Differentiated service delivery models among PLHIV in Akwa Ibom and Cross River States, Nigeria during the COVID-19 pandemic: descriptive analysis of programmatic data.

INTRODUCTION: The rapid increase in the number of people living with HIV (PLHIV) on antiretroviral therapy (ART) in Akwa Ibom and Cross River states in Nigeria led to overcrowding at clinics. Patients were devolved to receive ART refills through five differentiated service delivery (DSD) models: fast-track (FT), adolescent refill clubs (ARCs), community pharmacy ART refill programs (CPARPs), community ART refill clubs (CARCs) and community ART refill groups (CARGs) designed to meet the needs of different groups of PLHIV. In the context of COVID-19-related travel restrictions, out-of-facility models offered critical mechanisms for continuity of treatment. We compared retention and viral suppression among those devolved to DSD with those who continued standard care at facilities. METHODS: A retrospective cohort study was conducted among patients devolved to DSD from January 2018 to December 2020. Bivariate analyses were conducted to assess differences in retention and viral suppression by socio-demographic characteristics. Kaplan-Meier assessed retention at 3, 6, 9 and 12 months. Differences in proportions were compared using the chi-square test; a p-value of <0.05 was considered significant. RESULTS: A total of 40,800 PLHIV from 84 facilities received ART through the five models: CARC (53%), FT (19.1%), ARC (12.1%), CPARP (10.4%) and CARG (5.4%). Retention rates at 6 months exceeded 96% for all models compared to 94% among those continuing standard care. Among those using DSD, retention rate at 12 months was higher among adults than children (97.8% vs. 96.7%, p = 0.04). No significant sex differences in retention rates were found among those enrolled in DSD. Viral suppression rates among PLHIV served through DSD were significantly higher among adults than children (95.4% vs. 89.2%; p <0.01). Among adults, 95.4% enrolled in DSD were virally suppressed compared to 91.8% of those in standard care (p <0.01). For children, 89.2% enrolled in DSD were virally suppressed compared to 83.2% in standard care (p <0.01). CONCLUSIONS: PLHIV receiving ART through DSD models had retention but higher viral suppression rates compared to those receiving standard care. Expanding DSD during COVID-19 has helped ensure uninterrupted access to ART in Nigeria. Further scale-up is warranted to decongest facilities and improve clinical outcomes.

Reaching the unreached: Performance of an enhanced peer outreach approach to identify new HIV cases among female sex workers and men who have sex with men in HIV programs in West and Central Africa.

Finding new HIV-positive cases remains a priority to achieve the UNAIDS goals. An enhanced peer outreach approach (EPOA) was implemented to expand the delivery of HIV services to female sex workers (FSWs) and men who have sex with men (MSM) in three countries in West and Central Africa. The aim of EPOA is to identify new HIV-positive cases. EPOA was implemented in Burundi among FSWs, and in Cote d'Ivoire and Democratic Republic of the Congo (DRC) among both FSWs and MSM. Implementation ranged from five to nine weeks and was nested within a three-month reporting period. Standard outreach was suspended for the duration of EPOA implementation but was resumed thereafter. Summary service statistics were used to compare HIV seropositivity during standard outreach and EPOA. Trends were analyzed during the quarter in which EPOA was implemented, and these were compared with the two preceding quarters. Differences in proportions of HIV seropositivity were tested using Pearson's chi-square test; p-values of less than 0.05 were considered statistically significant. Overall, EPOA resulted in a higher proportion of new HIV-positive cases being found, both within and between quarters. In Burundi, HIV seropositivity among FSWs was significantly higher during EPOA than during standard outreach (10.8% vs. 4.1%, p<0.001). In Cote d'Ivoire, HIV seropositivity was significantly higher during EPOA among both populations (FSWs: 5.6% vs. 1.81%, p<0.01; MSM: 15.4% vs. 5.9%; p<0.01). In DRC, HIV seropositivity was significantly higher during EPOA among MSM (6.9% vs. 1.6%; p<0.001), but not among FSWs (5.2% vs. 4.3%; p = 0.08). Trends in HIV seropositivity during routine outreach for both populations were constant during three successive quarters but increased with the introduction of EPOA. EPOA is a public health approach with great potential for reaching new populations and ensuring that they are aware of their HIV status.

