PEPFAR’s Role in Protecting and Leveraging HIV Services in the COVID-19 Response in Africa

Holtzman, Carol W.; Godfrey, Catherine; Lawal, Ismail; Raizes, Elliot; Ake, Julie A; Tefera, Fana; Okutoyi, Salome; Siberry, George K.

doi:10.1007/s11904-021-00587-6

Cited by 22 publications

(24 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Partial Integration or Stand-alone services: TB and HIV/AIDS service delivery points are located in the same health facility; some HIV/AIDS services are provided in TB clinics, and some TB services are provided in HIV/AIDS clinics [49,50].…”

Section: Perceived Quality Of Integrated Tb/hiv Services By Character...mentioning

confidence: 99%

See 1 more Smart Citation

Models of Integration of TB and HIV Services and Factors associated with Perceived Quality of TB-HIV integrated Service Delivery in OR Tambo District, South Africa

Dlatu

Longo-Mbenza

Apalata

2022

Preprint

View full text Add to dashboard Cite

Background Tuberculosis is the leading infectious cause of death among people living with HIV. Reducing morbidity and mortality from HIV-associated TB requires strong collaboration between TB and HIV services at all levels with full-integrated people-centred models of care. Methods This is a qualitative study design using principles of ethnography and application of the aggregate complexity theory. A total of 54 individual interviews with health care workers and patients took place in 5 primary healthcare facilities in O.R Tambo district. The participants were purposively selected until data reached saturation point, and all interviews were tape-recorded. Quantitative analysis of qualitative data was used after coding ethnographic data, looking for emerging patterns, and counting the number of times a qualitative code occurred. A Likert scale was used to assess perceived quality of TB/HIV integration. Regression models and canonical discriminant analysis were used to explore the associations between perceived quality of TB and HIV integrated service delivery and independent predictors of interest using SPSS® version 23.0 (Chicago, IL) considering a type I error of 0.05. Result Of the 54 participants, 39 (72.2%) reported that TB and HIV services were partially integrated while 15 (27.8%) participants reported that TB/HIV services were fully integrated. Using Likert scale gradient, 23 (42.6%) participants perceived quality of integrated TB/HIV services as poor while 13 (24.1%) and 18 (33.3%) perceived quality of TB/HIV integrated services as moderate and excellent, respectively. Multiple linear regression analysis showed that the access to healthcare services was significantly and independently associated with the perceived quality of integrated TB/HIV services following the equation: Y = 3.72–0.06X (adjusted R2 = 23%, p-value = 0.001). Canonical discriminant analysis (CDA) showed that in all 5 municipal facilities, long distances to healthcare facilities leading to reduced access to services were significantly more likely to be the most impeding factor which is negatively influencing the perceived quality of integrated TB/HIV services with functions’ coefficients ranging from 9.175 in Mhlontlo to 16.514 in KSD (Wilk’s Lambda = .750, p = .043). Conclusion HIV and TB integration is inadequate with limited accessibility. Full integration (one-stop shop services) is recommended.

show abstract

Section: Perceived Quality Of Integrated Tb/hiv Services By Character...mentioning

confidence: 99%

“…There are some challenges that impact negatively from partial integration model of TB and HIV integration, that have been encountered elsewhere by other studies elsewhere demonstrated [48, 50,51]:…”

Section: Perceived Quality Of Integrated Tb/hiv Services By Character...mentioning

confidence: 99%

Models of Integration of TB and HIV Services and Factors associated with Perceived Quality of TB-HIV integrated Service Delivery in OR Tambo District, South Africa

Dlatu

Longo-Mbenza

Apalata

2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Similarly, younger children were allowed refills in some countries at three or even 6-month intervals. Overall, MMD uptake increased from 46 to 70% in PEPFAR-supported countries [ 26 ••]. For the first time, children were represented within that marked percentage increase.…”

Section: Review Of the Literature: Pediatric Dsd Programming In The C...mentioning

confidence: 99%

COVID-19 Ignited a Successful Growth Spurt in Pediatric HIV Differentiated Service Delivery Programming

Petrus¹,

Balungi²,

Wanless³

2022

Curr Trop Med Rep

View full text Add to dashboard Cite

Purpose of Review Pediatric HIV differentiated service delivery (DSD) programming has historically lagged behind adult care despite WHO recommendations to include family-friendly alternatives for children and caregivers. This review explores the status of Pediatric DSD programming before the COVID-19 pandemic and then reviews published differentiated approaches that developed during the pandemic. Recent Findings Differentiated service delivery programming for adults living with HIV has increased worldwide, and patient outcomes from these programs have been positive. Pediatric DSD programming has lagged, with many children ineligible for multi-month refills. Despite WHO recommendations to space ART visits for children, limited access to viral load monitoring and a lack of viral suppression among children have left them out of this more convenient care option. Community ART groups historically were not structured to include children. Furthermore, after-hours clinics and teen clubs with ART dispensing have not reached the majority of CLHIV. Summary This review highlights programs that developed out of necessity during the lockdowns of the pandemic. Ingenuity and creativity forced programmers to provide care to their patients with less patient-clinician interaction. Children became eligible for multi-month dispensing as programs loosened eligibility criteria. Technology helped provide virtual psychological support, and unique ART delivery methods were developed. This rapid expansion or growth spurt, of pediatric DSD programming sped up the inclusion of children into care options that were less burdensome to the family. As we move away from the pandemic and adjust to a new standard, we will remain diligent in ensuring that CLHIV outcomes remain stable or perhaps, improve.

