HIV testing and linkage to ART following secondary distribution of HIV self-test kits to male partners of women living with HIV: a pilot randomized control trial in Mpumalanga, South Africa.

INTRODUCTION: South African men are underrepresented in HIV testing and treatment services. Secondary distribution of oral HIV self-test (HIVST) kits by women living with HIV (WLHIV) to their male partners (i.e. index partner HIVST) may increase men's testing and treatment but has been understudied. METHODS: Between March and July 2021, we evaluated the effectiveness of index partner HIVST versus the standard of care (SOC) (invitations for men's facility-based testing) on men's testing in a 1:1 randomized control trial. Eligibility criteria included: WLHIV; ≥18 years of age; attending one of four high-density rural clinics; have a working cell phone; and self-reported having a primary male partner of unknown serostatus. The primary outcome was the proportion of WLHIV reporting that her partner tested for HIV within 3 months after enrolment. RESULTS: We enrolled 180 WLHIV and 176 completed an endline survey (mean age = 35 years, 15% pregnant, 47% unmarried or non-cohabiting). In the HIVST arm, 78% of male partners were reported to have tested for HIV versus 55% in SOC (RR = 1.41; 95% CI = 1.14-1.76). In the HIVST arm, nine men were reactive with HIVST (14% positivity), six were confirmed HIV positive with standard testing (67%) and all of those started antiretroviral therapy (ART), and four HIV-negative men started pre-exposure prophylaxis (PrEP) (5%). In SOC, six men were diagnosed with HIV (12% positivity), 100% started ART and seven HIV-negative men started PrEP (16%). One case of verbal intimate partner violence was reported in the HIVST arm. CONCLUSIONS: Secondary distribution of HIVST to partners of WLHIV was acceptable and effective for improving HIV testing among men in rural South Africa in our pilot study. Interventions are needed to link reactive HIVST users to confirmatory testing and ART.

Experience in fostering regional collaboration and Coordination to use data for battling infectious diseases in sub-Saharan Africa.

The emergence of COVID-19 highlights globalisation realties, where diseases may emerge from anywhere and rapidly spread globally. Lessons emphasise the necessity for strengthening regional and global collaboration and coordination to allow rapid risk identification, resource mobilisation and joint actions. We report the experience of the Regional Action through Data (RAD) partnership in fostering regional cooperation and collaboration to use data for battling infectious diseases and the effects of COVID-19. The Partnership comprised;BoadReach company, The West African Health Organization (WAHO) and the Intergovernmental Authority on Development (IGAD); Duke University Global Health Centre and the Jembi Health Systems, South Africa. MAIN OBJECTIVE: To address the problem of limited used of data to drive performance in healthcare service delivery in sub-Saharan Africa; by changing how and why data is collected, analysed, and then used to achieve results. SPECIFIC OBJECTIVES: 1. Regional level: To equip and empower IGAD and WAHO with evidence-based analytics to drive data use for evidence-based policy and program action in public health (regional level). 2. Patient-provider level: To deploy and implement a digital health solution for child-hood vaccination services focused on mobile cross-border populations along the Uganda-Kenya border.Engagement approaches used included; meetings, workshops, technical working groups, establishing monitoring system and annual implementation revision. Targeted training and capacity building were conducted. All activities were built on existing systems and structures to strengthen ownership and sustainability. REGIONAL LEVEL ACHIEVEMENTS: 1. Regional health data sharing and protection policy, 2. Strengthened regional health information platform. Patient provider level: Deployment of a cloud based digital health solution to enhance childhood access to vaccination services for cross border populations of Kenya and Uganda, 3. Both regions developed resource mobilisation plans for sustainability.RAD established the foundation for building trust and strengthening regional collaboration and coordination in health in Sub-Saharan Africa.

Same-day antiretroviral therapy is associated with increased loss to follow-up in South African public health facilities: a prospective cohort study of patients diagnosed with HIV.

