Tuberculosis preventive treatment uptake among adults living with human immunodeficiency virus: Analysis of Zimbabwe population-based human immunodeficiency virus impact assessment 2020.

BACKGROUND: Tuberculosis remains the leading cause of death by an infectious disease among people living with HIV (PLHIV). TB Preventive Treatment (TPT) is a cost-effective intervention known to reduce morbidity and mortality. We used data from ZIMPHIA 2020 to assess TPT uptake and factors associated with its use. METHODOLOGY: ZIMPHIA a cross-sectional household survey, estimated HIV treatment outcomes among PLHIV aged ≥15 years. Randomly selected participants provided demographic and clinical information. We applied multivariable logistic regression models using survey weights. Variances were estimated via the Jackknife series to determine factors associated with TPT uptake. RESULTS: The sample of 2419 PLHIV ≥15 years had 65% females, 44% had no primary education, and 29% lived in urban centers. Overall, 38% had ever taken TPT, including 15% currently taking TPT. Controlling for other variables, those screened for TB at last HIV-related visit, those who visited a TB clinic in the previous 12 months, and those who had HIV viral load suppression were more likely to take TPT. CONCLUSION: The findings show suboptimal TPT coverage among PLHIV. There is a need for targeted interventions and policies to address the barriers to TPT uptake, to reduce TB morbidity and mortality among PLHIV.

Comparison of COVID-19 Pandemic Waves in 10 Countries in Southern Africa, 2020-2021.

We used publicly available data to describe epidemiology, genomic surveillance, and public health and social measures from the first 3 COVID-19 pandemic waves in southern Africa during April 6, 2020-September 19, 2021. South Africa detected regional waves on average 7.2 weeks before other countries. Average testing volume 244 tests/million/day) increased across waves and was highest in upper-middle-income countries. Across the 3 waves, average reported regional incidence increased (17.4, 51.9, 123.3 cases/1 million population/day), as did positivity of diagnostic tests (8.8%, 12.2%, 14.5%); mortality (0.3, 1.5, 2.7 deaths/1 million populaiton/day); and case-fatality ratios (1.9%, 2.1%, 2.5%). Beta variant (B.1.351) drove the second wave and Delta (B.1.617.2) the third. Stringent implementation of safety measures declined across waves. As of September 19, 2021, completed vaccination coverage remained low (8.1% of total population). Our findings highlight opportunities for strengthening surveillance, health systems, and access to realistically available therapeutics, and scaling up risk-based vaccination.

Improving the quality of HIV rapid testing in Ghana using the dried tube specimen-based proficiency testing program.

BACKGROUND: The introduction of human immunodeficiency virus (HIV) antibody rapid testing (RT) in resource-limited settings has proven to be a successful intervention to increase access to prevention measures and improve timely linkage to care. However, the quality of testing has not always kept pace with the scale-up of this testing strategy. To monitor the accuracy of HIV RT test results, a national proficiency testing (PT) program was rolled out at selected testing sites in Ghana using the dried tube specimen (DTS) approach. METHODS: Between 2015 and 2018, 635 HIV testing sites, located in five regions and supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), were enrolled in the HIV PT program of the Ghana Health Service National AIDS/STI Control Programme. These sites offered various services: HIV Testing and Counselling (HTC), prevention of mother-to-child transmission (PMTCT) and Antiretroviral Treatment (ART). The PT panels, composed of six DTS, were prepared by two regional laboratories, using fully characterized plasma obtained from the regional blood banks and distributed to the testing sites. The results were scored by the PT providers according to the predefined acceptable performance criteria which was set at ≥ 95%. RESULTS: Seven rounds of PT panels were completed successfully over three years. The number of sites enrolled increased from 205 in round 1 (June 2015) to 635 in round 7 (December 2018), with a noticeable increase in Greater Accra and Eastern regions. The average participation rates of enrolled sites ranged from 88.0% to 98.0% across the PT rounds. By round 7, HTC (257/635 (40.5%)) and PMTCT (237/635 (37.3%)) had a larger number of sites that participated in the PT program than laboratory (106/635 (16.7%)) and ART (12/635 (1.9%)) sites. The average testing performance rate improved significantly from 27% in round 1 to 80% in round 7 (p < 0.001). The highest performance rate was observed for ART (100%), HTC (92%), ANC/PMTCT (90%) and Laboratory (89%) in round 5. CONCLUSION: The DTS PT program showed a significant increase in the participation and performance rates during this period. Sub-optimal performances observed was attributed to non-compliance to the national testing algorithm and testing technique. However, the implementation of review meetings, peer-initiated corrective action, supportive supervisory training, and mentorship proved impactful. The decentralized approach to preparing the PT panels ensured ownership by the region and districts.

