Global HIV efforts need to focus on key populations in LMICs

Simbayi, Leickness C.; Moyo, Sizulu; Heerden, Alastair van; Zuma, Khangelani; Zungu, Nompumelelo; Marinda, Edmore; Jooste, Sean; Cloete, Allanise; Mabaso, Musawenkosi; Rooyen, Heidi van

doi:10.1016/s0140-6736(21)02692-1

Cited by 19 publications

(24 citation statements)

References 8 publications

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“…The goal of this study was to empirically investigate the association between different types of reinforcement and alcohol-related outcomes in a resource-limited setting outside of the U.S., with significant HIV burden. We recruited individuals living with HIV in South Africa given the country’s intersecting epidemics of heavy alcohol use (Vellios & Van Walbeek, 2018) and HIV (Simbayi et al, 2019). Results of this study show that in the multivariate models, alcohol-specific reward was associated with all substance-related outcomes.…”

Section: Discussionmentioning

confidence: 99%

The role of reward and reinforcement in understanding alcohol use among adults living with HIV in South Africa.

Belus¹,

Rose²,

Andersen³

et al. 2021

Psychology of Addictive Behaviors

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Objective: Most research investigating reinforcement in alcohol use is from high-income countries. The current study sought to understand the association of different reinforcement types (alcohol-specific reward, environmental reward, behavioral activation) with multiple measures of alcohol use and cravings among individuals living with HIV in South Africa. Method: Baseline data were obtained from a substance use clinical trial in Cape Town (N = 65). Unhealthy alcohol use was measured using the biomarker phosphatidylethanol (PEth), Alcohol Use Identification Test (AUDIT-C), average number of drinks from the timeline follow back (TLFB), and self-reported cravings. Reinforcement was measured using the proportion of income spent on alcohol (alcohol-specific reward), both subscales of the Reward Probability Index (environmental reward), and the Behavioral Activation Depression Scale (activation). Poisson and linear regression analyses were conducted. Results: Each percentage point increase in income spent on alcohol was significantly associated with PEth, RR = 1.004 [95% CI (1.001, 1.007)], which translates to a 13.6% increase in the relative risk of unhealthy alcohol use for the average person in the study. More alcohol-specific reward was significantly associated with higher scores on the AUDIT-C, higher average number of drinks on the TLFB, and more cravings. Higher activation was associated with lower scores on the AUDIT-C. Neither subscale of environmental reward was associated with model outcomes. Conclusion: Greater alcohol-specific reward and less behavioral activation were associated with more frequent and unhealthy alcohol use in this setting, but not environmental reward. Findings highlight how different reinforcement types potentially influence alcohol use in a low-resource global setting. Public Health Significance StatementMore money spent on alcohol and less goal-directed behavior were associated with more alcohol use in adult drinkers living with HIV in South Africa. Identifying readily available rewarding opportunities outside of alcohol is needed in a population with very few financial resources and comorbid HIV in South Africa.

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Section: Discussionmentioning

confidence: 99%

The role of reward and reinforcement in understanding alcohol use among adults living with HIV in South Africa.

Belus¹,

Rose²,

Andersen³

et al. 2021

Psychology of Addictive Behaviors

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“…In recent studies, the prevalence of any STI amongst pregnant women in the Tshwane sub-district was about 40% [15] and 22.9% amongst women attending a rural community clinic in the Eastern Cape [16]. The antenatal HIV prevalence in Tshwane districts and Nelson Mandela Bay were estimated at 28.7% and 29.7% % respectively [17].…”

Section: Methodsmentioning

confidence: 99%

Preferences for the management of sexually transmitted infections in the South African health system: A discrete choice experiment

Iwuji

Martin

Pillay

et al. 2022

Preprint

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Introduction Young people have a disproportionate burden of sexually transmitted infections. Despite strengthening HIV prevention with the introduction of PrEP, STI services have remained relatively unchanged, and the standard of care remains syndromic management. We used a discrete choice experiment to investigate young people’s preferences for the diagnosis and treatment of STIs in South Africa. Methods and Findings Between 1 March 2021 and 20 April 2021, a cross-sectional online questionnaire hosted on REDCap was administered through access links sent to WhatsApp support groups for HIV PrEP users and attendees of two primary healthcare clinics and two mobile facilities in the Eastern Cape and Gauteng provinces aged between 18-49 years. Participants either self-completed the questionnaire or received support from a research assistant. We used a CLOGIT model for the initial analysis and latent class model (LCM) to establish class memberships with results displayed as odds ratios and probabilities. We enrolled 496 individuals, the majority were female (69%) and <30 years (74%). About 29% reported previous STI treatment and 20% reported current STI symptoms. The LCM showed two distinct groups within the respondent sample with different preferences for STI care. The first group comprising 68% of participants showed a strong preference for self-sampling compared to sampling by a healthcare professional (HCP) [OR 2.32; 95%-CI (1.79-3.00)] and viewed no sampling as similar to HCP sampling [OR 1.08; 95%-CI (0.92-1.26)]. There was a lower preference to receive results within 4-hours versus 2-hours [OR 0.63; 95%-CI (0.51-0.77)] and the later was viewed as equal to the receipt of results in 1-7 days by SMS or online [OR 1.03; 95%-CI (0.88–1.21). A clinic follow-up appointment for treatment was less preferable than same-day treatment [OR 0.78; 95%-CI (0.63–0.95)] while treatment from a local pharmacy was viewed with equal preference as same-day treatment [OR 1.16; 95%-CI (1.04-1.29)]. Contact slip from index patient [OR 0.86; 95%-CI (0.76-0.96)] and HCP-initiated partner notification [OR 0.63; 95%-CI (0.55-0.73)] were both less preferable than expedited partner treatment (EPT). The second group included 32% of participants with a much lower preference for self-sampling compared to sampling by HCP [OR 0.55; 95%-CI (0.35–0.86)]. No sampling was not significantly different to HCP-sampling [OR 0.85; 95%-CI (0.64-1.13)]. There was a strong preference for a 4-hour wait than a 2-hour wait for results [OR 1.45; 95%-CI (1.05-2.00)]. There was no treatment option that was significantly different from the others, however there was a strong preference for HCP-initiated partner notification than EPT [OR 1.53; 95%-CI (1.10-2.12)]. Participants were more likely to be members of group 1 than group 2 if they were aged 25-49 years compared to 18-24 years (p=0.001) and receive care from a rural compared to urban facility (p=0.011). Employed individuals were more likely to be in group 2 than group 1 (p=0.038). Conclusions Our results suggest that health service users preferred to undergo STI testing prior to treatment but there were subgroups who differed on how this should be done. This highlights the need for STI care to be flexible to accommodate different patient choices.

