Browsing by Author "Mathews, Catherine"
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- ItemOpen AccessA comparison of linkage to HIV care after provider-initiated HIV testing and counselling (PITC) versus voluntary HIV counselling and testing (VCT) for patients with sexually transmitted infections in Cape Town, South Africa(2014-08-18) Leon, Natalie; Mathews, Catherine; Lewin, Simon; Osler, Meg; Boulle, Andrew; Lombard, CarlAbstract Background We examined linkage to care for patients with sexually transmitted infection who were diagnosed HIV-positive via the provider-initiated HIV testing and counselling (PITC) approach, as compared to the voluntary counselling and testing (VCT) approach, as little is known about the impact of expanded testing strategies on linkage to care. Methods In a controlled trial on PITC (Cape Town, 2007), we compared HIV follow-up care for a nested cohort of 930 HIV-positive patients. We cross-referenced HIV testing and laboratory records to determine access to CD4 and viral load testing as primary outcomes. Secondary outcomes were HIV immune status and time taken to be linked to HIV care. Logistic regression was performed to analyse the difference between arms. Results There was no difference in the main outcomes of patients with a record of CD4 testing (69.9% in the intervention, 65.2% in control sites, OR 0.82 (CI: 0.44-1.51; p = 0.526) and viral load testing (14.9% intervention versus 10.9% control arm; OR 0.69 (CI: 0.42-1.12; p = 0.131). In the intervention arm, ART-eligible patients (based on low CD4 test result), accessed viral load testing approximately 2.5 months sooner than those in the control arm (214 days vs. 288 days, HR: 0.417, 95% CI: 0.221-0.784; p = 0.007). Conclusion The PITC intervention did not improve linkage to CD4 testing, but shortened the time to viral load testing for ART-eligible patients. Major gaps found in follow-up care across both arms, indicate the need for more effective linkage-to-HIV care strategies. Trial registration Current Controlled Trials ISRCTN93692532
- ItemOpen AccessA multi-component theory-based behaviour change intervention to increase HIV self–testing uptake and linkage to HIV prevention, care and treatment among hard to reach adults in Northern Tanzania(2021) Njau, Bernard Joseph; Mathews, Catherine; Boulle, AndrewTo achieve the WHO targets of 95–95–95 by 2030, whereby 95% of all people living with HIV (PLHIV) know their status, 95 % of all people with an HIV diagnosis receive sustained antiretroviral therapy (ART), and 95 % of all people receiving ART achieve viral suppression, it is imperative to introduce novel community–based testing approaches such as HIV self-testing (HIVST). HIV self–testing has been shown to empower non– testers in both developed and underdeveloped countries, to be aware of their HIV status. However, no studies on the uptake of HIVST have been conducted on hard to reach populations in Northern Tanzania. The hard to reach populations for this thesis were female bar workers (FBWs) and mountain climbing porters (MCPS) in Northern Tanzania, who exhibit high-risk behaviours for HIV infection and low rates of HIV testing and / or repeat testing. It is important to find ways to increase the uptake of HIV testing in these populations and HIVST is proposed as a means of improving HIV testing coverage in hard-to-reach populations in the context of a long-standing HIV testing program. Existing implementation science literature suggests that behaviour change interventions (BCIs) guided by behaviour change theories and using planning and evaluation frameworks (i.e. PRECEDE-PROCEED model) can be effective in increasing HIV-related behaviour change. However, the current evidence on the effectiveness of HIV-related BCI is from studies conducted in high-income countries. To address the low HIV testing rates and/or repeat testing, it was important to undertake a project of research to develop and evaluate a theory-based behaviour change intervention (BCI) to increase HIVST uptake and linkage to HIV prevention, care and treatment among FBWs and MCPs in Northern Tanzania. This thesis aimed to develop and evaluate a multi-component theory-based BCI to increase HVST uptake and linkage to HIV prevention, care and treatment among female bar workers and mountain climbing porters in Northern Tanzania.