Differences in HIV-risk behaviours among recidivists and persons with their first episode of an STD in Guyana

OBJECTIVE: To ascertain differences in HIV-risk behaviour patterns between recidivists and persons having their first episode of an STD. DESIGN AND METHODS: A cross-sectional survey was conducted among 300 consecutive persons who complained of a new STD. RESULTS: 164/300 (55 percent) persons were recidivists while 136 (45 percent) were persons with their first STD episode. Recidivists were more likely to be males odds ratio (OR=1.89; 95 percent CI: 1.16-3.09) and Afro-Guyanese (OR=3.8; 95 percent CI: 1.96-5.50). As compared to recidivists, persons with their first STD episode were more likely to be younger, <20 years old, (23.4 percent vs. 8.8 percent; p=0.009). No significant differences were found between recidivists and first-timers with respect to educational attainment and marital status. As compared to the first-timers, recidivists were significantly less likely to report condom use (OR=0.56; 95 percent CI: 0.31-0.99) and two times more likely to report having had sex for money (OR=2.22; 95 percent CI: 1.23-5.32). No significant differences were found between recidivists and first-timers with respect to mean age of first sexual intercourse and mean number of partners during the past 12 months. Recidivists were more likely to report alcohol use (76.2 percent vs. 58. percent; p=0.003) and use of marijuana (23.2 percent vs. 16.3 percent; p=0.176). CONCLUSIONS: Recidivists were more likely to engage in high-risk sexual behaviour patterns, indicating that they should be targeted by HIV-prevention programmes that focus on the reduction of high-risk sexual practices.(Au)

Drug use and syphilis: co-factors for HIV transmission among commercial sex workers in Guyana

A cross-sectional survey was conducted among 124 street-and brothel-based female commercial sex workers (CSWs) in Georgetown in January and February 1997 to determine the seroprevalence of human immunodeficiency virus (HIV) infection and describe the sexual practices and drug use patterns. Their median age was 30 years (range 17 to 52 years). 119 (88 percent) reported regular alcohol consumption while looking for clients, 27 (22 percent) said they smoked cocaine and 51 (42 percent) reported use of marijuana. Street-based CSWs were significantly more likely to report marijuana use (p = 0.033). 72 percent reported that they never used condoms with regular sex partners and 35 percent reported that they never used condoms with clients. Brothel-based women were significantly more likely to report consistent condom use with their clients (p = 0.05). 46 percent (54/118) tested HIV positive and 28 percent (33/118) had a positive serological test for syphilis. Factors that were significantly associated with HIV infection included a positive serological test for syphilis (OR = 7.56; 95 percent CI = 2.7-21.97; p < 0.01) and a history of having received treatment for syphilis (OR = 2.93; 95 percent CI = 1.12-7.8). Weak associations were also found between HIV infection and a history of cocaine use (OR = 2.57; 95 percent CI = 0.95-7.11; p = 0.039); having more than four clients per night (OR = 5.14; 95 percent CI = 1.65-16.74; p = 0.04; and a history of receiving treatment for salpingitis (OR = 2.31; 95 percent CI = 0.93-5.75; p = 0.0035). No statistically significant association was found between HIV infection and marijuana use nor any sociodemographic variables (age, place of work, and duration of sex work). There is an urgent need for a community based behavioural intervention programme targetting this high risk population (AU)

Epidemiology of non-ulcerative sexually transmitted diseases in a high risk population in Jamaica

The role of ulcerative STDs such as syphilis in facilitating the transmission and acquisition of HIV is well established. Non-ulcerative STDs such as gonorrhoea and Chlamydia infection are considered facilitators of HIV transmission. This study was designed to determine the types of non-ulcerative sexually transmitted diseases and associated risk factors among high-risk Jamaican men and women. A cross-sectional survey was conducted including 510 clients attending an STD clinic in Kingston. A standardised questionnaire was administered and microbiological investigations performed on urethral or cervical swab specimens obtained from each participant. All the subjects were symptomatic; 377 (74 percent) had genital discharge and 197 (39 percent) had dysuria with or without discharge. There were 309 cases of NGU; 115 cases of Candidiasis, 275 confirmed gonococcal infections and 226 cases of Trichomoniasis. Men were two times more likely to have gonococcal infection than women (69 percent vs. 50 percent; p<0.01). History of smoking marijuana was significantly associated with a positive test for gonorrhoea (69 percent vs. 52 percent; p<0.01). Forty one percent of women reported that their partners never used condoms (41 percent vs. 19 percent; p<0.01). Only nine men acknowledged consistent condom use. Those who were first time attendees at the STD clinic (n=263) were more likely to report never using condoms (38 percent vs. 27 percent; p<0.01). These data highlight the need for priority targetting in this high-risk group for counselling and health education in controlling, STD and HIV infection in Jamaica.(AU)

