Despite progress in improving antiretroviral therapy (ART) for people with HIV in Malawi, the burden of HIV infections and HIV treatment outcomes among key populations is suboptimal. Client-centered differentiated service delivery approaches may facilitate addressing HIV prevention and treatment nee...ds of key populations in Malawi.
Methods
De-identified program data routinely collected as part of the LINKAGES project–Malawi were assembled from October 2017 to September 2019. HIV case finding was compared across different testing modalities for each population. Poisson regression was used to estimate the association between testing modalities and ART initiation.
Results
Of the 18 397 people included in analyses, 10 627 (58%) were female sex workers (FSWs), 2219 (12%) were men who have sex with men (MSM), and 4970 (27%) were clients of FSWs. HIV case finding varied by modality and population, with index testing and enhanced peer outreach demonstrating high yield despite reaching relatively few individuals. FSWs who tested positive through risk network referral testing were more likely to initiate ART within 30 days compared with those who tested positive through clinic-based testing (adjusted risk ratio [aRR], 1.50; 95% CI, 1.23–1.82). For MSM, index testing (aRR, 1.45; 95% CI, 1.06–2.00) and testing through a drop-in center (aRR, 1.82; 95% CI, 1.19–2.78) were associated with 30-day ART initiation.
Conclusions
These data suggest that differentiated HIV testing and outreach approaches tailored to the needs of different key populations may facilitate improved ART initiation in Malawi. Achieving 0 new infections by 2030 suggests the need to adapt treatment strategies given individual and structural barriers to treatment for key populations with HIV in high-prevalence settings.
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The updated guidelines present a standard minimum dataset, priority indicators and recommendations to strengthen data use across HIV prevention, testing and treatment, and linkages to services for sexually transmitted infections, viral hepatitis, tuberculosis and cervical cancer. The guidelines also... cover the use of routinely collected data for HIV surveillance (including measurement of HIV prevalence and incidence) and emphasize the use of data from different sources to gain a better picture of epidemiologic trends.
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PEPFAR Malawi’s Country Operational Plan 2022 (COP22) embodies joint priorities from national and subnational dialogues building on the 2020-2025 National Strategic Plan for HIV/AIDS. The interagency team has developed a person-centered, district-tailored and Malawi Population-Based HIV Impact Ass...essment (MPHIA)-informed strategy through extensive engagement with Government of Malawi (GoM) and Civil Society Organizations (CSOs) to sustain HIV epidemic control. At the end of COP21, PEPFAR Malawi was commended for contributing to reaching epidemic control in strong collaboration with GoM and stakeholders including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). This includes enrollment of 88% of recipients of care on three or more months of antiretroviral treatment (ART), better outcomes for Malawian children through remarkable efforts in Orphans and Vulnerable Children (OVC) programming and progress made towards reaching men with more intentional and focused programming.
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The leishmaniases are a group of diseases caused by Leishmania spp., which occur in cutaneous, mucocutaneous and visceral forms. They are neglected tropical diseases (NTDs), which disproportionately affect marginalized populations who have limited access to health care. HIV co-infected patients with... Leishmania infection are highly infectious to sandflies, and an increase in the coinfection rate in an endemic area is likely to increase the effective infective reservoir.
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Namibia is estimated to be at 94-97-93 as defined by the UNAIDS 95-95-95 treatment cascade, one of the first high burden countries to approach epidemic control. COP22 is about sustaining the impact of years of investment and partnership with the Namibian government and other stakeholders by employin...g targeted and innovative approaches to prevent new infections, reduce mortality rates, and strengthen the health system to endure the impact of unexpected external shocks, while still providing person-centered health services.
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Lesotho’s Social and Behaviour Change Communication Strategy is a strategic response to the high levels of HIV and TB prevalence in the country that are exacerbated by the persistence of structural and sio-economic difficulties, such as poverty, unemployment, gender inequality and more. This strat...egy aims to address these issues.
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Campbell Syst Review Vol. 18 no.1.
