Linkage to care following home-based HIV counseling and testing: a mixed methods study in rural South Africa

Thesis (D.P.H.)--Boston UniversityBackground: The mandate for scale up of home-based HIV counseling and testing (HBHCT) is strong. To maximize the benefits of testing, prompt linkage to care and treatment for HIV-positive clients is essential. Timely linkage can lead to decreased morbidity and mortality, as well as increased quality of life and life expectancy. Early treatment initiation can also reduce HIV transmission to uninfected partners. While data exists on the transition to care from mobile and facility-based HIV testing, less is known about the transition from HBHCT. Methods: A mixed methods study was conducted among a sample of 492 HIV-positive HBHCT clients in rural South Africa to: 1) determine the rate of linkage from HBHCT to facility-based services; and 2) identify factors that influence linkage. Clients were followed up to assess linkage to care, defined as providing a blood sample for a facility-based CD4 count. Using data from a cross-sectional survey conducted among a subsample of 196 clients 6-153 days after testing, Cox regression was performed to determine factors associated with linkage. To further explore potential barriers and facilitating factors, in-depth interviews were conducted with 30 clients who were purposively selected based on timely versus delayed care seeking. Results: Among 359 HIV-positive HBHCT clients, 62.1% (95% CI: 55.7% - 68.5%) linked to care within 3 months. For those who did not link promptly, barriers occurred at all levels: individual, relationships, community, and health systems. Delayed care seeking was influenced by poor psychological responses to the diagnosis; challenges surrounding disclosure and limited social support; lack of time, opportunity, and financial resources; and internalized negative experiences with the healthcare system. Often, barriers interacted and were subtly reinforced by stigma. Women and youth may be particularly vulnerable to these barriers. Conclusion: The findings highlight important gaps in our understanding, and provide the basis for policy and programmatic recommendations. Key recommendations include: 1) including HBHCT and monitoring of linkage to care in the role of community health workers; 2) offering tailored counseling and motivational interviewing; 3) conducting short-term intensive community-based support groups; 4) offering mobile point-of-care CD4 counts; and 5) piloting and evaluating community based nurse-initiated treatment

Reflections from Five Years of Research on FGM/C

From 2015 to 2019, the Evidence to End FGM/C research consortium took a fresh approach to examining the longstanding practice of female genital mutilation/cutting (FGM/C). The African-led program developed innovative research methods and uncovered new evidence about the practice and how it is changing—focusing on families and communities, and health and legal systems. This report documents the consortium’s research methods, the key lessons learned, capacity strengthening efforts, enhanced advocacy for research uptake, and recommendations. The research sheds light on key areas for future investments that would ensure that FGM/C policies and programs are informed by rigorous evidence. The recommendations stem from the lessons learned on how local variations, social and cultural underpinnings, the health sector, and laws influence the practice of FGM/C. Wide-ranging partnerships brought together researchers, civil society members, government officials, and technical experts to find new answers. Going forward, such partnerships among institutions with well-established national, regional, and global networks will be key to ensuring that evidence is effectively used to influence policy and program actions

Maternal and fetal outcome in primigravida with unengaged head at term in labour

Background: Unengaged head in a primigravida at term gestation at the onset of labor is considered as an obstetric risk factor for dysfunctional labor. Careful monitoring of the progress of labor and timely medical intervention reduced the risk of dysfunctional labor and Cesarean delivery. This study was to assess the effect of unengaged head on course of labor, duration of labor, its maternal and fetal outcome in primigravida at term in labor. Methods: This prospective cross-sectional study was conducted in 100 primigravida with term gestation, unengaged head with spontaneous onset of labor meeting the inclusion criteria admitted to labor ward, Department of Obstetrics & Gynecology, ESIC-MC & PGIMSR Hospital, Bengaluru during January 2019 to June 2020. After detailed clinical evaluation, labor monitored partographically and CTG for fetal surveillance and when necessary, interventions like augmentation of labor and operative vaginal or cesarean delivery performed. Results: Among 100 primigravidae, 19% had floating head, 53% at -3 and 28% at -2 station at the time of onset of labor. The mean duration of 1st, 2nd stage and total duration of labor       was higher in freely floating head compared to -3 and -2 station. The need for augmentation of labor was 100% with freely floating head than with -3 and -2 station. 77% delivered vaginally and 23% by LSCS, arrest disorders being the main indication. There was no significant difference in maternal morbidity or APGAR score at 5 min. 88% of the babies delivered with good APGAR and 12% required NICU admission Conclusions: Our study demonstrates that higher the fetal head station at the onset of labor, greater the duration of labor and the need for augmentation. Unengaged head per se is not an indication for LSCS as 77% of them delivered vaginally with partographically monitored labor