HIV seropositivity and associated factors among female commercial sex workers in Guyana

To determine the prevalence of, and risk factors for, HIV infection among female commercial sex workers in Guyana a cross sectional survey was done among 124 streetwalkers and brothel based female sex workers in Georgetown during January and February, 1997. The mean age was 30.6 years (range = 17 to 52; sd = 7.24). Sixty-one percent said they had worked in the sex industry for 1 to 4 years while 30 percent indicated they had worked for >4 years. Forty-six percent (54/118) tested HIV positive while 28 percent (33/118) had a positive serological test for syphilis. Factors that were significantly associated with HIV infection included a positive serological test for syphilis (OR = 7.56; 95 percent CI = 2.7 - 21.97, p<0.01), a history of cocaine use (OR = 2.57, 95 percent CI = 0.95 - 7.11, p = 0.039), having > 4 clients per night (OR = 5.14, 95 percent CI = 1.65 - 16.74, p = 0.04), a history of having received treatment for syphilis (OR = 2.93, 95 percent CI = 1.12 - 7.8, p = 0.0035) and a history of receiving treatment for salpingitis (OR = 2.31, 95 percent CI = 0.93. 95 percent CI = 1.12 - 7.8, p = 0.0035) and a history of receiving treatment for salpingitis (OR = 2.31, 95 percent CI = 0.93 - 5.75, p = 0.0035). These results show a high prevalence of HIV infection and inconsistent condom use among the participants of the study. Exposure to syphilis seems to be a major risk factor for HIV. There is an urgent need for an integrated and innovative internvention targeting this high risk population. (AU)

Correlates of HIV infection among women attending a sexually transmitted disease clinic in Guyana - abstract

A prospective study was conducted among 351 women who attended the Genitourinary Medical clinic in Georgetown for the first time between February and April, 1993 to determine the prevalence of HIV infection and describe the factors associated with HIV infection among these women. Information on demographics, sexual behaviour and medical and reproductive history was collected using a structured questionnaire. Blood samples were collected for testing HIV (320), syphilis (335) and Hepatitis B (318). HIV seropositivity was observed in 6.6 percent (21/320). 3.1 percent (10/318) tested positive for Hepatitis B surface antigen and 18.5 percent (68/335) had a positive serologic test for syphilis. The HIV seropositivity rate was significantly higher among single women (8.7 percent vs 2.6 percent, p=0.035) and women who thought they were at risk of HIV (9.9 percent vs 2.7 percent, p=0.0097). 6.95 percent of the women who lived in Georgetown tested positive for HIV compared to 6.01 percent of those who lived outside of Georgetown (p=0.75). 8.9 percent of those women who reported ever having used a condom tested HIV positive as compared to 5.5 percent of women who never used a condom. The prevalence of HIV infection did not vary significantly with age (p=0.299) nor level of education (p=0.476). Conclusion: This study demonstrated a high prevalence of HIV infection among women attending a sexually transmitted disease clinic in Guyana. These findings indicate that any effective strategy for the control of HIV spread in Guyana must include targeting of STD clinic attenders(AU)

Knowledge of acquired immune deficiency syndrome (AIDS) and sexual practices among STD Clinic attenders in Georgetown Hospital, Guyana - abstract

