The Socio-demographic characteristics of employees who had HIV testing in 2005 within selected companies on the Direct AIDS Intervention Programme.

Background and Objectives: South African businesses are feeling the brunt of HIV & AIDS and experiencing losses in productivity and profitability due to high levels employee absenteeism, sick leave and disability as well as the added costs of recruiting and retraining. These losses have had a negative impact on the national economy and in response some employers have agreed to recognize that HIV is a business issue and introduced HIV workplace programmes. It is not really known whether the employees that are most at risk are actually testing through these employer funded programmes in order for them as well as the employer to gain maximum benefit. There is a need to identify barriers to HIV testing so that workplace programmes can design better targeting strategies. Methods: This study was a retrospective review and analysis of the 2005 records of tested and untested employees in 8 companies registered on the Direct AIDS Intervention (DAI) Programme. Results: Overall there was very poor utilization of Voluntary Counselling and Testing (VCT) services with an average uptake of 13%. Multivariate logistic regression analyses showed that race, sex, period of employment and sector were significantly associated with HIV testing while there was no association with age and marital status. In general, Blacks were more likely to be tested for HIV (OR(95%CI)1.47(1.24 – 1.74);p<0.0001) and so were Coloureds (OR(95%CI) 1.79;(1.48 – 2.18); p<0.0001) and Indians(OR(95%CI)1.35(1.04 – 1.76);p=0.03) when compared to Whites. Males were less likely to have an HIV test (OR 0.69;p<0.0001) compared to female employees. Those who had been employed for more than one year were more likely to test (OR(95%CI); 1.83(1.37 – 2.43);p<0.0001) than newer employees. Employees who worked within a manufacturing company were more likely to have an HIV test (OR(95%CI) 2.39(1.96 – 2.92);p<0.0001) and so were those employed by a health/research companies (OR(95%CI) 2.83(2.11 – 3.81);p<0.0001) compared to those that were employed by a services sector company. Conclusions: The low uptake of VCT in this study is attributed to stigma which if not addressed will to continue to have a negative impact on the success of workplace programmes. Employers need to develop specific education activities in order to protect employees from discrimination and thus build confidence in the independence of the programmes thereby encouraging utilization

Access to HIV care and treatment for migrants between Lesotho and South Africa: a mixed methods study

Abstract Background HIV treatment and care for migrants is affected by their mobility and interaction with HIV treatment programs and health care systems in different countries. To assess healthcare needs, preferences and accessibility barriers of HIV-infected migrant populations in high HIV burden, borderland districts of Lesotho. Methods We selected 15 health facilities accessed by high patient volumes in three districts of Maseru, Leribe and Mafeteng. We used a mixed methods approach by administering a survey questionnaire to consenting HIV infected individuals on anti-retroviral therapy (ART) and utilizing a purposive sampling procedure to recruit health care providers for qualitative in-depth interviews across facilities. Results Out of 524 HIV-infected migrants enrolled in the study, 315 (60.1%) were from urban and 209 (39.9%) from rural sites. Of these, 344 (65.6%) were women, 375 (71.6%) were aged between 26 and 45 years and 240 (45.8%) were domestic workers. A total of 486 (92.7%) preferred to collect their medications primarily in Lesotho compared to South Africa. From 506 who responded to the question on preferred dispensing intervals, 63.1% (n = 319) preferred 5–6 month ARV refills, 30.2% (n = 153) chose 3–4 month refills and only 6.7% (n = 34) opted for the standard-of-care 1–2 month refills. A total of 126 (24.4%) defaulted on their treatment and the primary reason for defaulting was failure to get to Lesotho to collect medication (59.5%, 75/126). Treatment default rates were higher in urban than rural areas (28.3% versus 18.4%, p = 0.011). Service providers indicated a lack of transfer letters as the major drawback in facilitating care and treatment for migrants, followed by discrimination based on nationality or language. Service providers indicated that most patients preferred all treatment services to be rendered in Lesotho, as they perceive the treatment provided in South Africa to be different often less strong or with more serious side effects. Conclusion Existing healthcare systems in both South Africa and Lesotho experience challenges in providing proper care and treatment for HIV infected migrants. A need for a differentiated model of ART delivery to HIV infected migrants that allows for multi-month scripting and dispensing is warranted

Additional file 1: of Access to HIV care and treatment for migrants between Lesotho and South Africa: a mixed methods study

Survey data from 524 HIV infected migrants, Lesotho, 2016. (XLSX 44 kb

Treatment outcomes and costs of a simplified antiviral treatment strategy for hepatitis C among monoinfected and HIV and/or hepatitis B virus-co-infected patients in Myanmar.

Access to hepatitis C virus&nbsp;(HCV) testing and treatment is limited in Myanmar. We assessed an integrated HIV and viral hepatitis testing and HCV treatment strategy. Sofosbuvir/velpatasvir (SOF/VEL)&nbsp;±&nbsp;weight-based ribavirin for 12&nbsp;weeks was provided at three treatment sites in Myanmar and sustained virologic response (SVR) assessed at 12&nbsp;weeks after treatment. Participants co-infected with HBV were treated concurrently with tenofovir. Cost estimates in 2018 USD were made at Yangon and Mandalay using standard micro-costing methods. 803 participants initiated SOF/VEL; 4.8% were lost to follow-up. SVR was achieved in 680/803 (84.6%) by intention-to-treat analysis. SVR amongst people who inject drugs (PWID) was 79.7% (381/497), but 92.5% among PWID on opioid substitution therapy (OST) (74/80), and 97.4% among non-PWID (298/306). Utilizing data from 492 participants, of whom 93% achieved SVR, the estimated average cost of treatment per patient initiated was $1030 (of which 54$1109 and real-world estimate of $1250. High SVR rates were achieved for non-PWID and PWID on OST. However, the estimated average cost of the intervention (under the assumption of no genotype testing and reduced real-world effectiveness) of$1250/patient is unaffordable for a national elimination strategy. Reductions in the cost of antivirals and linkage to social and behavioural health services including substance use disorder treatment to increase retention and adherence to treatment are critical to HCV elimination in this population