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“…South Africa has the biggest HIV epidemic globally, with more than 7.9 million people living with HIV (PLHIV) in 2020 [1,2]. Adolescent girls and young women (AGYW) aged 15-24 years represent one of the populations at highest risk for HIV-infection with an estimated HIV incidence of 1.5% [3]. Recent estimates show that 5.8% of adolescent girls aged 15-19 years were HIV-positive, compared with 4.7% of adolescent boys in that age group in year 2017.…”

Section: Introductionmentioning

confidence: 99%

“…Recent estimates show that 5.8% of adolescent girls aged 15-19 years were HIV-positive, compared with 4.7% of adolescent boys in that age group in year 2017. In the 20-24 year age group, 10.9% of young women were HIV-positive compared with 4.8% of young men; in the 25-29 year age group, 27.5% of women were HIV-positive versus 12.4% of men; in the 30-34 year age group, 34.7% of women were HIV-positive versus 18.4% of men [3]. These figures highlight the specific vulnerability of AGYW, but they also show that adolescent boys and young men (ABYM) have a substantial risk of HIV.…”

Section: Introductionmentioning

confidence: 99%

“…Despite South Africa’s remarkable progress with antiretroviral therapy (ART) scale-up, ART coverage remains sub-optimal, particularly among HIV-positive AGYW and ABYM aged 15-24 years among whom only 40% were receiving ART in 2017 [3]. Among people living with HIV aged 25-49 years, 63.1% were receiving ART, showing that there is a gap in linkage to, and retention in, HIV treatment services.…”

Section: Introductionmentioning

confidence: 99%

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Strengthening Health System’s Capacity for Linkage to HIV Care for adolescent girls and young women and adolescent boys and young men in South Africa (SheS’Cap-Linkage): Protocol for a mixed methods study in KwaZulu-Natal, South Africa

Nicol

Basera

Lombard

et al. 2022

Preprint

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Introduction In South Africa, HIV prevalence among adolescent girls and young women (AGYW) was 5.8% (15-19 years) and 15.6% (20-24 years) respectively in 2017. Amongst South African males, HIV prevalence in 2017 was 4.7% (15-19 years), 4.8% (20-24 years), 12.4% (25-29 years) and 18.4% (30-34 years). The National Department of Health adopted the universal test and treat (UTT) strategy in 2016, resulting in increases in same-day antiretroviral therapy initiations and linkage to care. Monitoring progress towards attainment of South Africa’s 95-95-95 targets amongst AGYW and adolescent boys and young men (ABYM) relies on high quality data to identify and address gaps in linkage to care. The purpose of this study is to provide evidence to guide efforts to improve linkage to, and retention in, HIV care among AGYW and ABYM in KwaZulu-Natal, in the context of the UTT strategy. Methods and analysis This is a mixed methods study, which will be conducted in uMgungundlovu district of KwaZulu-Natal, over a 24-month period, in 22 purposively selected HIV testing and treatment service delivery points (SDPs). For the quantitative component, a sample size of 1100 participants will be recruited into the study. The qualitative component will include 30 participating patients who were successfully linked to care, 30 who were not, and 30 who have never tested for HIV. The questionnaire study population comprises of 231 healthcare providers and AGYW aged 15-24 years and ABYM aged 15-35 years old. Primary outcomes will be evaluated using a logistic regression model. A time to event analysis will also be conducted taking the study design into account. Quantitative data for outcome variables and process indicators will be summarized by domain evaluated with logistic regression to account for potential confounders. For qualitative data, manual thematic content analysis will be conducted. Ethics and dissemination The protocol was approved by the South African Medical Research Council Health Research Ethics Committee (EC052-11/2020). Findings from the study will be communicated to the study population and results will be presented to stakeholders and at appropriate local and international conferences. Outputs will also include a policy brief, peer reviewed journal articles and research capacity building through research degrees.

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Global HIV efforts need to focus on key populations in LMICs

Cited by 19 publications

References 8 publications

The role of reward and reinforcement in understanding alcohol use among adults living with HIV in South Africa.

The role of reward and reinforcement in understanding alcohol use among adults living with HIV in South Africa.

Preferences for the management of sexually transmitted infections in the South African health system: A discrete choice experiment

Strengthening Health System’s Capacity for Linkage to HIV Care for adolescent girls and young women and adolescent boys and young men in South Africa (SheS’Cap-Linkage): Protocol for a mixed methods study in KwaZulu-Natal, South Africa

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