A5079777913- HIV/AIDS Research and Interventions
- HIV, Drug Use, Sexual Risk
- Global Maternal and Child Health
- Adolescent Sexual and Reproductive Health
- HIV/AIDS Impact and Responses
- HIV/AIDS drug development and treatment
- HIV Research and Treatment
- Adolescent and Pediatric Healthcare
- Sex work and related issues
- Gender Roles and Identity Studies
- Renal Transplantation Outcomes and Treatments
- Qualitative Research Methods and Applications
- HIV/AIDS oral health manifestations
- Pneumocystis jirovecii pneumonia detection and treatment
- African Sexualities and LGBTQ+ Issues
- Poverty, Education, and Child Welfare
Clinton Health Access Initiative
2017-2022
Family Health International 360
2022
Eswatini Economic Policy Analysis and Research Centre
2022
University of South Africa
2017
To understand the relationship between HIV preexposure prophylaxis (PrEP) and resilience among Emaswati women.
People in receipt of pre-exposure prophylaxis (PrEP) for the prevention HIV Sub-Saharan Africa often discontinue taking medication. We conducted 27 semi-structured interviews with men and women who had started PrEP but did not return to clinic a refill after 1, 2 or 3-month period. These 'discontinuation' clients were enrolled demonstration project general population nurse-led, public-sector, primary-care clinics Eswatini. Reasons discontinuation included changes self-perceived risk such as...
The WHO recommends antiretroviral treatment (ART) for all HIV-positive patients regardless of CD4 count or disease stage, referred to as "Early Access ART All" (EAAA). health systems effects EAAA implementation are unknown. This trial was implemented in a government-managed public system with the aim examine "real world" impact on care retention and viral suppression.In this stepped-wedge randomized controlled trial, 14 sector facilities Eswatini were paired randomly assigned stepwise...
Information regarding HIV pre-exposure prophylaxis (PrEP) for the general population is largely lacking, because majority of PrEP demonstration projects have focused on key populations. This qualitative study examines barriers and facilitators to uptake adherence among in Eswatini, where offered through public-sector primary-care clinics. We analysed 106 semi-structured in-depth interviews with healthcare workers (n = 26), stakeholders 30), clients who initiated, continued, declined or...
Few studies on HIV Pre-Exposure Prophylaxis (PrEP) have focused men who sex with women. We present findings from a mixed-methods study in Eswatini, the country highest prevalence world (27%). Our are based risk assessments, in-depth interviews and focus-group discussions which describe men's motivations for taking up or declining PrEP. Quantitatively, self-reported starting PrEP because they had multiple sero-discordant partners did not know partner's HIV-status. Men's self-perception of was...
Since the 1980s studies on men have frequently utilized Connell's framework of hegemonic masculinities. We critically appraise this in context a population-based HIV pre-exposure prophylaxis study Eswatini. Our findings highlight that confidently show variation their behavior and choices, which manifest across different within same acting particular situations over life course. This led us to interrogate masculinities following grounds: Men's choices do not seem fit model aspiring ideal;...
Promoting HIV pre-exposure prophylaxis at primary care clinics in Eswatini led to an increase uptake among at-risk adults.
Rapid diagnostic testing has made HIV diagnosis and subsequent treatment more accessible. However, multiple factors, including improper implementation of strategies clerical errors, have been reported to lead misdiagnosis. The World Health Organization recommended retesting prior antiretroviral therapy (ART) initiation which become pertinent with scaling up Early Access ART for All (EAAA). In this analysis, misdiagnosed clients are identified from a subgroup enrolled in EAAA study...
: Long-acting injectable (LAI) HIV pre-exposure prophylaxis (PrEP) may mitigate adherence challenges reported by young women in Southern Africa. We assessed preferences for PrEP public-sector, primary care clinics Swaziland. Among surveyed respondents, 75% (95% confidence interval = 65-83%) stated preference LAI over oral PrEP; with no differences sex, age, or sexual behavior (all P > 0.05). Notably, 70% 58-82%) current use of also PrEP.
User costs constitute a barrier to the uptake of HIV pre-exposure prophylaxis (PrEP), but their magnitude appears rarely assessed. In this prospective observational study, we assessed self-reported out-of-pocket expenses (OOPE) and time spent on clinic visits during PrEP demonstration project in Eswatini. At six public primary care clinics, 240 users other attendees were interviewed after visit. Among 79.2% reporting any medical OOPE (e.g., for consultations or drugs) and/or non-medical...
Since 2015, the World Health Organisation (WHO) recommends immediate initiation of antiretroviral therapy (ART) for all HIV-positive patients. Epidemiological evidence points to important health benefits ART initiation; however, policy’s impact on economic aspects patients' lives remains unknown. We conducted a stepped-wedge cluster-randomised controlled trial in Eswatini determine causal patients’ individual- and household-level outcomes. Fourteen healthcare facilities were non-randomly...
