linkage to care

Re-thinking Linkage to Care in the Era of Universal Test and Treat: Insights from Implementation and Behavioral Science for Achieving the Second 90

To successfully link to care, persons living with HIV must negotiate a complex series of processes from HIV diagnosis through initial engagement with HIV care systems and providers. Despite the complexity involved, linkage to care is often oversimplified and portrayed as a single referral step. In this article, we offer a new conceptual framework for linkage to care, tailored to the current universal test and treat era that presents linkage to care as its own nuanced pathway within the larger HIV care cascade. Conceptualizing linkage to care in this way may help better identify and specify processes posing a barrier to linkage, and allow for the development of targeted implementation and behavioral science-based approaches to address them. Such approaches are likely to be most relevant to programmatic and clinical settings with limited resources and high HIV burden.
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Gender Norms and HIV Testing/Treatment Uptake: Evidence from a Large Population-Based Sample in South Africa

How does the endorsement of different dimensions of gender norms by men and/or women influence their use of HIV testing and antiretroviral treatment? This question was examined using data from a 2014 population-based survey of 1053 women and 1004 men, ages 18–49, in rural South Africa. We used a global measure for views toward gender norms (the GEM Scale), plus four subsets of scale items (all reliabilities ≥ 0.7).

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Project SOAR’s AIDS and Behavior special issue: Using implementation science to accelerate progress toward achieving the 90-90-90 goals

Since its inception, Project SOAR has conducted 70 activities in 21 countries. This supplement features findings from select activities that cover all three pillars of the project: research, research utilization, and capacity strengthening. The papers are organized by the following topics:

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Re-thinking Linkage to Care in the Era of Universal Test and Treat: Insights from Implementation and Behavioral Science for Achieving the Second 90

To successfully link to care, persons living with HIV must negotiate a complex series of processes from HIV diagnosis through initial engagement with HIV care systems and providers. Despite the complexity involved, linkage to care is often oversimplified and portrayed as a single referral step. In this article, we offer a new conceptual framework for linkage to care, tailored to the current universal test and treat era that presents linkage to care as its own nuanced pathway within the larger HIV care cascade.

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Linking HIV-positive key population members to treatment: Burundi’s five secrets to success

The LINKAGES project first started working in Burundi in August 2016 to reduce HIV transmission among key populations and improve their enrollment and retention in care and treatment. Within the past three years, LINKAGES Burundi has consistently experienced high rates of linking newly diagnosed HIV-positive female sex workers, men who have sex with men, and transgender people to care and treatment. Between the first quarter of FY18 and the second quarter of FY19, the average rates for linkage to antiretroviral treatment were 98 percent among FSWs, 96 percent among MSM, and 100 percent among transgender people. This blog outlines the five “secrets” LINKAGES Burundi credits for their success.
Author
Aubrey Weber, Tiffany Lillie, Dorica Boyee and Dismas Gashobotse
Source
LINKAGES

Breaking the cycle of transmission: Finding new ways to reach young men with HIV services in South Africa

South Africa’s health data demonstrate that young men are less likely to test for HIV and less likely to start treatment when diagnosed as HIV-positive. Young men living with HIV often transmit the virus to younger female partners, contributing to an inter-generational cycle of transmission. Consequently, it is important to ensure men are fully incorporated into a holistic response in order to achieve epidemic control.

Author
Johanna Theunissen, Communications Officer, Technical Support to PEPFAR Programs, Baylor College of Medicine Children’s Foundation Malawi

Screening and supporting through schools: educational experiences and needs of adolescents living with HIV in a South African cohort

Many adolescents living with HIV remain disconnected from care, especially in high-prevalence settings. Slow progressors-adolescents infected perinatally who survive without access to lifesaving treatment-remain unidentified and disconnected from heath systems, especially in high-prevalence settings. This study examines differences in educational outcomes for ALHIV, in order to i) identify educational markers for targeting HIV testing, counselling and linkages to care, and ii) to identify essential foci of educational support for ALHIV.
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HIV self-testing alone or with additional interventions, including financial incentives, and linkage to care or prevention among male partners of antenatal care clinic attendees in Malawi: An adaptive multi-arm, multi-stage cluster randomised trial

Conventional HIV testing services have been less comprehensive in reaching men than in reaching women globally, but HIV self-testing (HIVST) appears to be an acceptable alternative. Measurement of linkage to post-test services following HIVST remains the biggest challenge, yet is the biggest driver of cost-effectiveness. We investigated the impact of HIVST alone or with additional interventions on the uptake of testing and linkage to care or prevention among male partners of antenatal care clinic attendees in a novel adaptive trial.
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Constructing care cascades for active tuberculosis: A strategy for program monitoring and identifying gaps in quality of care

Author
Ramnath Subbaraman, Ruvandhi R. Nathavitharana, Kenneth H. Mayer, Srinath Satyanarayana, Vineet K. Chadha, Nimalan Arinaminpathy, Madhukar Pai

The cascade of care is a model for evaluating patient retention across sequential stages of care required to achieve a successful treatment outcome. This approach was first used to evaluate HIV care and has since been applied to other diseases. The tuberculosis (TB) community has only recently started using care cascade analyses to quantify gaps in quality of care. In this article, we describe methods for estimating gaps (patient losses) and steps (patients retained) in the care cascade for active TB disease.

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Does distance to clinic affect utilization of HIV care and treatment services

Author
Dr Gesine Meyer-Rath

We assessed the relationship between distance to clinic and progression through the HIV care cascade. We have two key findings. First, distance matters but only for women. Second, for women, distance affected linkage to care, but was not associated with later transitions in the care cascade. It is possible that distance is a less important barrier once people find out their HIV status, learn about treatment, and overcome the hurdle of their first clinic visit.

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