INTRODUCTION: South Africa introduced Universal Test and Treat in 2016 including antiretroviral therapy (ART) initiation on the same-day as HIV diagnosis. Our study sought to evaluate the impact of same-day ART initiation on loss to follow-up (LTFU) and mortality comparing with patients who initiated ART after their HIV diagnosis. METHODS: We conducted a file review of patients with a HIV diagnosis and ART start date on file between September 2016 and May 2018 in six high HIV burden districts. Our primary outcome was LTFU (>90 days from the last clinical visit or drug pick-up until database closure 31 July 2018). The secondary outcome was mortality after ART initiation. Time to outcome was assessed comparing same-day vs. one to seven, eight to twenty-one and ≥ twenty-two days to ART initiation using Kaplan-Meier estimators stratified by sex. We investigated predictors using univariate and multivariable Cox proportional hazards models, adjusting for a priori characteristics. RESULTS: Overall, 92,609 ART patients contributed 43,922 person-years from ART initiation, with a median follow-up time of 246 days (IQR = 112 to 455). Of these patients, 33,399 (36%) initiated ART on the same-day as their HIV diagnosis date and had a median follow-up time of 174 days (IQR = 85 to 349). Same-day patients were predominantly non-pregnant females (56%) and aged 25 to 34 years (40%). Same-day ART initiation increased from 2.8% in September 2016 to 7.1% in April 2018. In same-day patients, 33% (n = 11,114) were classified as LTFU with a median time of 55 days (IQR = 1 to 185), compared to 371 mean days (IQR = 161 to 560) in patients who initiated ≥22 days after diagnosis. A similar proportion of LTFU was observed for patients who initiated later: 31% 1 to 21 day and 33% ≥22 day. Same-day ART patients had an increased risk of LTFU vs. ≥1 day (adjusted hazard ratio (aHR) = 1.28, 95% CI = 1.24 to 1.33) adjusting for covariates. Although all-cause mortality was slightly lower in same-day patients (0.9%) vs. >1 day (1.4%; aHR = 0.87, 95% CI = 0.72 to 1.05) adjusting for covariates. Men had highest risk of mortality and LTFU. CONCLUSIONS: Same-day ART increased the risk of LTFU, but same-day patients experienced slightly lower mortality. Same-day patients may require additional counselling and interventions to improve retention. Additional research is needed on targeted interventions, including differentiated care, to reduce LTFU in patients initiating ART same-day.

HIV Positivity and Referral to Treatment Following Testing of Partners and Children of PLHIV Index Patients in Public Sector Facilities in South Africa.

BACKGROUND: There is an imperative need for innovative interventions to identify people living with HIV and initiate them on antiretroviral therapy. The objective of this study was to determine the feasibility of providing index partner/child testing of people living with HIV. METHODS: We trained 86 nurses and counsellors in 56 public health facilities in 6 high HIV burden Districts in South Africa 2017 to provide index partner/child testing (tracing and testing of partners/children of people living with HIV). We collected programmatic data including index partner/child HIV positivity by age, gender, and location of testing. In subanalyses, we evaluated factors associated with identifying HIV-positive partners and children in separate models using multivariable logistic regression. RESULTS: We tested 16,033 partners and children of index patients between October 2017 and June 2018. Most of those tested were women (61%) and 20-39 years old (39%). Overall, 6.4% were 10-14 years old, 9.5% were 15-19 years, and 8% were ≥50 years. HIV positivity was 38% [95% confidence interval (CI) = 36% to 40%]. In children ages 10-14 years, 13% were HIV-infected (95% CI = 11% to 14%). In subanalyses, HIV positivity in partners was associated with their increased age [adjusted odds ratio (aOR) for increase in 5-year age category = 1.21; 95% CI = 1.04 to 1.42], female gender (aOR = 1.38; 95% CI = 1.04 to 1.82), and index partner bringing the partner in for HIV testing vs. referring the partner through the provider or recommending testing to the partner (aOR = 1.94, 95% CI = 1.43 to 2.63), adjusting for location of testing. Almost all patients diagnosed (97%) were referred to antiretroviral therapy. CONCLUSIONS: Providing index partner/child testing was feasible and we identified a very high yield when testing partners and children of index patients. Index partner and children testing should be offered to all patients living with HIV to improve case finding.

Investigation of the Anxiolytic and Antidepressant Effects of Eucalyptol (1,8-Cineole), a Compound From Eucalyptus, in the Adult Male Sprague-Dawley Rat.

Anxiety and depression are debilitating, costly psychological disorders that account for $133 billion in direct medical expenses per year in the United States. Finding alternative means of treatment to reduce the personal and financial burden for patients with these disorders, while maintaining patient safety, is vital for overall patient wellness. The purposes of this study were 2-fold: (1) to determine if pure eucalyptol (1,8-cineole) produces anxiolytic and/or antidepressant effects using rat models for anxiety and behavioral despair and (2) to determine the effects of eucalyptol at the benzodiazepine site on the γ-aminobutyric acid (GABA) A receptor in the rat central nervous system. Fifty-five male Sprague-Dawley rats were randomly assigned to 1 of 5 groups: vehicle (dimethyl sulfoxide), eucalyptol, midazolam, flumazenil plus eucalyptol, and midazolam plus eucalyptol. Behavioral analyses were conducted on the elevated plus-maze and in the forced swim test. Data were analyzed using a 2-tailed multivariate analysis of variance and a least significant difference post hoc test. Data from the maze suggested eucalyptol may produce anxiolytic effects by acting at the benzodiazepine site on the GABAA receptor while not affecting psychomotor activity. However, no effects on behavioral despair were demonstrated in the Forced Swim test.