Can the UNAIDS modes of transmission model be improved? A comparison of the original and revised model projections using data from a setting in west Africa.

OBJECTIVE: The UNAIDS modes of transmission model (MoT) is a user-friendly model, developed to predict the distribution of new HIV infections among different subgroups. The model has been used in 29 countries to guide interventions. However, there is the risk that the simplifications inherent in the MoT produce misleading findings. Using input data from Nigeria, we compare projections from the MoT with those from a revised model that incorporates additional heterogeneity. METHODS: We revised the MoT to explicitly incorporate brothel and street-based sex-work, transactional sex, and HIV-discordant couples. Both models were parameterized using behavioural and epidemiological data from Cross River State, Nigeria. Model projections were compared, and the robustness of the revised model projections to different model assumptions, was investigated. RESULTS: The original MoT predicts 21% of new infections occur in most-at-risk-populations (MARPs), compared with 45% (40-75%, 95% Crl) once additional heterogeneity and updated parameterization is incorporated. Discordant couples, a subgroup previously not explicitly modelled, are predicted to contribute a third of new HIV infections. In addition, the new findings suggest that women engaging in transactional sex may be an important but previously less recognized risk group, with 16% of infections occurring in this subgroup. CONCLUSION: The MoT is an accessible model that can inform intervention priorities. However, the current model may be potentially misleading, with our comparisons in Nigeria suggesting that the model lacks resolution, making it challenging for the user to correctly interpret the nature of the epidemic. Our findings highlight the need for a formal review of the MoT

Chronic Disease Self-Management Challenges among Rural Women Living with HIV/AIDS in Prakasam, Andhra Pradesh, India: A Qualitative Study.

Rural women living with HIV/AIDS (WLHA) in India experience challenges self-managing HIV/AIDS in their rural communities. The purpose of this qualitative study was to explore factors influencing their care and antiretroviral treatment (ART) adherence. Themes that emerged from the qualitative focus groups among WLHA (N = 24) in rural Prakasam, Andhra Pradesh, India, included: (1) coming to know about HIV and other health conditions, (2) experiences being on ART, (3) challenges maintaining a nutritious diet, (4) factors affecting health care access and quality, and (5) seeking support for a better future. Chronic disease self-management in rural locales is challenging, given the number of barriers which rural women experience on a daily basis. These findings suggest a need for individual- and structural-level supports that will aid in assisting rural WLHA to self-manage HIV/AIDS as a chronic illness

Attitude of Counsellors towards undergoing HIV Voluntary Counselling and Testing in Ado-Odo/Ota, Nigeria

This study was an investigation into the attitude of counsellors who offer HIV pre and post counselling. Sixteen counsellors who offer HIV pre-post-test counselling were identified from the preliminary field work, of these, 9 counsellors who reported they had not presented for HIV/AIDS testing were identified and 7 eventually participated in the study. The participants were active counsellors, 27 through 46 years of age, who provided HIV pre-post-test counselling services. A purposive sampling technique was employed to select the participants. The non-scheduled structured interview was employed for data collection while the cross case method was used to analyze the data. The study found that the participants possessed negative attitude towards undergoing voluntary HIV/AIDS testing though they acknowledged the importance of HIV/AIDS test. The participants identified fear of being HIV/AIDS positive, lack of confidentiality and knowledge of HIV/AIDS as barriers to their undergoing HIV/AIDS test. Being counselled by a professional counsellor/ psychologist or someone living with HIV/AIDS, feeling too sick or being pregnant were highlighted as factors that may facilitate their undergoing HIV/AIDS test. It was also found that HIV/AIDS counsellors are as vulnerable to HIV/AIDS as the general population. Counsellors who by their training or job schedule encourage others to undergo HIV test were themselves unwilling to test for HIV. In conclusion, counsellors are advised to undergo voluntary HIV/AIDS test. Key words: HIV/AIDS counsellors, attitude, HIV/AIDS VCT, interview, confidentiality