Despite progress in several dimensions of the global HIV response, there seems to be a significant gender and age disparity. Numerous organizations consider it a top priority to accelerate HIV prevention programming among Adolescent Girls and Young Women (AGYW) as... unequal gender norms, limited agency and voice, and reduced access to resources put them at higher HIV risk. Gender and age have also been identified as critical gaps within prevention research to ensure the development of biomedical interventions that are responsive to the biological and social needs of AGYW. Towards this, the objectives of the proposed evidence and gap map are to; identify and map existing evidence and gaps on the use of diverse Social and Behaviour Change Communication (SBCC) strategies to strengthen adoption of HIV prevention measures and participation in research among AGYW in LMICs; and, identify areas where more interventions and evidence are needed to inform the design of future SBCC strategies and programs for AGYW engagement in HIV prevention and research.
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AIDS Behav. 2022 Feb;26(2):375-384.doi: 10.1007/s10461-021-03391.
A community health worker (CHW) model can promote HIV prevention and treatment behaviors,
especially in highly mobile populations. In a fishing community in Rakai, Uganda, the Rakai
Health Sciences Program implemented a communit...y health worker HIV intervention called Health
Scouts. The situated Information, Motivation, and Behavioral Skills (sIMB) framework informed
the design and a qualitative evaluation of the intervention. We interviewed 51 intervention
clients and coded transcripts informed by sIMB framework dimensions.
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Current HIV/AIDS Reports (2022) 19:358–374. https://doi.org/10.1007/s11904-022-00615-z.
MINDSPACE is an acronym developed by the UK's behavioural insights team to summarise nine key influences on human behaviour: Messenger, Incentives, Norms, Default, Salience, Priming, Affect, Commitment, and E...go. These effects have been used in various settings to design interventions that encourage positive behaviours. Currently, over 200 institutionalised behavioural insight teams exist internationally, which may draw upon the MINDSPACE framework to inform policy and improve public services.
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HUMANITIES AND SOCIAL SCIENCES COMMUNICATIONS | (2022)9:295 | https://doi.org/10.1057/s41599-022-01312-3 .
Sub-Saharan Africa (SSA), particularly Southern and East Africa, has the highest AIDS deaths
and HIV-infected people in the world. Even though considerable effort has been made over
the yea...rs to study HIV transmission risk behaviours of different population groups in SSA,
there is little evidence of studies that have looked at pooled effects of associated HIV risk
factors among men, particularly in Southern Africa.
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This implementation brief addresses integration of HIV testing services into family planning (FP) services. It is intended as a practical resource for national health programmes seeking to introduce or scale up HIV testing and linkage to HIV prevention, sexually transmitted infection, and antiretrov...iral therapy services in FP.
This document highlights emerging good practices and country experiences of integrated HIV prevention and testing services within FP and advocates for increased linkage for FP clients to HIV services according to their needs. It also brings together information on models of integration of HIV testing into FP services, programme examples from east and southern Africa and guidance on the implementation monitoring process.
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Men are underrepresented in HIV testing services throughout sub-Saharan Africa. HIV testing is critical to achieve the UNAIDS 95-95-95 goals, as it is the first entry point to HIV care. In Malawi, an estimated 14% of HIV positive men are undiagnosed, while only 6% of HIV positive women remain undiag...nosed. Improved HIV testing among men is key to reaching UNAIDS goals, and to curbing HIV epidemics in the region.
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Testing men for HIV during their partner’s pregnancy can guide couples-based HIV prevention and treatment, but testing rates remain low. We investigated a combination approach, using evidence-based strategies, to increase HIV testing in male partners of HIV-positive and HIV-negative ...pregnant women.
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These guidelines provide new and updated recommendations on the use of point-of-care testing in children under 18 months of age and point-of-care tests to monitor treatment in people living with HIV; the treatment monitoring algorithm; and timing of antiretroviral therapy (ART) among people living w...ith HIV who are being treated for tuberculosis.
New recommendations launched today outline key new actions that countries can take to improve the delivery of HIV testing, treatment and care services by providing greater options for differentiated approaches such as, supporting HIV treatment start in the community, ensuring that children are diagnosed and treated early, and that viral load treatment monitoring is more accessible, focused and triggers clinical action
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3 June 2021. After 40 years of AIDS, charting a course to end the pandemic.
The report shows that countries with progressive laws and policies and strong and inclusive health systems have had the best outcomes against HIV. In those countries, people living with and affected by HIV are more likely t...o have access to effective HIV services, including HIV testing, pre-exposure prophylaxis (medicine to prevent HIV), harm reduction, multimonth supplies of HIV treatment and consistent, quality follow-up and care.
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