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HIV Testing, Prevention and Care Cascade

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A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366). This special issue belongs to the section "Infectious Diseases".

Deadline for manuscript submissions: closed (30 September 2022) | Viewed by 26609

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Special Issue Editors

Dr. Chen Zhang

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Guest Editor

School of Nursing, University of Rochester, Rochester, NY 14642, USA
Interests: behavioral and biomedical interventions (e.g., circumcision, pre-exposure prophylaxis) targeting high-risk populations (e.g., MSM, FSW, IDU, PLWHA); using both quantitative and qualitative methods (e.g., grounded theory, generalized linear models); develop and implement tailored interventions with high efficacy/effectiveness and cost-effectiveness

Dr. Yu Liu

E-Mail Website
Guest Editor

Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA
Interests: leveraging advanced quantitative/qualitative methods; behavioral theories; implementation science and technology (e.g., data science, social media) to design/implement novel HIV prevention interventions to reduce HIV/STI risks and enhance the adoption of proven HIV prevention strategies (e.g., HIV; bisexual and other men who have sex with men (GBMSM)

Special Issue Information

Dear Colleagues,

The HIV prevention and care cascade has been designed to guide and disseminate programs focusing on HIV prevention and treatment in HIV care while identifying gaps along the process required for effective use of these programs and resources. Starting from HIV testing, if the individual is negative, with comprehensive counseling and assessment, they will be linked to the prevention cascade (i.e., behavioral and biomedical risk-reduction approaches, continuous monitoring and assessment, maintain seronegative status). If the person is positive, they will be guided into the treatment cascade (i.e., diagnosis, linkage to care, receive treatment, remain in care, and receive viral suppression). Research suggests that the cascade can be enhanced if interventions address supply-side demands (i.e., making prevention or treatment programs available, accessible, and affordable), demand-side demands (i.e., awareness, willingness, and intention to adopt the prevention or treatment approaches), and adherence support (i.e., ongoing engagement with the prevention and treatment programs). This Special Issue aims to provide multidisciplinary perspectives on the HIV testing, prevention, and treatment cascade. We invite submissions from health professionals, epidemiologists, healthcare providers, public health practitioners, social scientists, and researchers to provide different perspectives regarding the opportunities and challenges in the HIV testing, prevention, and care cascade, to curb the HIV epidemic among key populations (e.g., men who have sex with men, sex workers, injecting drug users, transgender people) who are at increased risk of HIV infection and transmission.

Dr. Chen Zhang
Dr. Yu Liu
Guest Editors

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Keywords

HIV testing
HIV prevention
HIV care cascade
health disparities and health equity

Published Papers (13 papers)

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Editorial

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2 pages, 183 KiB

Open AccessEditorial

Editorial for the Special Issue−‘HIV Testing, Prevention, and Care Cascade’

by Chen Zhang and Yu Liu

Trop. Med. Infect. Dis. 2022, 7(11), 387; https://doi.org/10.3390/tropicalmed7110387 - 18 Nov 2022

Viewed by 1069

Abstract

Since the early 1980s, HIV/AIDS has been an ongoing public health concern [...] Full article

(This article belongs to the Special Issue HIV Testing, Prevention and Care Cascade)

Research

Jump to: Editorial, Other

14 pages, 1005 KiB

Open AccessArticle

Substance Use and Adherence to Antiretroviral Therapy among People Living with HIV in the United States

by Sarahmona Przybyla, Rebecca L. Ashare, Loriann Cioffi, Isabella Plotnik, Jonathan Shuter, Elizabeth K. Seng and Andrea H. Weinberger

Trop. Med. Infect. Dis. 2022, 7(11), 349; https://doi.org/10.3390/tropicalmed7110349 - 4 Nov 2022

