Internet Res. 2019 October 12; Volume 21 (Issue 12); DOI:10.2196/14012
Background: Youths in South Africa are poor utilizers of HIV health services. Medecins Sans Frontieres has been piloting youth-adapted services at a youth clinic in Khayelitsha, including a peer virtual mentorship program over mobile phones, piloted from March 2015 to May 2016.
Objective: The objective of this study was to evaluate the effect of the peer mentorship program on youth engagement with HIV services and explore the acceptability of the program to both mentors and mentees.
Methods: Antiretroviral initiation, retention in care (RIC), and viral load suppression were compared between youths engaged in the virtual mentorship program and two matched controls. In-depth interviews were also conducted for 5 mentors and 5 mentees to explore acceptability and impact of the program.
Results: A total of 40 youths were recruited into the virtual mentorship program over the study period. Of these, data were obtained for 35 and 2 matched controls were randomly sampled for each. There was no difference in baseline demographics (eg, age, gender, and CD4 count). Mentees had increased antiretroviral initiation (28/35, 80% vs 30/70, 42% in matched controls) and viral load completion (28/35, 80% vs 32/70, 45%); however, no differences were found in viral load suppression or RIC at 6 or 12 months. Mentors reported being motivated to participate in the program because of previous personal struggles with HIV and a desire to help their peers. Mentees reported fears of disclosure and lack of acceptance of their status as barrier to accessing services, but they felt free to talk to their mentors, valued the mentorship program, and indicated a preference for phone calls.
Conclusions: Peer mentorship in youths is acceptable to both mentors and mentees and appears to increase linkage to care and viral load completion rates.
Objective: The objective of this study was to evaluate the effect of the peer mentorship program on youth engagement with HIV services and explore the acceptability of the program to both mentors and mentees.
Methods: Antiretroviral initiation, retention in care (RIC), and viral load suppression were compared between youths engaged in the virtual mentorship program and two matched controls. In-depth interviews were also conducted for 5 mentors and 5 mentees to explore acceptability and impact of the program.
Results: A total of 40 youths were recruited into the virtual mentorship program over the study period. Of these, data were obtained for 35 and 2 matched controls were randomly sampled for each. There was no difference in baseline demographics (eg, age, gender, and CD4 count). Mentees had increased antiretroviral initiation (28/35, 80% vs 30/70, 42% in matched controls) and viral load completion (28/35, 80% vs 32/70, 45%); however, no differences were found in viral load suppression or RIC at 6 or 12 months. Mentors reported being motivated to participate in the program because of previous personal struggles with HIV and a desire to help their peers. Mentees reported fears of disclosure and lack of acceptance of their status as barrier to accessing services, but they felt free to talk to their mentors, valued the mentorship program, and indicated a preference for phone calls.
Conclusions: Peer mentorship in youths is acceptable to both mentors and mentees and appears to increase linkage to care and viral load completion rates.
Journal Article > ResearchFull Text
PLOS One. 2023 November 3; Volume 18 (Issue 11); e0286906.; DOI:10.1371/journal.pone.0286906
Nelson AM, Lebelo K, Cassidy T, Duran LT, Mantangana N, et al.
PLOS One. 2023 November 3; Volume 18 (Issue 11); e0286906.; DOI:10.1371/journal.pone.0286906
BACKGROUND
Despite the overall reduction in the HIV mother-to-child transmission (MTCT) rate in South Africa, poor adherence and retention in care during breastfeeding contribute to this period being a major driver of MTCT in South Africa. To improve this retention, postnatal clubs were created as an integrated, differentiated model of care providing psychosocial support and comprehensive care for the mother-infant pairs (MIP), including HIV and under-5-child services. We describe the implementation of these facility-based clubs and examine its health outcomes in a peri-urban primary health care setting in Cape Town, South Africa.
METHODS
In this prospective cohort study, conducted between June 2016 and December 2019, MIPs were recruited into postnatal clubs between 6 weeks and 6 months of age and followed-up until 18 months of age. Outcomes including maternal Viral Load (VL), and children’s HIV testing were compared to a historical control group. Children’s immunizations and maternal sexual and reproductive health outcomes are also described.
RESULTS
During the implementation of the postnatal club study period, 484 MIP were recruited with 84% overall attendance, 95% overall viral load suppression, and 98% overall uptake of HIV infant testing. Compared to historical controls, the club infant rapid test uptake was 1.6 times higher (95% CI: 1.4–1.9) at 9 months and 2.0 times higher at 18 months (95% CI: 1.6–2.6). Through 12 months and between 12–18 months, maternal VL monitoring was higher in the club group compared to the historical control by 1.5 times (95% CI: 1.3–1.6) and 2.6 times (95% CI: 2.1–3.2), respectively, with similar maternal VL suppression. Of 105 infants attending the 12 months visit, 99% were fully vaccinated by one year.
CONCLUSION
MIP in the postnatal clubs showed better PMTCT outcomes than historical controls with high levels of retention in care. Other outcomes such as immunisation results suggest that integration of services, such as in the postnatal club, is feasible and beneficial for MIPs.
Despite the overall reduction in the HIV mother-to-child transmission (MTCT) rate in South Africa, poor adherence and retention in care during breastfeeding contribute to this period being a major driver of MTCT in South Africa. To improve this retention, postnatal clubs were created as an integrated, differentiated model of care providing psychosocial support and comprehensive care for the mother-infant pairs (MIP), including HIV and under-5-child services. We describe the implementation of these facility-based clubs and examine its health outcomes in a peri-urban primary health care setting in Cape Town, South Africa.