Community leaders play an important role in the acceptance of public health services, but little is known about their willingness to facilitate HIV pre-exposure prophylaxis (PrEP) roll-out Eswatini. We conducted in-depth interviews ( n = 25) with purposefully selected male and female community analysed our data inductively using a thematic analysis approach. feel they are communicators culturally appropriate PrEP messaging. Our participants described complex social space within communities...
Background Swaziland has the highest HIV prevalence globally. It faces a critical shortage of health workers for addressing pandemic. To curb this human resource challenge, adopted nurse-driven model antiretroviral therapy delivery in line with recommendations World Health Organization on task shifting. Objective The study explored perceptions registered nurses nurse-led initiation programme Hhohho region (NARTIS). Design utilized phenomenological design, specifically phenomenographic...
Objectives Current WHO guidelines recommend the treatment of all HIV‐infected individuals with antiretroviral therapy (ART) to improve survival and quality life, decrease infection others. MaxART is first implementation trial this strategy embedded within a government‐managed health system, assesses mortality as secondary outcome. Because primary findings strongly supported scale‐up ‘treat all’ (hereafter Treat All), analysis examines an additional indicator its impact. Methods was conducted...
Abstract Immediate initiation of antiretroviral therapy (ART) for all people living with HIV has important health benefits but implications the economic aspects patients' lives are still largely unknown. This stepped-wedge cluster-randomized controlled trial aimed to determine causal impact immediate ART on patients’ healthcare expenditures in Eswatini. Fourteen facilities were randomly assigned transition at one seven time points from standard care (ART eligibility below a CD4 count...
Due to the high HIV incidence among general population of Eswatini, pre-exposure prophylaxis (PrEP) for HIV-exposed individuals is recommended. However, little known about PrEP uptake and preferences in delivery healthcare setting population. We conducted a secondary analysis randomized trial that aimed increase uptake. All clients eligible one six public-sector facilities Eswatini were included. was stratified by initial reason visit (e.g. outpatient). Preferences collected those who...
Abstract HIV treatment and prevention as well other chronic disease care can require regular kidney function assessment based on a creatinine test. To assess the costs of testing in public health system, we conducted activity-based costing during pre-exposure prophylaxis (PrEP) demonstration project Hhohho region Eswatini. Resource use was assessed by laboratory technician valued with government procurement prices, sector salaries, own cost estimates. Obtaining blood sample clinic performing...
Introduction Universal access to antiretroviral therapy (ART) is a cornerstone of Eswatini’s national HIV strategy, and the number people on ART in country more than tripled between 2010 2019. Building these achievements, Ministry Health (MOH) scaling up differentiated service delivery, including less-intensive (DART) models for doing well treatment. We conducted mixed-methods study explore client health care worker (HCW) perceptions DART Eswatini. Methods The included structured site...
Objectives Universal test and treat (UTT) is recommended for people living with HIV (PLHIV) to reduce morbidity/mortality minimize transmission. However, concerns exist that this strategy may lead more crowded hospitals, longer wait times poorer service, adversely impacting health outcomes clients severe disease. We assessed how UTT was related markers of disease progression in PLHIV overall specifically among low CD4 count/high World Health Organization (WHO) stage. Methods The analysis...
Abstract BackgroundImplementation evidence for pre-exposure prophylaxis (PrEP) the general population in primary-care clinics Southern Africa is limited. Perspective from those providing PrEP ‘real world’ settings needed to better inform future programming, policy, and scale up. MethodsFrom September 2017 January 2019 we conducted 54 semi-structured in-depth interviews with purposively selected healthcare workers (HCWs) six public sector, nurse-led, Eswatini. Data observational notes, daily...
<h3>ABSTRACT</h3> <h3>Background:</h3> Evidence of HIV drug resistance (HIVDR) in individuals using oral pre-exposure prophylaxis (PrEP) who acquire is limited to clinical trials and case studies. More data are needed understand the risk HIVDR with PrEP during rollout. Mechanisms collect these vary, dependent on cost, scale distribution, in-country infrastructure for identification, collection, testing samples from seroconverters. <h3>Methods:</h3> The Global Evaluation Microbicide...
The global expansion of HIV pre-exposure prophylaxis (PrEP) includes health systems that face a shortage skilled care workers (HCWs). We estimated the human resource needs and costs for providing PrEP in nurse-led primary clinics Eswatini. Furthermore, we assessed potential cost savings from task sharing between nurses other HCW cadres.We conducted time-and-motion costing study demonstration project August 2017 January 2019. A form recording time performed activities ("motion") was filled by...