Cited by 4 | Viewed by 1717

Abstract

People with HIV (PWH) report substance use at higher rates than HIV-uninfected individuals. The potential negative impact of single and polysubstance use on HIV treatment among diverse samples of PWH is underexplored. PWH were recruited from the Center for Positive Living at the Montefiore Medical Center (Bronx, NY, USA) from May 2017-April 2018 and completed a cross-sectional survey with measures of substance use, antiretroviral therapy (ART) use, and ART adherence. The overall sample included 237 PWH (54.1% Black, 42.2% female, median age 53 years). Approximately half of the sample reported any current substance use with 23.1% reporting single substance use and 21.4% reporting polysubstance use. Polysubstance use was more prevalent among those with current cigarette smoking relative to those with no current smoking and among females relative to males. Alcohol and cannabis were the most commonly reported polysubstance combination; however, a sizeable proportion of PWH reported other two, three, and four-substance groupings. Single and polysubstance use were associated with lower ART adherence. A thorough understanding of substance use patterns and related adherence challenges may aid with targeted public health interventions to improve HIV care cascade goals, including the integration of substance use prevention into HIV treatment and care settings. Full article

(This article belongs to the Special Issue HIV Testing, Prevention and Care Cascade)

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11 pages, 309 KiB

Open AccessArticle

Prevalence and Vulnerability Factors Associated with HIV and Syphilis in Older People from Subnormal Agglomerate, Brazilian Amazon

by Wanderson Santiago de Azevedo Junior, Eduarda Pastana dos Santos, Nábia Pereira Pedreira, Lucas Bittencourt Dantas, Valéria Gabrielle Caldas Nascimento, Geyse Aline Rodrigues Dias, Fabiane de Jesus Dias Sousa, Nádile Juliane Costa de Castro, Eliã Pinheiro Botelho and Glenda Roberta Oliveira Naiff Ferreira

Trop. Med. Infect. Dis. 2022, 7(11), 332; https://doi.org/10.3390/tropicalmed7110332 - 28 Oct 2022

Cited by 3 | Viewed by 1506

Abstract

Background: This study aimed to estimate the prevalence of HIV and syphilis and associated factors among elderly people from subnormal agglomerations in a city in the Brazilian Amazon. Methods: An observational, cross-sectional study was carried out in a subnormal agglomerate from the Brazilian Amazon. Data collection was conducted from August 2021 to February 2022, using a structured questionnaire. Whole blood samples were collected to perform a rapid test for HIV and syphilis. People aged 50 and over were included in the study, and the sample consisted of 213 participants. The odds ratio was calculated by multiple logistic regression. Results: A total of 203 participants with a mean age of 63.5 years were considered (95% CI: 62.4; 64.6; standard deviation: 8.1; minimum age: 50 years and maximum age: 94 years). The prevalence of either HIV or syphilis was 16.4% (35/213; 95% CI: 0.11; 0.21); syphilis was 15.5% (33/213) and HIV was 1.40% (3/213). One coinfection (0.46%; 1/213) was registered. In the final multiple logistic regression, the elderly with an education level of illiterate/elementary were two times more likely to have a positive rapid test result for HIV or syphilis. Conclusions: Testing for HIV and syphilis identified that STI represented a burden on populations affected by socioeconomic inequality. Full article

(This article belongs to the Special Issue HIV Testing, Prevention and Care Cascade)

12 pages, 269 KiB

Open AccessArticle

Socio-Structural Factors and HIV Care Engagement among People Living with HIV during the COVID-19 Pandemic: A Qualitative Study in the United States

by Jacob Bleasdale, Lucia A. Leone, Gene D. Morse, Yu Liu, Shelby Taylor and Sarahmona M. Przybyla

Trop. Med. Infect. Dis. 2022, 7(10), 259; https://doi.org/10.3390/tropicalmed7100259 - 23 Sep 2022

Cited by 7 | Viewed by 2076

Abstract

Achieving HIV prevention goals will require successful engagement in each stage of the HIV continuum. The present study sought to understand the ways in which socio-structural factors influence HIV care engagement among people living with HIV (PLH) within the context of the ongoing COVID-19 pandemic. Twenty-five PLH were recruited from January to October 2021. Semi-structured interviews discussed various socio-contextual factors that influenced engagement in HIV-related care as a result of the pandemic. A thematic content analysis reported semantic level themes describing factors influencing HIV care following an integrated inductive–deductive approach. Qualitative analysis revealed three themes that either supported or hindered engagement in care within the context of the COVID-19 pandemic: (1) social determinants of health, (2) social support, and (3) modes of healthcare delivery. The results underscore the need to assess socio-structural factors of health as means to promote successful engagement in the HIV care continuum and shed new insights to guide future practice in the era of COVID-19. Full article

