Perceived Hiv Stigma as a Barrier to Sustained Art Adherence in North West Ethiopia: A Cohort Study

Abstract

Objectives: Colorado has the lowest rate of measles vaccination in the entire country, partially due to the ease of obtaining non-medical exemptions. Our primary objective was to determine the magnitude and cost of a measles outbreak in Denver at current vaccination coverage levels. We then simulated the effect of changing the Colorado non-medical exemption complexity to medium or difficult. MethOds: An agent based transmission model simulated the transmission of the measles virus in Denver following the introduction of a measles case. We modeled public health response, including contact tracing and quarantine of cases. Model outputs included the number of secondary cases, hospitalizations and deaths. Four vaccination scenarios were modeled: Colorado vaccination rate, national vaccination rate, Colorado vaccination rate under medium exemption regulations, and Colorado vaccination rate under difficult exemption regulations. Results: At the Colorado vaccination rate, seven secondary cases followed the introduction of an index case, two of which required hospitalization. This outbreak ranged in cost from $111,048-$338,304, which is equivalent to the purchase of 5,580-17,000 measles vaccines. This could increase 2-dose vaccination coverage in Denver by 1.3%. If Colorado increased their difficulty in obtaining non-medical exemptions, the number of secondary cases reduced by 86%, alleviating costs related to public health interventions and the negative consequences of a measles outbreak. At the national vaccination level, no other individuals became infected due to herd immunity. cOnclusiOns: Herd immunity is not established at the Colorado vaccination rate and thus an outbreak is likely following the introduction of an index case. There is an inverse relationship between non-medical exemption complexity and exemption rate. Increasing vaccination coverage by as little as 3.1% (from easy to medium complexity) would reduce the likelihood and magnitude of an outbreak. Adding a required education component or a written statement of objection would be a prudent public health nudge toward measles herd immunity.

A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries

“…Those who experience stigma in a healthcare setting are also less likely to initiate antiretroviral therapy [25]. Available cohort data suggests that perceived stigma is associated with poor medication adherence according to participant reports and chart reviews [53–55]. A longitudinal cohort study of adults living with HIV in South Africa revealed that internalized stigma was associated with a greater incidence of condomless sex with both HIV-negative/unknown and HIV-positive partners [5].…”

Research priorities to inform “Treat All” policy implementation for people living with HIV in sub‐Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA)

“…MSM, SW, PWID, those with mental health or other substance use disorders, etc. ), stigma remains a barrier to HIV care, contributing to delays in ART initiation . Men, particularly, are not adequately served by traditional approaches, as they remain less likely than women to start ART and they have more advanced disease than women when they start ART .…”

“…Late ART initiation has persisted and is preventing more rapid declines in HIV mortality and incidence in the region. Importantly, men, those experiencing multiple dimensions of stigma, and other underserved populations are being left behind as HIV treatment expands in SSA . New age and sex‐disaggregated metrics and targeted strategies for earlier diagnosis (i.e.…”

Hubungan Dukungan Sosial Dg Stigma Pada Orang Dengan Hiv/Aids (Odha) Di Kabupaten Purbalingga

“…Penelitian Yang et al, (2020) menunjukkan hasil skor rata-rata stigma berdasarkan Berger HIV Stigma Scale adalah 105.13 (stigma tingkat sedang). Erku et al, (2016) dalam penelitiannya didapatkan bahwa dalam pelaksanaan untuk mengurangi stigma pada penderita HIV positif atau ODHA, dalam pelaksanaanya dapat melakukan berbagai faktor yang dapat mempengaruhi, seperti dukungan orang tua atau orang terdekat dan dukungan masyarakat untuk meningkatkan kepatuhan dalam terapi ARV yang lebih baik.…”