- ItemOpen AccessA qualitative study of the experiences of care and motivation for effective self-management among diabetic and hypertensive patients attending public sector primary health care services in South Africa(2015-08-01) Murphy, Katherine; Chuma, Thandie; Mathews, Catherine; Steyn, Krisela; Levitt, NaomiBackground: Diabetes and hypertension constitute a significant and growing burden of disease in South Africa. Presently, few patients are achieving adequate levels of control. In an effort to improve outcomes, the Department of Health is proposing a shift to a patient-centred model of chronic care, which empowers patients to play an active role in self-management by enhancing their knowledge, motivation and skills. The aim of this study was to explore patients’ current experiences of chronic care, as well as their motivation and capacity for self-management and lifestyle change. Methods: The study involved 22 individual, qualitative interviews with a purposive sample of hypertensive and diabetic patients attending three public sector community health centres in Cape Town. Participants were a mix of Xhosa and Afrikaans speaking patients and were of low socio-economic status. Results: The concepts of relatedness, competency and autonomy from Self Determination Theory proved valuable in exploring patients’ perspectives on what a patient-centred model of care may mean and what they needed from their healthcare providers. Overall, the findings of this study indicate that patients experience multiple impediments to effective self-management and behaviour change, including poor health literacy, a lack of self-efficacy and perceived social support. With some exceptions, the majority of patients reported not having received adequate information; counselling or autonomy support from their healthcare providers. Their experiences suggests that the current approach to chronic care largely fails to meet patients’ motivation needs, leaving many of them feeling anxious about their state of health and frustrated with the quality of their care. Conclusions: In accordance with other similar studies, most of the hypertensive and diabetic patients interviewed for this study were found to be ill equipped to play an active and empowered role in self-care. It was clear that patients desire greater assistance and support from their healthcare providers. In order to enable healthcare providers in South Africa to adopt a more patient-centred approach and to better assist and motivate patients to become effective partners in their care, training, resources and tools are needed. In addition, providers need to be supported by policy and organisational change.
- ItemOpen AccessA systematic review of qualitative evidence on factors enabling and deterring uptake of HIV self-testing in Africa(2019-10-15) Njau, Bernard; Covin, Christopher; Lisasi, Esther; Damian, Damian; Mushi, Declare; Boulle, Andrew; Mathews, CatherineAbstract Background More than 40% of adults in Sub-Saharan Africa are unaware of their HIV status. HIV self-testing (HIVST) is a novel approach with a potential to increase uptake of HIV testing and linkage to care for people who test HIV positive. We explored HIV stakeholder’s perceptions about factors that enable or deter the uptake of HIV self-testing and experiences of self-testing of adult users in Africa. Methods This systematic review of qualitative evidence included articles on qualitative studies published or made available between January 1998 to February 2018 on perspectives of key stakeholders, including HIV policymakers, HIV experts, health care providers, and adult men and women (18 years and above) about factors that enable or deter the uptake of HIV self-testing and experiences of self-testing among adult users. We searched CINAHL, MEDLINE in Pubmed, EMBASE, AJOL, PsycINFO, Social Science Citation Index (SSCI), and Web of Science for articles in English on HIVST with qualitative data from different African countries. Results In total, 258 papers were retrieved, and only nine (9) studies conducted in 5 African countries were eligible and included in this synthesis. Perceived facilitators of the uptake of HIVST were autonomy and self-empowerment, privacy, confidentiality, convenience, opportunity to test, including couples HIV testing, and ease of use. The perceived barriers included the cost of buying self-test kits, perceived unreliability of test results, low literacy, fear and anxiety of a positive test result, and potential psychological and social harms. HIV stakeholder’s concerns about HIVST included human right issues, lack of linkage to care, lack of face-to-face counseling, lack of regulatory and quality assurance systems, and quality of self-test kits. Actual HIVST users expressed preference of oral-fluid self-testing because of ease of use, and that it is less invasive and painless compared to finger-stick/whole blood-based HIV tests. Lack of clear instructions on how to use self-test kits, and existing different products of HIVST increases rates of user errors. Conclusions Overcoming factors that may deter HIV testing, and HIVST, in particular, is complex and challenging, but it has important implications for HIV stakeholders, HIVST users, and public health in general. Research is warranted to explore the actual practices related to HIVST among different populations in Africa.