show abstract

“…Although the African continent reported relatively low COVID-19 cases, compared to other regions in the world, the impact of the pandemic on health service delivery was still very significant. Access to health facility-based services was interrupted as a result of 1) health workers shortages due to illness, self-quarantine, or strikes, 2) health facilities repurposed for COVID-19 treatment, covering minimum services, or closed completely, and 3) clients' reluctance to attend to visits, due to fear of increased risk of COVID-19 exposure, or decreased availability of public transportation (6,9,10). A review by Gizachew A.…”

Section: Introductionmentioning

confidence: 99%

“…From December 2020 to August 2022, MistraL reinforced the health system response (table 1), contributing to aspects such as: 1) support to the COVID-19 response coordination at district and national level; 2) addition of resources to improce health facilities infrastructure and provision of medical equipment; 3) integration of COVID-19/TB/HIV testing and linkage model; 4) addition and training of health workers for provision of services; and 5) implementation of research activities, including SARS-CoV-2 RTT tests validation in nasopharyngeal and nasal samples, or use and validation a of computer-aided diagnostic software for COVID-19 (CAD4COVID). In recent years, there has been an increasing interest to understand whether and how integrated screening and testing services could provide access to prompt COVID-19 diagnosis and management, while maintaining diagnostic and linkage services for TB and HIV, in an epidemic context (30)(31)(32). Nonetheless, to date, there have been few studies demonstrating feasibility or wider impact of such services in sub-Saharan Africa (33)(34)(35).…”

Section: Introductionmentioning

confidence: 99%

Impact of a multi-disease integrated screening and diagnostic model for COVID-19, TB, and HIV in Lesotho

Katende¹,

Bresser

Kamele³

et al. 2022

Preprint

View full text Add to dashboard Cite

Introduction The surge of the COVID-19 pandemic challenged health services globally, and in Lesotho, the HIV and tuberculosis (TB) services were similarly affected. Integrated, multi-disease diagnostic services were proposed solutions to mitigate these disruptions. We describe and evaluate the effect of an integrated, hospital-based COVID-19, TB and HIV screening and diagnostic model in two rural districts in Lesotho, during the period between December 2020 and August 2022. Methods Adults and children above 5 years attending two hospitals were screened for COVID-19 and TB symptoms. After a positive screening, participants were offered to enroll in a service model that included clinical evaluation, chest radiography, SARS-CoV-2, Xpert MTB/RIF Ultra and HIV testing. Participants diagnosed with COVID-19, TB, or HIV were contacted after 28 days evaluate their health status, and linkage to HIV or TB services. Results Of the 179160 participants screened, 6623(37%) screened positive, and 4371(66%) were enrolled in this service model, yielding a total of 458 diagnoses. One positive rapid antigen test for SARS-CoV-2 was found per 11 participants screened, one Xpert-positive TB case was diagnosed per 85 people screened, and 1 new HIV diagnosis was done per 182 people screened. Of the 321(82.9%) participants contacted after 28 days of diagnosis, 304(94.7%) reported to be healthy. Of the individuals that were newly diagnosed with HIV or TB, 18/24(75.0%) and 46/51(90.1%) started treatment. This service showed no difference in the detection of new HIV and TB cases when compared to other hospitals, where no such integrated service model was provided. Conclusion This screening and diagnostic model successfully maintained same-day, integrated COVID-19, TB, and HIV testing services through different COVID-19 incidence periods in a resource-limited context. There were positive effects in avoiding diagnostic delays and ensuring linkage to services, however, efficiencies were contingent on the successful adaptation to the changing environment.

show abstract

PEPFAR’s Role in Protecting and Leveraging HIV Services in the COVID-19 Response in Africa

Cited by 22 publications

References 17 publications

Models of Integration of TB and HIV Services and Factors associated with Perceived Quality of TB-HIV integrated Service Delivery in OR Tambo District, South Africa

Models of Integration of TB and HIV Services and Factors associated with Perceived Quality of TB-HIV integrated Service Delivery in OR Tambo District, South Africa

COVID-19 Ignited a Successful Growth Spurt in Pediatric HIV Differentiated Service Delivery Programming

Impact of a multi-disease integrated screening and diagnostic model for COVID-19, TB, and HIV in Lesotho

Contact Info

Product

Resources

About