The absolute increase in the number of trials in HIV/AIDS, malaria and tuberculosis in Africa has led to a modest increase in LMIC first-authors, and a much larger increase in non-LMIC authors. The findings suggest that more inclusive policies by international funders are important in shifting research control to LMICs and improving research equity in the future.
Background Expanding HIV services by decentralizing provision to primary care raises a possible concern of HIV-related stigma and discrimination (SAD) from health care workers (HCWs) as new service points gain experience in HIV care delivery during early implementation. We surveyed indicators and examined the correlates of HIV-related SAD among HCWs in a decentralizing district of rural Gunungkidul, Indonesia. Methods We conducted a cross-sectional survey on a random stratified sample of 234 HCWs in 14 public health facilities (one district hospital, 13 primary health centers [PHC]) during the second year of decentralization roll-out in the district. We computed the prevalence of SAD indicators and used multivariable logistic regression to identify the correlates of these SAD indicators. Results The prevalence of SAD among HCWs was similarly high between hospital and PHC HCWs for fear of HIV transmission (~71%) and perceived negative image of PHIV (~75%). Hospital HCWs exhibited somewhat lower avoidance of service duties (52.6% vs. 63.7%; p = 0.088) with weak evidence of a difference and significantly higher levels of discriminatory practice (96.1% vs. 85.6%; p = 0.009) than those working in PHCs. Recent interactions with PLHIV and receipt of training lowered the odds of fear of HIV transmission (p<0.021). However, the odds of avoiding care duties increased with receipt of training (p =0.003) and decreased for hospital HCWs (p = 0.030). HIV knowledge lowered the odds of discriminatory practice (p = 0.002), but hospital facility and nurse/midwife cadres were associated with increased odds of discriminatory practices (p<0.021). No significant correlate was found for perceived negative image of PLHIV. Conclusion HIV-related SAD among HCWs can be prevalent during early decentralization, highlighting the need for timely or preparatory interventions with a focus on building the capacity of hospital and non-physician workforce for positive patient-provider interactions when delivering HIV care.
Introduction Assisted partner notification (APN) safely and effectively increases partner awareness of HIV exposure, testing and case identification in community settings. Nonetheless, it has not been specifically developed or evaluated for use in prison settings where people with HIV often are diagnosed and may have difficulty contacting or otherwise notifying partners. We developed Impart, a prison‐based APN model, and evaluated its efficacy in Indonesia to increase partner notification and HIV testing. Methods From January 2020 to January 2021, 55 incarcerated men with HIV were recruited as index participants from six jail and prison facilities in Jakarta in a two‐group randomized trial comparing the outcomes of self‐tell notification (treatment as usual) versus Impart APN in increasing partner notification and HIV testing. Participants voluntarily provided names and contact information for sex and drug‐injection partners in the community with whom they had shared possible HIV exposure during the year prior to incarceration. Participants randomized to the self‐tell only condition were coached in how to notify their partners by phone, mail or during an in‐person visit within 6 weeks. Participants randomized to Impart APN could choose between self‐tell notification or anonymous APN by a two‐person team consisting of a nurse and outreach worker. We compared the proportion of partners in each group who were notified of exposure by the end of 6 weeks, subsequently tested and HIV diagnosed. Results Index participants (n = 55) selected 117 partners for notification. Compared to self‐tell notification, Impart APN resulted in nearly a six‐fold increase in the odds of a named partner being notified of HIV exposure. Nearly two thirds of the partners notified through Impart APN (15/24) completed HIV testing within 6 weeks post notification compared to none of those whom participants had self‐notified. One‐third of the partners (5/15) who completed HIV testing post notification were diagnosed as HIV positive for the first time. Conclusions Voluntary APN can be successfully implemented with a prison population and within a prison setting despite the many barriers to HIV notification that incarceration presents. Our findings suggest that the Impart model holds considerable promise to increase partner notification, HIV testing and diagnosis among sex and drug‐injecting partners of HIV‐positive incarcerated men.
Background People living with HIV (PLHIV) are at a higher risk of neurocognitive impairment (NI), more prominently in those who delay HIV treatment. Combined antiretroviral treatment (cART) though has been known to be effective in reducing morbidity and mortality, is not yet optimal in controlling NI. Studies have proposed theories explaining the risks, aetiology, and pathogenesis associated with neurocognitive problems of PLHIV and there were different cognitive domains impaired in PLHIV than in those without the infection, in which method of HIV exposure (MoHE) may have a role. This proposed meta-analysis aims at evaluating the excess risk of NI in PLHIV concerning the mode of HIV exposure. Methods This protocol was developed following The Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines and registered in PROSPERO 2021 (CRD42021271358). Literature searches will be conducted in the following electronic databases: Medline (OVID), Embase (OVID), PsycInfo (OVID), Web of Science, ProQuest, as well as OpenGrey and clinical trial databases to identify records relevant to our search terms, published from 1 January 2007 up to 31 May 2021, followed by hand-search of the reference of each selected article. We will include observational cross-sectional or cohort studies examining adolescents (12 years or older) and adults (18 years or older) reporting the proportion of NI. The exposure is HIV diagnosis or documented HIV status at study enrolment. The comparator is HIV negatives age 12 years or older, with contemporaneous study enrolment as the exposed group. The Newcastle Ottawa Scale (NOS) will be applied to assess each selected study's possible risk of bias. The primary outcome will be the number of participants diagnosed with NI by the MoHE in seropositive and seronegative groups. Discussion The evidence gathered from the selected studies will be discussed to provide insight into the risk of NI by different MoHE. Despite the significant decrease in the number of HIV related dementia, mild NI cases are still numerous. The MoHE may contribute to cognitive problems, considering different HIV exposures can be associated with specific NI risk factors. However, it is currently unknown whether the MoHE can alter the risk of NI. Systematic review registration: PROSPERO 2021 (CRD42021271358)
Background Expanding HIV services by decentralizing provision to primary care raises a possible concern of HIV-related stigma and discrimination (SAD) from health care workers (HCWs) as new service points gain experience in HIV care delivery during early implementation. We surveyed indicators and examined the correlates of SAD among HCWs in a decentralizing district of rural Gunungkidul, Indonesia. Methods We conducted a cross-sectional survey on a random stratified sample of 234 HCWs in 14 public health facilities (one referent hospital, 13 primary health centers [PHC]) during the second year of decentralization roll-out in the district. We computed the prevalence of SAD indicators and used multivariable logistic regression with bootstrap standard errors to estimate the correlates of these indicators controlling for variations across facility units. Results The prevalence of SAD among HCWs was ~ 71% in fear of HIV transmission when caring for people living with HIV (PLHIV), ~ 75% in perceived negative image of PLHIV, and tended to differ between hospital and PHC HCWs for avoidance of service duties to HIV key populations (52.5% vs. 63.8%; p = 0.081) and discriminatory practices during HIV care delivery (96.1% vs. 85.2%; p = 0.008). Recent interactions with PLHIV and receipt of training lowered the odds of fear of HIV transmission (p ≤ 0.036). However, the odds of avoiding care duties increased with receipt of training (p < 0.001) and male sex (p = 0.050). Age, HIV knowledge, hospital facility, and non-physician cadres increased the odds of discriminatory practices (p ≤ 0.026). No significant correlate was found for perceived negative image of PLHIV. Conclusion HIV-related SAD among HCWs can be prevalent during early decentralization, highlighting the need for timely or preparatory interventions with a focus on building the capacity of hospital and non-physician workforce for positive patient-provider interactions when delivering HIV care.
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