(This article belongs to the Special Issue HIV Testing, Prevention and Care Cascade)

15 pages, 2350 KiB

Open AccessArticle

Predicting HIV Status among Men Who Have Sex with Men in Bulawayo & Harare, Zimbabwe Using Bio-Behavioural Data, Recurrent Neural Networks, and Machine Learning Techniques

by Innocent Chingombe, Tafadzwa Dzinamarira, Diego Cuadros, Munyaradzi Paul Mapingure, Elliot Mbunge, Simbarashe Chaputsira, Roda Madziva, Panashe Chiurunge, Chesterfield Samba, Helena Herrera, Grant Murewanhema, Owen Mugurungi and Godfrey Musuka

Trop. Med. Infect. Dis. 2022, 7(9), 231; https://doi.org/10.3390/tropicalmed7090231 - 5 Sep 2022

Cited by 10 | Viewed by 2835

Abstract

HIV and AIDS continue to be major public health concerns globally. Despite significant progress in addressing their impact on the general population and achieving epidemic control, there is a need to improve HIV testing, particularly among men who have sex with men (MSM). This study applied deep and machine learning algorithms such as recurrent neural networks (RNNs), the bagging classifier, gradient boosting classifier, support vector machines, and Naïve Bayes classifier to predict HIV status among MSM using the dataset from the Zimbabwe Ministry of Health and Child Care. RNNs performed better than the bagging classifier, gradient boosting classifier, support vector machines, and Gaussian Naïve Bayes classifier in predicting HIV status. RNNs recorded a high prediction accuracy of 0.98 as compared to the Gaussian Naïve Bayes classifier (0.84), bagging classifier (0.91), support vector machine (0.91), and gradient boosting classifier (0.91). In addition, RNNs achieved a high precision of 0.98 for predicting both HIV-positive and -negative cases, a recall of 1.00 for HIV-negative cases and 0.94 for HIV-positive cases, and an F1-score of 0.99 for HIV-negative cases and 0.96 for positive cases. HIV status prediction models can significantly improve early HIV screening and assist healthcare professionals in effectively providing healthcare services to the MSM community. The results show that integrating HIV status prediction models into clinical software systems can complement indicator condition-guided HIV testing strategies and identify individuals that may require healthcare services, particularly for hard-to-reach vulnerable populations like MSM. Future studies are necessary to optimize machine learning models further to integrate them into primary care. The significance of this manuscript is that it presents results from a study population where very little information is available in Zimbabwe due to the criminalization of MSM activities in the country. For this reason, MSM tends to be a hidden sector of the population, frequently harassed and arrested. In almost all communities in Zimbabwe, MSM issues have remained taboo, and stigma exists in all sectors of society. Full article

(This article belongs to the Special Issue HIV Testing, Prevention and Care Cascade)

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11 pages, 277 KiB

Open AccessArticle

Factors Associated with Retention of HIV Patients on Antiretroviral Therapy in Care: Evidence from Outpatient Clinics in Two Provinces of the Democratic Republic of the Congo (DRC)

by Gulzar H. Shah, Gina D. Etheredge, Lievain Maluentesa Nkuta, Kristie C. Waterfield, Osaremhen Ikhile, John Ditekemena and Bossiky Ngoy Belly Bernard

Trop. Med. Infect. Dis. 2022, 7(9), 229; https://doi.org/10.3390/tropicalmed7090229 - 5 Sep 2022