METHODS
In this prospective cohort study, conducted between June 2016 and December 2019, MIPs were recruited into postnatal clubs between 6 weeks and 6 months of age and followed-up until 18 months of age. Outcomes including maternal Viral Load (VL), and children’s HIV testing were compared to a historical control group. Children’s immunizations and maternal sexual and reproductive health outcomes are also described.
RESULTS
During the implementation of the postnatal club study period, 484 MIP were recruited with 84% overall attendance, 95% overall viral load suppression, and 98% overall uptake of HIV infant testing. Compared to historical controls, the club infant rapid test uptake was 1.6 times higher (95% CI: 1.4–1.9) at 9 months and 2.0 times higher at 18 months (95% CI: 1.6–2.6). Through 12 months and between 12–18 months, maternal VL monitoring was higher in the club group compared to the historical control by 1.5 times (95% CI: 1.3–1.6) and 2.6 times (95% CI: 2.1–3.2), respectively, with similar maternal VL suppression. Of 105 infants attending the 12 months visit, 99% were fully vaccinated by one year.
CONCLUSION
MIP in the postnatal clubs showed better PMTCT outcomes than historical controls with high levels of retention in care. Other outcomes such as immunisation results suggest that integration of services, such as in the postnatal club, is feasible and beneficial for MIPs.
Journal Article > ResearchFull Text
AIDS Care. 2016 April 21; Volume 28 (Issue 7); 898-903.; DOI: 10.1080/09540121.2016.1173638
Henwood R, Patten GE, Barnett W, Hwang B, Metcalf CJ, et al.
AIDS Care. 2016 April 21; Volume 28 (Issue 7); 898-903.; DOI: 10.1080/09540121.2016.1173638
INTRODUCTION
Médecins Sans Frontières supports human immunodeficiency virus (HIV)-infected youth, aged 12-25 years, at a clinic in Khayelitsha, South Africa. Patients are enrolled in youth clubs, and provided with a virtual chat room, using the cell-phone-based social networking platform, MXit, to support members between monthly/bimonthly club meetings. The acceptability and uptake of MXit was assessed.
METHODS
MXit was facilitated by lay counsellors, was password protected, and participants could enter and leave at will. Club members were asked to complete self-administered questionnaires and participate in two focus-group discussions.
RESULTS AND DISCUSSION
In total, 60 club members completed the questionnaire, and 12 participated in the focus groups. Fifty-eight percentage were aged 23-25 years, 63% were female and 83% had a cell phone. Sixty percentage had used MXit before, with 38% having used it in the past month. Sixty-five percentage were aware of the chat-room and 39% knew how to access it. Thirty-four percentage used the chat-room at least once, 20% had visited the chat-room in the past month, and 29% had used MXit to have private conversations with other club members. Fifty-seven percentage used the chat-room to get advice, and 84% of all respondents felt that offering a service outside the youth club meetings was important and would like to see one to continue. The cost of using social media platforms was an issue with some, as well as the need for anonymity. Preference for other platforms, logistical obstacles, or loss of interest contributed to non-use.
CONCLUSIONS
Reported usage of the MXit chat-room was low, but participants indicated acceptance of the programme and their desire to interact with their peers through social media. Suggestions to improve the platform included accessible chat histories, using more popular platforms such as Facebook or WhatsApp, and to have topical discussions where pertinent information for youth is provided.
Médecins Sans Frontières supports human immunodeficiency virus (HIV)-infected youth, aged 12-25 years, at a clinic in Khayelitsha, South Africa. Patients are enrolled in youth clubs, and provided with a virtual chat room, using the cell-phone-based social networking platform, MXit, to support members between monthly/bimonthly club meetings. The acceptability and uptake of MXit was assessed.
METHODS
MXit was facilitated by lay counsellors, was password protected, and participants could enter and leave at will. Club members were asked to complete self-administered questionnaires and participate in two focus-group discussions.
RESULTS AND DISCUSSION
In total, 60 club members completed the questionnaire, and 12 participated in the focus groups. Fifty-eight percentage were aged 23-25 years, 63% were female and 83% had a cell phone. Sixty percentage had used MXit before, with 38% having used it in the past month. Sixty-five percentage were aware of the chat-room and 39% knew how to access it. Thirty-four percentage used the chat-room at least once, 20% had visited the chat-room in the past month, and 29% had used MXit to have private conversations with other club members. Fifty-seven percentage used the chat-room to get advice, and 84% of all respondents felt that offering a service outside the youth club meetings was important and would like to see one to continue. The cost of using social media platforms was an issue with some, as well as the need for anonymity. Preference for other platforms, logistical obstacles, or loss of interest contributed to non-use.
CONCLUSIONS
Reported usage of the MXit chat-room was low, but participants indicated acceptance of the programme and their desire to interact with their peers through social media. Suggestions to improve the platform included accessible chat histories, using more popular platforms such as Facebook or WhatsApp, and to have topical discussions where pertinent information for youth is provided.
Journal Article > LetterFull Text
Int J Tuberc Lung Dis. 2021 September 1; Volume 25 (Issue 9); 772-775(4).; DOI:10.5588/ijtld.21.0340
Mohr-Holland E, Hacking D, Daniels J, Scott V, Mudaly V, et al.
Int J Tuberc Lung Dis. 2021 September 1; Volume 25 (Issue 9); 772-775(4).; DOI:10.5588/ijtld.21.0340