- ItemOpen AccessAcceptance and access : home-based HIV counselling and testing and barriers to care in rural Western Kenya(2009) Nakao, Jolene H; Mathews, CatherineHome-based HIV counselling and testing (HBCT) is a wayt to provide confidential HIV testing in a person's home. As home-based testing has not yet been evaluated on a wide scale in Kenya among adult individuals [over age 15], this project is designed to assess in rural Kenya 1) overall acceptance rates and variables that predict differential acceptance rates of home-based HIV testing, 2) reasons for refusal of home-based testing, and 3) barriers to seeking treatment for people who are HIV positive.
- ItemOpen AccessThe benefits and harms of surveying adolescents about intimate partner violence and verbal, physical and sexual abuse by Tracy McClinton Appollis.(2013) McClinton Appollis Tracy; Mathews, Catherine; Lund, CrickIncludes abstract. Includes bibliographical references.
- ItemOpen AccessChanges to the law on consent in South Africa: implications for school-based adolescent sexual and reproductive health research(BioMed Central Ltd, 2012) Zuch, Melanie; Mason-Jones, Amanda; Mathews, Catherine; Henley, LesleyBACKGROUND:The National Health Act, No 61, 2003 in South Africa is the first effort made by the government to protect health-related research participants under law. Implemented on March 1, 2012, the law mandates active consent from a parent or legal guardian for all research conducted with research participants under the age of 18 years. This paper focuses on the Act's implications for school-based adolescent sexual and reproductive health research.DISCUSSION:Although well intentioned, the added legal protections in the National Health Act may have the unintended consequence of reducing participation rates in school-based adolescent sexual and reproductive health research, thereby excluding the most at-risk students. The Act may also compromise adolescents' right to dignity and privacy, especially considering the personal nature of research on sex and sexuality. Devolved, discretionary decision-making, which empowers local human research ethics committees to permit a wider range of protective measures, including passive consent, independent adolescent consent or community consultation ought to be considered. The continued and direct involvement of young people in their sexual and reproductive health and well-being is an important principle to uphold.SUMMARY:This paper calls for a re-examination of section 71's ethical guidelines relating to informed consent in the National Health Act, No 61, 2003 in South Africa in order to better serve the interests of South African adolescents in sexual and reproductive health research.
- ItemOpen AccessCondom use and sexuality communication with adults: a study among high school students in South Africa and Tanzania(BioMed Central Ltd, 2013) Namisi, Francis; Aaro, Leif; Kaaya, Sylvia; Onya, Hans; Wubs, Annegreet; Mathews, CatherineBACKGROUND: Fostering adolescents' communication on sexuality issues with their parents and other significant adults is often assumed to be an important component of intervention programmes aimed at promoting healthy adolescent sexual practices. However, there are few studies describing the relationship between such communication and sexual practices, particularly in sub-Saharan Africa. This study examined the relationships between adolescents' communication with significant adults and their condom use in three sites in this region. METHODS: Data stem from a multi-site randomized controlled trial of a school-based HIV prevention intervention implemented in Cape Town and Mankweng, South Africa and Dar es Salaam, Tanzania. Only data from comparison schools were used. The design is therefore a prospective panel study with three waves of data collections. Data were collected in 2004 from 6,251 participants in 40 schools. Associations between adolescents' communication with adults about sexuality issues and their use of condoms were analysed cross-sectionally using analysis of variance, as well as prospectively using multiple ordinal logistic regression analysis. RESULTS: Cross-sectional analyses showed that consistent condom users had significantly higher mean scores on communication (across topics and communication partners) than both occasional users and never-users, who had the lowest scores. After controlling for condom use at the first data collection occasion in each model as well as for possible confounders, communication scores significantly predicted consistent condom use prospectively in all three ordinal logistic regression models (Model R2 = .23 to .31). CONCLUSION: The findings are consistent with the assertion that communication on sexuality issues between adolescents and significant adults results in safer sexual practices, as reflected by condom use, among in-school adolescents. The associations between communication variables and condom use might have been stronger if we had measured additional aspects of communication such as whether or not it was initiated by the adolescents themselves, the quality of advice provided by adults, and if it took place in a context of positive adult-adolescent interaction. Studies with experimental designs are needed in order to provide stronger evidence of causality.