Cited by 2 | Viewed by 2333

Abstract

Interruptions in the continuum of care for HIV can inadvertently increase a patient’s risk of poor health outcomes such as uncontrolled viral load and a greater likelihood of developing drug resistance. Retention of people living with HIV (PLHIV) in care and determinants of attrition, such as adherence to treatment, are among the most critical links strengthening the continuum of care, reducing the risk of treatment failure, and assuring viral load suppression. Objective: To analyze the variation in, and factors associated with, retention of patients enrolled in HIV services at outpatient clinics in the provinces of Kinshasa and Haut-Katanga, Democratic Republic of the Congo (DRC). Methods: Data for the last visit of 51,286 patients enrolled in Centers for Disease Control (CDC)-supported outpatient HIV clinics in 18 health zones in Haut-Katanga and Kinshasa, DRC were extracted in June 2020. Chi-square tests and multivariable logistic regressions were performed. Results: The results showed a retention rate of 78.2%. Most patients were classified to be at WHO clinical stage 1 (42.1%), the asymptomatic stage, and only 3.2% were at stage 4, the severest stage of AIDS. Odds of retention were significantly higher for patients at WHO clinical stage 1 compared to stage 4 (adjusted odds ratio (AOR), 1.325; confidence interval (CI), 1.13–1.55), women as opposed to men (AOR, 2.00; CI, 1.63–2.44), and women who were not pregnant (vs. pregnant women) at the start of antiretroviral therapy (ART) (AOR, 2.80; CI, 2.04–3.85). Odds of retention were significantly lower for patients who received a one-month supply rather than multiple months (AOR, 0.22; CI, 0.20–0.23), and for patients in urban health zones (AOR, 0.75; CI, 0.59–0.94) rather than rural. Compared to patients 55 years of age or older, the odds of retention were significantly lower for patients younger than 15 (AOR, 0.35; CI, 0.30–0.42), and those aged 15 and <55 (AOR, 0.75; CI, 0.68–0.82). Conclusions: Significant variations exist in the retention of patients in HIV care by patient characteristics. There is evidence of strong associations of many patient characteristics with retention in care, including clinical, demographic, and other contextual variables that may be beneficial for improvements in HIV services in DRC. Full article

(This article belongs to the Special Issue HIV Testing, Prevention and Care Cascade)

22 pages, 738 KiB

Open AccessArticle

Trace the History of HIV and Predict Its Future through Genetic Sequences

by Zhen Wang, Zhiyuan Zhang, Chen Zhang, Xin Jin, Jianjun Wu, Bin Su, Yuelan Shen, Yuhua Ruan, Hui Xing and Jie Lou

Trop. Med. Infect. Dis. 2022, 7(8), 190; https://doi.org/10.3390/tropicalmed7080190 - 17 Aug 2022

Cited by 2 | Viewed by 2059

Abstract

Traditional methods of quantifying epidemic spread are based on surveillance data. The most widely used surveillance data are normally incidence data from case reports and hospital records, which are normally susceptible to human error, and sometimes, they even can be seriously error-prone and incomplete when collected during a destructive epidemic. In this manuscript, we introduce a new method to study the spread of infectious disease. We gave an example of how to use this method to predict the virus spreading using the HIV gene sequences data of China. First, we applied Bayesian inference to gene sequences of two main subtypes of the HIV virus to infer the effective reproduction number (

_{G} R_{e} (t)

) to trace the history of HIV transmission. Second, a dynamic model was established to forecast the spread of HIV medication resistance in the future and also obtain its effective reproduction number (

_{M} R_{e} (t)

). Through fitting the two effective reproduction numbers obtained from the two separate ways above, some crucial parameters for the dynamic model were obtained. Simply raising the treatment rate has no impact on lowering the infection rate, according to the dynamics model research, but would instead increase the rate of medication resistance. The negative relationship between the prevalence of HIV and the survivorship of infected individuals following treatment may be to blame for this. Reducing the MSM population’s number of sexual partners is a more efficient strategy to reduce transmission per the sensitivity analysis. Full article

(This article belongs to the Special Issue HIV Testing, Prevention and Care Cascade)

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12 pages, 1083 KiB

Open AccessArticle

Assessing the Prevalence and Determinants of Exposure-Influenced HIV Testing among a Sample of Pre- and Post-Exposure Prophylaxis-Naïve Young Men Who Have Sex with Men in the United States

by Yu Liu, Mary Hawkins, Amna Osman and Chen Zhang

Trop. Med. Infect. Dis. 2022, 7(8), 146; https://doi.org/10.3390/tropicalmed7080146 - 26 Jul 2022