Knowledge of AIDS and sexual practices were assessed among 604 men who presented at the Genitourinary Medicine Clinic, Georgetown Hospital, Guyana, with a new STD complaint from July, 13 to September 25, 1992, through a structured pre-coded questionnaire. Television (34.6 per cent) and radio (34.2 per cent) emerged as the major sources of information about AIDS. Almost all (99.17 per cent) of the respondents reported that they had heard of AIDS and 392/599 (65.4 per cent) thought they were at risk of catching the disease. Five hundred and sixty-one (93.7 per cent) persons suggested that they would be able to recognise an HIV/AIDS patient through appearances alone although only 38 (6.3 per cent) persons reported ever being questioned by a partner as to their HIV status. One hundred and ninety-five (32.3 per cent) persons did not know how long it takes to develop AIDS after acquiring the infection, while 276 (45.7 per cent) thought it took > 4 years and 130 (21.4 per cent) suggested ó 4 years. Homosexuality, unprotected sex and sharing of i.v. needles were recognized as ways in which HIV could be transmitted while 23.6 per cent and 17.4 per cent, respectively, implicated kissing and mosquitoes. Multiple (o 3) sex partners appeared to be the norm while only 45 per cent of persons admitted previous condom use. AIDS education needs to be intensified in Guyana. Promotion of a healthy sexual life style and stable family relationship are strongly indicated among the at-risk group for STD in Guyana (AU)

HTLV-1 seroprevalence among blood donors and food handlers in Guyana - a preliminary report - abstract

The aim of this study was to determine the prevalence of HTLV-1 seropositivity in those blood donors, food handlers and patients with symptoms suggestive of HTLV-1 infection who were seen at the Georgetown Hospital from July 15 to September 30, 1992. Sera were tested for HTLV-1 antibodies at the Caribbean Epidemiology Centre. Three hundred and fifty-four subjects were studied of whom 279 (79 per cent) were blood donors and 75 (21 per cent) food handlers; 3.9 per cent of the former (11/279) and 12.0 per cent of the latter (9/75) were seropositive with an overall seropositivity of 5.6 per cent. Although Indo-Guyanese accounted for about 40 per cent of the total sample there was only one Indo-Guyanese who was seropositive for HTLV-1. The presence of signs and symptoms associated with HTLV-1 infection was not a useful predictor of the disease (AU)

Industrial accidents at a bauxite mining community Linden, Guyana - abstract

The objectives of this prospective, 4-month study were to determine the incidence and types of injuries at Guymine (a bauxite mining company) and evaluate the factors which predispose to injuries at the work site. From June 1 to September 30, 1991, 86.5 percent (77) of all full-time employees referred for involvement in an industrial accident were seen by one of the investigators and information on the injury was collected, using a designed questionaire. There were 69 males and 8 females and most of the injured were in the age ranges 20-24 and 35-44 years. The incidence rate (IR) in males was 29.5/1,000 and 8/1,000 in females. The IR was highest in labourers (220/1,000), increased with increasing work experience and was highest in the mines (58.4/1,000). Most accidents occurred during the day-light hours and injuries most frequently involved the hands and fingers. Hazardous practices by workers and defective agencies were the main predisposing factors. Forty-four point four per cent of work sites were in a poor condition. About one year of work time was lost due to injuries during the study (AU)

Sexual experiences and perceived risk of HIV infection of females attending a Genitourinary Medicine Clinic in Georgetown, Guyana - abstract

Data on socio-demographics, past medical history, sexual activity and perceived risk of HIV infection were collected from 344/377 consecutive new clinic attenders during the period February 2 to April 22, 1993, using a structured pretested questionnaire. Most (79.4 percent) were between 15 and 29 years old and 65 percent were single. Virtually all (99.4 percent) had at least a primary school education and one-half (51.7 percent) attended secondary school. One-half (56.4 percent) were unemployed, 50.7 percent reported their age of first sexual intercourse as ó16 years, 30.6 percent between 17 and 18 years and 18.7 percent as o19 years. The mean age of first sexual intercourse was 18.4 (SD ñ3.5) years for those who were > 40 years old and 15.5 (SD ñ 1.6) years for those who were 10 - 19 years old. For those aged 20 - 29 years and 30 - 39 years, the mean ages of first sexual intercourse were 17.1 (SDñ 2.4) years and 17.3 (SD ñ 2.8) years, respectively. The majority (89.2 percent) reported "a single steady sex partner". One hundred and eighty-four women (53.6 percent) thought they were at risk of becoming HIV-infected. Women who had two or more sex partners during the previous year and three or more lifetime partners were significantly more likely to report being at risk. The apparent low sexual negotiating power of these women seems to produce behaviour which is conducive to the spread of HIV infection. These women as well as the men who visit them should be targeted for special education (AU)