- ItemOpen AccessThe development and evaluation of a smoking cessation programme for disadvantaged pregnant women in South Africa(2011) Everett-Murphy Katherine; Mathews, Catherine; Steyn, KriselaStudies of smoking during pregnancy in South Africa have found exceptionally high smoking rates among disadvantaged women of mixed ethnic descent (46%) (Steyn et al., 1997; Petersen et al., 2009a). As a consequence, these women are at high risk of smoking-related pregnancy complications and poor birth outcomes. It has long been recommended that a smoking cessation intervention be developed specifically for this high risk group. There is strong evidence that best practice smoking cessation interventions for pregnant women can be effective in increasing quit rates, as well as in reducing the incidence of premature birth and low birth weight (Lumley et al., 2009). However, these interventions have only been studied in developed countries and it was unknown whether such programmes could be successfully applied to a South African setting. From 2002, the Medical Research Council of SA undertook a programme of research for the purposes of developing and evaluating a smoking cessation intervention, specifically for disadvantaged pregnant women attending public-sector, antenatal clinics in Cape Town. This thesis reports on several aspects of this research.
- ItemOpen AccessEvaluating the implementation of Options for Health in the Western Cape: an intervention aimed at increasing ARV adherence and reducing sexual risk among people on ARVs in Cape Town, South Africa(2012) Dewing, Sarah; Louw, Johann; Mathews, CatherineOptions for Health is an evidence-based intervention for reducing sexual risk behaviour among people living with HIV. Options has been proposed as a feasible strategy for integrating HIV prevention with care and supporting adherence to antiretroviral treatment in the public healthcare sector in the Western Cape. To determine the feasibility of this intervention for strengthening the antiretroviral adherence counselling programme delivered by lay counsellors in Western Cape clinics.
- ItemOpen AccessAn evaluation of a provider-initiated HIV testing and counselling (PITC) intervention for patients with sexually transmitted infections in Cape Town, South Africa(2011) Leon, Natalie H; Mathews, Catherine; Lewin, SimonThe objectives of the study were to assess the impact of a PITC intervention on HIV test uptake rates and on access to HIV care, to evaluate the extent to which ethical principles were upheld in its implementation, and to examine the influence of implementation factors on the intervention.
- ItemOpen AccessAn exploration of the nature of contemporaty adolescents' intimate relationships(2013) Gevers, AnÃÂk; Flisher, Alan J; Mathews, Catherine; Jewkes, RachelIntimate relationships in adolescence play an important role in psychosocial development and can impact on relationships during adulthood. There is a need for evidence-based interventions to prevent intimate partner violence (IPV), promote sexual and reproductive health, and equitable, enjoyable relationships during adolescence. A nuanced understanding of contemporary adolescents' intimate relationships is needed to inform intervention development. A series of studies was undertaken to explore (a) contemporary adolescents' ideas about and experiences of relationships; (b) young adolescents' sexual behaviour and dating; (c) adolescents' conceptions of a good relationship; and (d) published-evidence guidelines for developing school-based violence prevention interventions. For study (a), qualitative data were collected during focus group discussions and in-depth interviews with 14-18 year olds. Survey data from 13-16 year olds (for study b) and 15-18 year olds (for study c) were analysed using regression analyses. Adolescents’ intimate relationships are fluid and unstructured, highly gendered, and greatly influenced by peer relationships; however, experience with relationships and sex are varied. For girls, good relationships were associated with having a mutual main partnership with an older, educated boyfriend in which there was good, open communication particularly about sexual and reproductive health. For boys, a mutual main partnership and very little quarrelling were associated with good relationships. Young adolescents' reported engaging in a variety of sexual behaviours ranging from kissing to sexual intercourse with the former more common than the latter. These findings indicate a need for early interventions that are carefully adapted and acceptable to adolescents who have varying levels of experience with relationships, sex, and violence. Adolescents would benefit from developing gender equitable attitudes; critically reflecting on their ideas and practices related to good and poor relationships; building sexual decision-making skills to better prepare them to develop and maintain good, healthy relationships and end poor or abusive ones. Interventions should incorporate adolescents' perspectives and balance evidence-based best practice and resource availability.