Cited by 2 | Viewed by 1635

Abstract

Self-initiated Human Immunodeficiency Virus (HIV) testing after potential sexual exposure to HIV (i.e., exposure-influenced HIV testing) has high utility in detecting individuals with the highest probabilities of HIV seroconversion. We conducted a cross-sectional study among a sample of sexually active, pre/post-exposure prophylaxis (PrEP/PEP)-naïve young men who have sex with men (YMSM) in two US cities to assess the determinants (e.g., demographic, psychosocial, sexual, substance use, and HIV prevention characteristics) of exposure-influenced HIV testing (never/rarely vs. mostly/always) in their lifetime. Of 261 YMSM, only 26.5% reported mostly/always seeking exposure-influenced prior to the study. Multivariable analyses showed that younger age, sexual orientation non-disclosure, perceived HIV stigma, internalized homophobia, lower general resilience, and lower social support were associated with a lower likelihood of mostly/always seeking exposure-influenced HIV testing. YMSM who never/rarely sought exposure-influenced HIV testing were more likely to use recreational drugs before sex, binge alcohol, and have group sex; while less likely to be aware of PrEP, test for sexually transmitted infections, or use condoms compared to those mostly/always seeking exposure-influenced HIV testing. Exposure-influenced HIV testing is suboptimal among YMSM with elevated risk for HIV. Our findings provide important implications for designing targeted interventions to promote exposure-influenced HIV testing among high-risk YMSM. Full article

(This article belongs to the Special Issue HIV Testing, Prevention and Care Cascade)

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13 pages, 290 KiB

Open AccessArticle

Suboptimal Follow-Up on HIV Test Results among Young Men Who Have Sex with Men: A Community-Based Study in Two U.S. Cities

by Ying Wang, Jason Mitchell, Chen Zhang, Lauren Brown, Sarahmona Przybyla and Yu Liu

Trop. Med. Infect. Dis. 2022, 7(7), 139; https://doi.org/10.3390/tropicalmed7070139 - 19 Jul 2022

Cited by 1 | Viewed by 1488

Abstract

Frequent HIV testing and knowledge of HIV serostatus is the premise before timely access to HIV prevention and treatment services, but a portion of young men who have sex with men (YMSM) do not always follow up on their HIV test results after HIV testing, which is detrimental to the implementation of HIV prevention and care among this subgroup. The comprehensive evaluation of factors associated with inconsistent follow-up on HIV test results may inform relevant interventions to address this critical issue among YMSM. To this end, we conducted a cross-sectional study in Nashville, Tennessee and Buffalo, New York from May 2019 to May 2020 to assess demographic, behavioral, and psychosocial correlates of inconsistent follow-up on HIV test results among YMSM. Of the 347 participants, 27.1% (n = 94) reported inconsistent follow-up on their HIV test results. Multivariable logistic regression showed that inconsistent follow-up on HIV test results was positively associated with condomless receptive anal sex, group sex, recreational drug use before or during sex, internalized homophobia, and stress; while negatively associated with housing stability, social support, and general resilience. Future HIV prevention intervention efforts should target these modifiable determinants to enhance the follow-up on HIV test results among YMSM. Full article

(This article belongs to the Special Issue HIV Testing, Prevention and Care Cascade)

11 pages, 941 KiB

Open AccessCommunication

Medical Care for Tuberculosis-HIV-Coinfected Patients in Russia with Respect to a Changeable Patients’ Structure

by Olga P. Frolova, Olga V. Butylchenko, Patimat G. Gadzhieva, Margarita Yu. Timofeeva, Valeria A. Basangova, Vladislava O. Petrova, Inna A. Fadeeva, Maria I. Kashutina, Nadezhda N. Zabroda, Artem A. Basov, Elena V. Belova, Yury V. Zhernov, Oleg V. Mitrokhin, Inga I. Enilenis and Lyudmila P. Severova

Trop. Med. Infect. Dis. 2022, 7(6), 86; https://doi.org/10.3390/tropicalmed7060086 - 31 May 2022

