Implementation and Operational Research

Hickey, Matthew D.; Salmen, Charles R.; Omollo, Dan; Mattah, Brian; Fiorella, Kathryn J.; Geng, Elvin; Bacchetti, Peter; Blat, Cinthia; Ouma, Gor Benard; Zoughbie, Daniel E.; Tessler, Robert A.; Salmen, Marcus; Campbell, Harold; Gandhi, Monica; Shade, Starley B.; Njoroge, Betty; Bukusi, Elizabeth A.; Cohen, Craig R.

doi:10.1097/qai.0000000000000664

Cited by 46 publications

(37 citation statements)

References 37 publications

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“…For example, microclinic interventions, which leverage patients’ existing social networks, have shown promise in Lake Victoria island communities in improving care retention. 52 …”

Section: Discussionmentioning

confidence: 99%

A Comparison of Home-Based Versus Outreach Event-Based Community HIV Testing in Ugandan Fisherfolk Communities

et al. 2016

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We compared two community-based HIV testing models among fisherfolk in Lake Victoria, Uganda. From May to July 2015, 1,364 fisherfolk residents of one island were offered (and 822 received) home-based testing, and 344 fisherfolk on another island were offered testing during 8 community mobilization events (outreach event-based testing). Of 207 home-based testing clients identified as HIV-positive (15% of residents), 82 were newly diagnosed, of whom 31 (38%) linked to care within 3 months. Of 41 who screened positive during event-based testing (12% of those tested), 33 were newly diagnosed, of whom 24 (75%) linked to care within 3 months. Testing costs per capita were similar for home-based ($45.09) and event-based testing ($46.99). Compared to event-based testing, home-based testing uncovered a higher number of new HIV cases but was associated with lower linkage to care. Novel community-based test-and-treat programs are needed to ensure timely linkage to care for newly diagnosed fisherfolk.

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“…For example, microclinic interventions, which leverage patients’ existing social networks, have shown promise in Lake Victoria island communities in improving care retention. 52 …”

Section: Discussionmentioning

confidence: 99%

A Comparison of Home-Based Versus Outreach Event-Based Community HIV Testing in Ugandan Fisherfolk Communities

et al. 2016

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“…( Mbita Division Population Projection , 2009) All adult HIV-infected patients on combination antiretroviral therapy (cART) were first invited to enroll in a parent study known as the Mfangano Island Healthy Networks Impact Study (MIHNIS), a quasi-experimental trial to evaluate a social support strategy for engagement in care. (Hickey et al, 2015; Hickey et al, 2014) Patients in the MIHNIS trial were followed for two years, from 11/2011–11/2013. For the present analysis, we included all MIHNIS participants who transferred out or were LTFU at any point during these two years of follow-up.…”

Section: Methodsmentioning

confidence: 99%

Movement between facilities for HIV care among a mobile population in Kenya: transfer, loss to follow-up, and reengagement

Hickey

Omollo²,

Salmen

et al. 2016

AIDS Care

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HIV treatment is life-long, yet many patients travel or migrate for their livelihoods, risking treatment interruption. We examine timely reengagement in care among patients who transferred-out or were lost-to-follow-up (LTFU) from a rural HIV facility. We conducted a cohort study among 369 adult patients on antiretroviral therapy between November 2011 and November 2013 on Mfangano Island, Kenya. Patients who transferred or were LTFU (i.e. missed a scheduled appointment by ≥90 days) were traced to determine if they re-engaged or accessed care at another clinic. We report cumulative incidence and time to reengagement using Cox proportional hazards models adjusted for patient demographic and clinical characteristics. Among 369 patients at the clinic, 23(6%) requested an official transfer and 78(21%) were LTFU. Among official transfers, cumulative incidence of linkage to their destination facility was 91% at three months (95%CI 69–98%). Among LTFU, cumulative incidence of reengagement in care at the original or a new clinic was 14% at three months (95%CI 7–23%) and 60% at six months (95%CI 48–69%). In the adjusted Cox model, patients who left with an official transfer reengaged in care six times faster than those who did not (aHR 6.2, 95%CI 3.4–11.0). Patients who left an island-based HIV clinic in Kenya with an official transfer letter reengaged in care faster than those who were LTFU, although many in both groups had treatment gaps long enough to risk viral rebound. Better coordination of transfers between clinics, such as assisting patients with navigating the process or improving inter-clinic communication surrounding transfers, may reduce delays in treatment during transfer and improve overall clinical outcomes.

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“…Social capital is one contextual factor associated with HIV-related outcomes that include HIV stigma, unprotected sexual intercourse, and HIV medication adherence 18–20 across different population and geographic settings. Neighborhood social capital is defined as the resources embedded within the neighborhood that residents can draw on for mutual benefit.…”

Section: Introductionmentioning

confidence: 99%

Social Capital is Associated With Late HIV Diagnosis: An Ecological Analysis

Ransome

Galea

Pabayo

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Late HIV diagnosis is associated with higher medical costs, early mortality among individuals, and HIV transmission in the population. Even under optimal configurations of stable or declining HIV incidence and increase in HIV case findings, no change in proportion of late HIV diagnosis is projected after year 2019. We investigated the association among social capital, gender, and late HIV diagnosis. Methods We conduct ecological analyses (ZIP code, N=166) using negative binomial regression of gender-specific rates of late HIV diagnoses (an AIDS defining illness or a CD4 count ≤200 cell/µL within 12 months of a new HIV diagnosis) in 2005 and 2006 obtained from the New York City HIV Surveillance Registry, and social capital indicators (civic engagement, political participation, social cohesion, and informal social control) from the New York Social Indicators Survey, 2004. Results Overall, low to high political participation and social cohesion corresponded with significant (p<.0001) decreasing trends in late HIV diagnosis rates. Among men (RR=0.66, 95% CI [0.47—0.98]) and women (RR=0.43, 95% CI [0.28—0.67]), highest political participation was associated with lower relative odds of late HIV diagnosis, independent of income inequality. Highest informal social control (RR=0.67, 95% CI [0.48—0.93]) among men only, and moderate social cohesion (RR=0.71, 95% CI [0.55—0.92]) among women only, were associated with the outcome adjusting for social fragmentation, income inequality, and racial composition. Discussion The magnitude of association between social capital and late HIV diagnosis varies by gender and by social capital indicator.

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Implementation and Operational Research

Cited by 46 publications

References 37 publications

A Comparison of Home-Based Versus Outreach Event-Based Community HIV Testing in Ugandan Fisherfolk Communities

A Comparison of Home-Based Versus Outreach Event-Based Community HIV Testing in Ugandan Fisherfolk Communities

Movement between facilities for HIV care among a mobile population in Kenya: transfer, loss to follow-up, and reengagement

Social Capital is Associated With Late HIV Diagnosis: An Ecological Analysis

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