A Reference Guide: Six Practical Tips for Understanding Data on Female Genital Mutilation/Cutting (FGM/C)

The Population Reference Bureau (PRB) was a core partner on the Population Council’s Evidence to End FGM/C: Research to Help Girls and Women Thrive—a UKAID-funded research program to help end female genital mutilation/cutting (FGM/C) within one generation. Their role was to build the consortium’s capacity for research utilization and to develop innovative tools and products to improve how researchers communicate their findings about FGM/C to key decisionmakers.This reference guide aims to help researchers, advocates, program managers, and policymakers understand, interpret, and use the latest FGM/C data

The female condom in Ghana: Exploring the current state of affairs and gauging potential for enhanced promotion

The female condom (FC) is the only safe and effective female-initiated method that provides simultaneous protection against unintended pregnancy as well as sexually transmitted infections, including HIV. An exploratory exercise was conducted by the Population Council to gain an understanding of the current and historical landscape of FC procurement, distribution, and programming in Ghana and to explore the viability of enhancing national FC promotion. The exercise revealed that a large-scale launch of the FC occurred in Ghana in 2000 and was largely successful in raising product awareness; however, uptake remained low. Momentum has waned since the initial launch and financial support for large-scale promotion and distribution is lacking. Thus, while the product is reportedly available in the public and private sector, social marketing efforts are virtually absent, education materials are limited, distribution primarily occurs in urban areas, and programmers have limited information about FC users. The majority of interviewed stakeholders feel that greater resources should be committed to the FC’s promotion. Drawing upon stakeholders’ suggestions and synthesis of key findings, this report offers specific recommendations for moving forward with an initiative to enhance FC promotion

Synthesis and characterization of novel imidazoquinoline based 2-azetidinones as potent antimicrobial and anticancer agents

AbstractA new series of N-substituted azetidinones (9a–h) synthesized by condensation of 4-arylidene hydrazino 1-isobutyl-1H-imidazo[4,5-c]quinolines (8a–h) with chloroacetyl chloride afforded 4-arylazetidin-2-ones (9a–h). The synthesized compounds were characterized by 1H NMR, 13C NMR, mass spectral and elemental analyses. All synthesized compounds were screened for their in vitro antimicrobial and anticancer activities. The hydrazone derivatives (8a–h) showed good antibacterial activity. Compounds 9a and 9b exhibited good anticancer activity. In a molecular docking study compounds 9a and 9b showed minimum binding energy and good affinity towards the active pocket. Thus, are believed to be good inhibitors of β-tubulin

A state-of-the-art synthesis on female genital mutilation/cutting: What do we know now?

Efforts to end female genital mutilation/cutting (FGM/C) are a rising priority on many national and global agendas. Thus it is imperative to have a clear understanding of the scale and scope of the practice, and where it occurs, as well as the dynamics of change and the broader context surrounding it. This state-of-the-art synthesis offers a snapshot of the most recent data available as of July 2016 and the most relevant contextual information on key FGM/C issues in clear, nontechnical language that can help inform policymakers, donors, program planners, and other key stakeholders. The data point to “hot spot” geographic areas; identify populations that may be more amenable to change; and highlight drivers, rationales, and patterns of influence related to the practice that should be acknowledged and addressed within policy and programmatic strategies. This synthesis also highlights how FGM/C data collection, analysis, and interpretation could be improved to fill some key gaps in our understanding and further guide the way forward

Effect of home based HIV counselling and testing intervention in rural South Africa: cluster randomised trial