Cited by 2 | Viewed by 2100

Abstract

To date, tuberculosis (TB) remains the primary cause of mortality in human immunodeficiency virus (HIV) patients in Russia. Since the beginning of 2000, a sharp change in the HIV patients’ structure, to the main known risk factors for HIV infection has taken place in Russia. The transmission of HIV through injectable drug use has begun to decline significantly, giving way to the prevalence of sexual HIV transmission today. These changes may require adjustments to organizational approaches to anti-TB care and the treatment of HIV-positive patients. Our study is aimed at identifying changes in TB-HIV coinfection patients’ structures in 2019 compared to 2000. Based on the results obtained, our goal was to point out the parameters that need to be taken into account when developing approaches to improve the organization of TB control care for people with HIV infection. We have carried out a cross-sectional, retrospective, epidemiological study using government TB registry data from four regions in two federal districts of Russia in 2019. The case histories of 2265 patients from two regions with high HIV prevalence, which are part of the Siberian Federal District of Russia, and 89 patient histories from two regions of low HIV prevalence, which are part of the Central Federal District of Russia, were analyzed. We found that parenteral transmission (69.4%) remains the primary route of HIV transmission among the TB-HIV coinfected. The unemployed of working age without disability account for 80.2% of all coinfected people, while the formerly incarcerated account for 53.7% and the homeless account for 4.1%. Those with primary multidrug-resistant TB (MDR-TB) comprise 56.2% of HIV-TB patients. When comparing the incidence of coinfection with HIV among TB patients, statistically significant differences were obtained. Thus, the chances of coinfection increased by 4.33 times among people with active TB (95% CI: 2.31; 8.12), by 2.97 times among people with MDR-TB (95% CI: 1.66; 5.32), by 5.2 times in people with advanced processes in the lungs, including destruction, (95% CI: 2.78; 9.7), as well as by 10.3 times in the case of death within the first year after the TB diagnosis (95% CI: 2.99; 35.5). The absence of data for the presence of TB during preventive examination was accompanied by a decrease in the chances of detecting coinfection (OR 0.36; 95% CI: 0.2; 0.64). We have identified the probable causes of the high incidence of TB among HIV-infected: HIV-patient social maladaptation usually results in delayed medical care, leading to TB treatment regimen violations. Furthermore, self-administration of drugs triggers MDR-TB within this group. Healthcare providers should clearly explain to patients the critical importance of immediately seeking medical care when initial TB symptoms appear. Full article

(This article belongs to the Special Issue HIV Testing, Prevention and Care Cascade)

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12 pages, 276 KiB

Open AccessArticle

Understanding the Association between PrEP Stigma and PrEP Cascade Moderated by the Intensity of HIV Testing

by Chen Zhang and Yu Liu

Trop. Med. Infect. Dis. 2022, 7(5), 74; https://doi.org/10.3390/tropicalmed7050074 - 16 May 2022

Cited by 2 | Viewed by 2332

Abstract

(1) Background: In the U.S., men who have sex with men (MSM) account for the majority of new HIV infections. On the other hand, pre-exposure prophylaxis (PrEP) is an effective strategy to curb HIV transmission, but it is widely underutilized. It is unknown how stigma affects PrEP care in the context of other HIV prevention strategies. (2) Methods: We included a total of 318 MSM in the current analysis. We employed bivariate and multivariable analyses to assess the association between PrEP stigma and PrEP cascade while controlling for potential confounders on each specific pathway. We further used a series of moderation analyses based upon the intensity of HIV testing within different timeframes to assess the association between PrEP stigma and PrEP cascade. (3) Results: Compared with MSM who used PrEP, those who never used PrEP reported higher internalized and vicarious PrEP stigma. Internalized PrEP stigma has significantly reduced the likelihood of PrEP willingness and PrEP uptake among this group. The trend analysis showed significant trend patterns across different frequencies of HIV testing. (4) Conclusions: A structural-level reform is urgently needed to turn the HIV service encounters into opportunities to facilitate and optimize the PrEP cascade among this group who may benefit from PrEP use. Full article

(This article belongs to the Special Issue HIV Testing, Prevention and Care Cascade)

Other

Jump to: Editorial, Research

6 pages, 221 KiB

Open AccessBrief Report

Testing for HIV Increases the Odds of Correct Fetal Ultrasound Result

by Carlo Bieńkowski, Małgorzata Aniszewska, Justyna D. Kowalska and Maria Pokorska-Śpiewak

