ART coverage

Towards UNAIDS Fast-Track goals: targeting priority geographic areas for HIV prevention and care in Zimbabwe

Zimbabwe has made substantial progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) targets of 90-90-90 by 2020, with 73% of people living with HIV diagnosed, 87% of those diagnosed on antiretroviral therapy (ART) and 86% of those on ART virally suppressed. Despite this exceptional response, more effort is needed to completely achieve the UNAIDS targets. Here, we conducted a detailed spatial analysis of the geographical structure of the HIV epidemic in Zimbabwe to include geographical prioritization as a key component of their overall HIV intervention strategy.
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Do female sex workers have lower uptake of HIV treatment services than non-sex workers? A cross-sectional study from east Zimbabwe

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Yes
Author
Rebecca Rhead, Jocelyn Elmes, Eloghene Otobo, Kundai Nhongo, Albert Takaruza, Peter J White, Constance Anesu Nyamukapa, Simon Gregson

Globally, HIV disproportionately affects female sex workers (FSWs) yet HIV treatment coverage is suboptimal. To improve uptake of HIV services by FSWs, it is important to identify potential inequalities in access and use of care and their determinants. Our aim is to investigate HIV treatment cascades for FSWs and non-sex workers (NSWs) in Manicaland province, Zimbabwe, and to examine the socio-demographic characteristics and intermediate determinants that might explain differences in service uptake.

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Brief counselling after home-based HIV counselling and testing strongly increases linkage to care: a cluster-randomized trial in Uganda

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Yes
Author
Eugene Ruzagira, Heiner Grosskurth, Anatoli Kamali, Kathy Baisley

The aim of this study was to determine whether counselling provided subsequent to HIV testing and referral for care increases linkage to care among HIV-positive persons identified through home-based HIV counselling and testing (HBHCT) in Masaka, Uganda. The study found that counselling substantially increases linkage to care among HIV-positive adults identified through HBHCT and may enhance efforts to increase antiretroviral therapy coverage in sub-Saharan Africa.

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Multi-month prescription of antiretroviral therapy and its feasibility: experiences from the Baylor International Pediatric AIDS initiative (BIPAI) in six southern African countries

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Yes
Author
M. Kim, R.S. Wanless, S. Ahmed, J. Mhango, D. Damba, A. Kayabu, M. Chodota, S. Dlamini, N. Chidah, M. Mokhali, N. Calles, A. Amzel, R. Golin, E.J. Abrams

To improve antiretroviral coverage (ART) and help reach the 90-90-90 treatment targets, differentiated approaches to care are necessary, including reduced frequency of clinic visits for stable patients. Given the paucity of data regarding the impact of differentiated care models on pediatric outcomes, BIPAI conducted a retrospective analysis of clinical outcomes, comparing monthly (MS) with multi-monthly (MMS) ART prescription schedules for children and adolescents in Botswana, Lesotho, Swaziland, Malawi, Uganda and Tanzania.

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Decentralizing ART Supply for Stable HIV Patients to Community-Based Distribution Centers: Program Outcomes From an Urban Context in Kinshasa, DRC

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Yes
Author
Florian Vogt, Lucien Kalenga, Jean Lukela, Freddy Salumu, Ibrahim Diallo, Elena Nico, Emmanuel Lampart, Rafael Van den Bergh, Safieh Shah, Olumide Ogundahunsi, Rony Zachariah, Johan Van Griensven

Facility-based antiretroviral therapy (ART) provision for stable patients with HIV congests health services in resource-limited countries. We assessed outcomes and risk factors for attrition after decentralization to community-based ART refill centers among 2603 patients with HIV in Kinshasa, Democratic Republic of Congo, using a multilevel Poisson regression model. Death, loss to follow-up, and transfer out were 0.3%, 9.0%, and 0.7%, respectively, at 24 months. Overall attrition was 5.66/100 person-years.

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Assessment of epidemic projections using recent HIV survey data in South Africa: a validation analysis of ten mathematical models of HIV epidemiology in the antiretroviral therapy era

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Yes
Author
Jeffrey W Eaton, Nicolas Bacaër, Anna Bershteyn, Valentina Cambiano, Anne Cori, Rob E Dorrington, Christophe Fraser, Chaitra Gopalappa, Jan A C Hontelez, Leigh F Johnson, Daniel J Klein, Andrew N Phillips, Carel Pretorius, John Stover, Thomas M Rehle, Tim

Background

Mathematical models are widely used to simulate the effects of interventions to control HIV and to project future epidemiological trends and resource needs. We aimed to validate past model projections against data from a large household survey done in South Africa in 2012.

Methods

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Modeling the Implementation of Universal Coverage for HIV Treatment as Prevention and its Impact on the HIV Epidemic

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Yes
Author
Roger Ying, Ruanne V. Barnabas, Brian G. Williams

The Joint United Nations Programme on HIV/AIDS (UNAIDS) recently updated its global targets for antiretroviral therapy (ART) coverage for HIV-positive persons under which 90 % of HIV-positive people are tested, 90 % of those are on ART, and 90 % of those achieve viral suppression. Treatment policy is moving toward treating all HIV-infected persons regardless of CD4 cell count—otherwise known as treatment as prevention—in order to realize the full therapeutic and preventive benefits of ART.

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Antiretroviral Therapy Uptake, Attrition, Adherence and Outcomes among HIV-Infected Female Sex Workers: A Systematic Review and Meta-Analysis

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Yes
Author
Elisa Mountain, Sharmistha Mishra, Peter Vickerman, Michael Pickles, Charles Gilks, Marie-Claude Boily

Purpose

We aimed to characterize the antiretroviral therapy (ART) cascade among female sex workers (FSWs) globally.

Methods

We systematically searched PubMed, Embase and MEDLINE in March 2014 to identify studies reporting on ART uptake, attrition, adherence, and outcomes (viral suppression or CD4 count improvements) among HIV-infected FSWs globally. When possible, available estimates were pooled using random effects meta-analyses (with heterogeneity assessed using Cochran's Q test and I2 statistic).

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