Lessons Learned from Programmatic Gains in HIV Service Delivery During the COVID-19 Pandemic - 41 PEPFAR-Supported Countries, 2020.

The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) supports country programs in identifying persons living with HIV infection (PLHIV), providing life-saving treatment, and reducing the spread of HIV in countries around the world (1,2). CDC used Monitoring, Evaluation, and Reporting (MER) data* to assess the extent to which COVID-19 mitigation strategies affected HIV service delivery across the HIV care continuum† globally during the first year of the COVID-19 pandemic. Indicators included the number of reported HIV-positive test results, the number of PLHIV who were receiving antiretroviral therapy (ART), and the rates of HIV viral load suppression. Percent change in performance was assessed between countries during the first 3 months of 2020, before COVID-19 mitigation efforts began (January-March 2020), and the last 3 months of the calendar year (October-December 2020). Data were reviewed for all 41 countries to assess total and country-level percent change for each indicator. Then, qualitative data were reviewed among countries in the upper quartile to assess specific strategies that contributed to programmatic gains. Overall, positive percent change was observed in PEPFAR-supported countries in HIV treatment (5%) and viral load suppression (2%) during 2020. Countries reporting the highest gains across the HIV care continuum during 2020 attributed successes to reducing or streamlining facility attendance through strategies such as enhancing index testing (offering of testing to the biologic children and partners of PLHIV)§ and community- and home-based testing; treatment delivery approaches; and improvements in data use through monitoring activities, systems, and data quality checks. Countries that reported program improvements during the first year of the COVID-19 pandemic offer important information about how lifesaving HIV treatment might be provided during a global public health crisis.

Evaluating the Factors Associated With the Completion of a Community-Based Group Exercise Program Among Older Women.

Despite the well-known benefits of exercise, only 50% of U.S. women met recommended physical activity levels in 2014. To combat this issue, the Healthy Aging Regional Collaborative of South Florida has been offering the EnhanceFitness (EF) program in community-based settings since 2008. In the current study, we examined the factors associated with the program completion among older women (≥ 60 years). During the first 4 years, 3,829 older women attended EF sessions. Of these, 924 (24.2%) attended the recommended 32 sessions within first 4 months. Results revealed that women who lived in Miami-Dade County, were ≥ 80 years, and did not report depression and/or risk factors for chronic conditions were more likely to complete EF. Black women were less likely to complete the program. Recognition of these factors might help identify at-risk individuals. More efforts are needed to improve completion rates. Theory-based interventions would allow comprehensive understanding of all factors and, therefore, should be explored in the future.

Intermediate outcomes of chronic disease self-management program offered by members of the Healthy Aging Regional Collaborative in South Florida.

Currently, 80% of adults over the age of 65 have at least one chronic disease. The Chronic Disease Self-management Program (CDSMP) focuses on increasing self-efficacy for managing chronic disease. Few studies have evaluated the effectiveness of CDSMP when offered by multiple agencies, as a collaborative effort, in community-based settings. Seven agencies delivered 108 CDSMP workshops at 81 sites from October 1, 2008, to December 31, 2010. A total of 811 participants were eligible for analysis. Participants completed surveys at baseline and week 6, the end of instruction. Controlling for agency effect and general health at baseline, the general linear model was used to assess the significance of outcomes at 6 weeks. Outcomes showing significant improvement included self-efficacy to manage disease (p = .001), self-efficacy to manage emotions (p = .026), time spent walking (p = .008), and perceived social/role activities limitations (p = .001). Findings showed that CDSMP is an effective program at improving self-efficacy, increasing physical activity, and decreasing limitations.