Trop. Med. Infect. Dis. 2022, 7(9), 242; https://doi.org/10.3390/tropicalmed7090242 - 13 Sep 2022

Cited by 1 | Viewed by 1620

Abstract

Introduction: Infectious diseases during pregnancy may pose a threat to both mother and the developing fetus. It also creates an opportunity to screen for diseases being widely underdiagnosed among women in Poland, such as human immunodeficiency virus (HIV) or sexually transmitted infections (STI). Therefore, we aimed to assess the number of pregnant women that had not been tested for HIV despite the recommendations. In addition, a comparison of clinical evaluation between HIV-tested and non-tested pregnant women was also performed. Material and methods: Medical records of all consecutive pregnant women, referred to our Infectious Diseases Hospital between September 2019 and March 2020 were retrospectively analyzed. Implementation of recommended screening testing towards infectious diseases during pregnancy including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), cytomegalovirus (CMV), syphilis, and rubella, were also analyzed. Results: Medical records of 273 women were included in the analysis. The median age was 32 years (interquartile range: 26–33 years). In total 243/273 (89.0%) had been tested for HIV as recommended, and the remaining 30/273 (11.0%) had not been tested. HIV infection was not confirmed in any of the participants. Only one woman within the HIV non-tested group had been correctly tested towards other infections during her pregnancy. The recommended full testing was more likely to be correctly implemented in women who had also been tested for HIV (171/243, 70.4% vs. 1/30, 3.3%, OR 68.9; 95% CI 9.2–515.3, p < 0.00001). Moreover, the correct fetal ultrasound result was more likely to be obtained in women who had been tested for HIV as recommended (234/243, 96.3% vs. 11/30, 36.7%, OR 44.9; 95% CI 16.6–121.8, p < 0.00001). Conclusions: Despite the law regulations, 11% of pregnant women referred to consultations to the infectious diseases center had not been tested for HIV. At the same time, correct fetal ultrasound results are more likely to occur in women tested for HIV according to recommendations. This suggests that a holistic approach to screening, both for communicable and non-communicable diseases, among pregnant women may translate to better pregnancy outcomes. Full article

(This article belongs to the Special Issue HIV Testing, Prevention and Care Cascade)

8 pages, 220 KiB

Open AccessPerspective

Long-Acting Injectable Drugs for HIV-1 Pre-Exposure Prophylaxis: Considerations for Africa

by Enos Moyo, Grant Murewanhema, Godfrey Musuka and Tafadzwa Dzinamarira

Trop. Med. Infect. Dis. 2022, 7(8), 154; https://doi.org/10.3390/tropicalmed7080154 - 29 Jul 2022

Cited by 8 | Viewed by 2567

Abstract

Sub-Saharan Africa carries the highest burden of HIV-1 and AIDS. About 39% of all new infections in the world in 2020 were in this region. Oral PrEP was found to be very effective in reducing the risk of HIV-1 transmission. However, its effectiveness is highly dependent on users adhering to the drugs. The availability of long-acting injectable PrEP that eliminates the need for a daily pill may increase PrEP uptake and adherence in people who struggle to adhere to oral PrEP. The USA’s FDA approved long-acting cabotegravir (CAB-LA) for PrEP of HIV-1 in December 2021. In this review, we discussed the implementation challenges to the successful roll-out of CAB-LA in Africa and measures to address these implementation challenges. Some health system-level challenges include the cost of the drug, its refrigeration requirement, and the shortage of healthcare providers trained to administer parenteral medicines. In contrast, client challenges include lack of knowledge, accessibility of the drug, side effects, stigma, and lack of family and community support. These challenges can be addressed by several measures emanating from lessons learned from the successful implementation of ART, oral PrEP, and immunization in the continent. Some steps include advocating for waiving of CAB-LA patent licence, conducting demonstration projects in Africa, promoting the use of renewable energy sources such as solar energy, healthcare provider training, task shifting, community engagement, client education, and implementing adherence promotion strategies. Full article

(This article belongs to the Special Issue HIV Testing, Prevention and Care Cascade)

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