OBJECTIVE: To assess the effect of home based HIV counselling and testing on the prevalence of HIV testing and reported behavioural changes in a rural subdistrict of South Africa. DESIGN: Cluster randomised controlled trial. SETTING: 16 communities (clusters) in uMzimkhulu subdistrict, KwaZulu-Natal province, South Africa. PARTICIPANTS: 4154 people aged 14 years or more who participated in a community survey. INTERVENTION: Lay counsellors conducted door to door outreach and offered home based HIV counselling and testing to all consenting adults and adolescents aged 14-17 years with guardian consent. Control clusters received standard care, which consisted of HIV counselling and testing services at local clinics. MAIN OUTCOME MEASURES: Primary outcome measure was prevalence of testing for HIV. Other outcomes were HIV awareness, stigma, sexual behaviour, vulnerability to violence, and access to care. RESULTS: Overall, 69% of participants in the home based HIV counselling and testing arm versus 47% in the control arm were tested for HIV during the study period (prevalence ratio 1.54, 95% confidence interval 1.32 to 1.81). More couples in the intervention arm had counselling and testing together than in the control arm (2.24, 1.49 to 3.03). The intervention had broader effects beyond HIV testing, with a 55% reduction in multiple partners (0.45, 0.33 to 0.62) and a stronger effect among those who had an HIV test (0.37, 0.24 to 0.58) and a 45% reduction in casual sexual partners (0.55, 0.42 to 0.73). Conclusions Home based HIV counselling and testing increased the prevalence of HIV testing in a rural setting with high levels of stigma. Benefits also included higher uptake of couple counselling and testing and reduced sexual risk behaviour.Department of HE and Training approved lis

What influences linkage to care after home-based HIV counseling and testing?

To maximize the benefits of test and treat strategies that utilize community-based HIV testing, clients who test positive must link to care in a timely manner. However, linkage rates across the HIV treatment cascade are typically low and little is known about what might facilitate or hinder care-seeking behavior. This qualitative study was conducted within a home-based HIV counseling and testing (HBHCT) intervention in South Africa. Indepth interviews were conducted with 30 HBHCT clients who tested HIV positive to explore what influenced their care-seeking behavior. A set of field notes for 196 additional HBHCT clients who tested HIV positive at home were also reviewed and analyzed. Content analysis showed that linkage to care is influenced by a myriad of factors at the individual, relationship, community, and health system levels. These factors subtly interact and at times reinforce each other. While some factors such as belief in test results, coping ability, social support, and prior experiences with the health system affect clients’ desire and motivation to seek care, others such as limited time and resources affect their agency to do so. To ensure that the benefits of community- based testing models are realized through timely linkage to care, programs and interventions must take into account and address clients’ emotions, motivation levels, living situations, relationship dynamics, responsibilities, and personal resources

Quality of home-based rapid HIV testing by community lay counsellors in a rural district of South Africa

INTRODUCTION: Lack of universal, annual testing for human immunodeficiency virus (HIV) in health facilities suggests that expansion of HIV testing and counselling (HTC) to non-clinical settings is critical to the achievement of national goals for prevention, care and treatment. Consideration should be given to the ability of lay counsellors to perform home-based HTC in community settings. METHODS: We implemented a community cluster randomized controlled trial of home-based HTC in Sisonke District, South Africa. Trained lay counsellors conducted door-to-door HIV testing using the same rapid tests used by the local health department at the time of the study (SD Bioline and Sensa). To monitor testing quality and counsellor skill, additional dry blood spots were taken and sent for laboratory-based enzyme-linked immunosorbent assay (ELISA) testing. Sensitivity and specificity were calculated using the laboratory result as the gold standard. RESULTS AND DISCUSSION: From 3986 samples, the counsellor and laboratory results matched in all but 23 cases. In 18 cases, the counsellor judged the result as indeterminate, whereas the laboratory judged 10 positive, eight negative and three indeterminate, indicating that the counsellor may have erred on the side of caution. Sensitivity was 98.0% (95% CI: 96.3 98.9%), and specificity 99.6% (95% CI: 99.4 99.7%), for the lay counsellor field-based rapid tests. Both measures are high, and the lower confidence bound for specificity meets the international standard for assessing HIV rapid tests. CONCLUSIONS: These findings indicate that adequately trained lay counsellors are capable of safely conducting high-quality rapid HIV tests and interpreting the results as per the kit guidelines. These findings are important given the likely expansion of community and home-based testing models and the shortage of clinically trained professional staff.Department of HE and Training approved lis