Factors associated with the completion of falls prevention program.

Falls and fear of falling can affect independence and quality of life of older adults. Falls prevention programs may help avoiding these issues if completed. Understanding factors that are associated with completion of falls prevention programs is important. To reduce fear of falling and increase activity levels, a Matter of Balance (MOB) and un Asunto de Equilibrio (ADE) workshops were offered to 3420 older adults in South Florida between 1 October 2008 and 31 December 2011. Workshops were conducted in English or Spanish over eight, 2-hour sessions. Participants completed a demographic and a pre-post questionnaire. Factors associated with program completion were identified using logistic regression. For MOB, females were more likely to complete the program (OR = 2.076, P = 0.02). For ADE, females, moderate and extreme interference by falls in social activities were found to affect completion (OR = 2.116, P = 0.001; OR = 2.269, P = 0.003 and OR = 4.133, P = 0.008, respectively). Different factors predicted completion of both programs. Awareness of these factors can help lower the attrition rates, increase benefits and cost effectiveness of program. Future research needs to explore why certain groups had a higher likelihood of completing either program.

Intermediate outcomes of a chronic disease self-management program for Spanish-speaking older adults in South Florida, 2008-2010.

INTRODUCTION: The prevalence and negative health effects of chronic diseases are disproportionately high among Hispanics, the largest minority group in the United States. Self-management of chronic conditions by older adults is a public health priority. The objective of this study was to examine 6-week differences in self-efficacy, time spent performing physical activity, and perceived social and role activities limitations for participants in a chronic disease self-management program for Spanish-speaking older adults, Tomando Control de su Salud (TCDS). METHODS: Through the Healthy Aging Regional Collaborative, 8 area agencies delivered 82 workshops in 62 locations throughout South Florida. Spanish-speaking participants who attended workshops from October 1, 2008, through December 31, 2010, were aged 55 years or older, had at least 1 chronic condition, and completed baseline and post-test surveys were included in analysis (N=682). Workshops consisted of six, 2.5-hour sessions offered once per week for 6 weeks. A self-report survey was administered at baseline and again at the end of program instruction. To assess differences in outcomes, a repeated measures general linear model was used, controlling for agency and baseline general health. RESULTS: All outcomes showed improvement at 6 weeks. Outcomes that improved significantly were self-efficacy to manage disease, perceived social and role activities limitations, time spent walking, and time spent performing other aerobic activities. CONCLUSION: Implementation of TCDS significantly improved 4 of 8 health promotion skills and behaviors of Spanish-speaking older adults in South Florida. A community-based implementation of TCDS has the potential to improve health outcomes for a diverse, Spanish-speaking, older adult population.

Evaluation of a community-based falls prevention program in South Florida, 2008-2009.

INTRODUCTION: Many older adults experience fear of falling, which may reduce participation in routine activities. A Matter of Balance (MOB) and Un Asunto de Equilibrio (ADE) workshops were offered in South Florida to reduce fear of falling and increase activity levels in older adults. The objectives of this study were to evaluate the effectiveness of the lay leader model of the programs in the first year of their implementation and to further report on participant outcome measures. METHODS: We analyzed reach, adoption, and implementation data for participants who attended workshops between October 1, 2008, and December 31, 2009, who were aged 60 years or older, and who had both baseline and posttest outcome data. Workshops were in English and Spanish and consisted of 8 two-hour sessions. Participants completed a 7-item baseline and posttest questionnaire that consisted of a falls management scale, a social activity item, and modified version of Physician-Based Assessment and Counseling on Exercise. We analyzed outcome data on multiple characteristics using a general linear model. A class evaluation questionnaire measured participant satisfaction. RESULTS: Results for 562 participants who provided both baseline and posttest data showed significant improvement on 6 of 7 questions for MOB and all questions for ADE (P < .001). The 391 participants who provided evaluation data indicated that the programs were effective, beneficial, and well organized. CONCLUSION: Lay leaders successfully implemented the programs in community settings. The programs were effective in reducing fear of falling among older adults.