- ItemOpen AccessExploring motivation to notify and barriers to partner notification of sexually transmitted infections in South Africa(2017) Wood, Julia M; Harries, Jane; Mathews, CatherineObjectives: This article will review qualitative data from intervention-based counselling sessions to explore barriers to partner notification for men and women who have contracted sexually transmitted infections (STIs) in a township community in South Africa. It will further assess the intervention's impact on participants' motivation and skills to notify their partners about their STI status. Methods: Relying on recorded counselling sessions from an intervention run by a parent study, this substudy reviewed 30 transcripts from enhanced counselling sessions with 15 men and 15 women. Participants were adults between the ages of 19-41 (mean age = 28.4) who live within the catchment area of a South African township. Recordings were chosen based on verbal responsiveness of the participant and were manually coded for analysis. In addition, two programme counsellors were interviewed to enhance rigour and to reduce potential bias. Results: By the conclusion of the intervention session, both male and female participants were motivated to notify their partners face-to-face about their positive STI status. Despite this, misperceptions about the etiology and transmission of STIs, as well as inadequate support from the clinical level and power imbalances amongst men and women emerged as major barriers for the prevention of future STIs. Conclusions: While the intervention appears to be successful in facilitating partners' intentions to notify, the data shows significant social and structural barriers that will create difficulties for the prevention of future STIs. Participants' persistent concerns about acquiring HIV or their current positive status affect decision-making and therefore, could be a window of opportunity for health-care providers or lay counsellors to discuss STIs in high prevalence areas.
- ItemOpen AccessExploring motivation to notify and barriers to partner notification of sexually transmitted infections in South Africa: a qualitative study(BioMed Central, 2018-08-06) Wood, Julia M; Harries, Jane; Kalichman, Moira; Kalichman, Seth; Nkoko, Koena; Mathews, CatherineBackground This article will review qualitative data from intervention-based counselling sessions to explore barriers to partner notification (PN) for South African men and women who have contracted sexually transmitted infections (STIs). This qualitative study took place in a township where there is high STI and HIV prevalence. In addition to reviewing barriers to PN, the study will also identify participants’ perceptions about effective PN strategies that are presented during the intervention. Ultimately, the study will assess the intervention’s impact on participants’ motivation and skills to notify their partners about their STI status. Methods Relying on recorded counselling sessions from an intervention run by a parent study, this sub- study reviewed 30 transcripts from counselling sessions with 15 men and 15 women. The intervention was a 60 min interactive session where STI and HIV education, risk mitigation, and effective PN strategies were discussed. Participants were between 19 and 41 years old (mean age = 28.4) and lived within the catchment area of a South African township. Recordings were chosen based on verbal responsiveness of the participant and were manually coded for analysis. In addition, two programme counsellors were interviewed about their perceptions of the intervention and their experiences with participants to enhance rigour and reduce potential bias. Results By the conclusion of the intervention session, both male and female participants were motivated to notify their partners face-to-face about their positive STI status. Despite this, misperceptions about the etiology and transmission of STIs, as well as inadequate support from the clinical level and power imbalances amongst men and women emerged as major barriers for the prevention of future STIs. Conclusions While the intervention appears to be successful in facilitating partners’ intentions to notify, the data shows significant social and structural barriers that will create difficulties for the prevention of future STIs. Participants’ persistent concerns about acquiring HIV or their current positive status affect decision-making and therefore, could be a window of opportunity for health-care providers or lay counsellors to discuss STIs in high prevalence areas.
- ItemOpen AccessFactors affecting men’s support for the use of the contraceptive implant by their female intimate partners(2020-11-23) Jonas, Kim; Kalichman, Moira; Kalichman, Seth; Morroni, Chelsea; Mathews, CatherineAbstract Background Family planning services have been available at no cost in the public health settings of South Africa since 1994, and now include the long-acting reversible contraceptives (LARCs) namely, the contraceptive implant and intra-uterine device (IUD). However, the uptake of LARCs has been declining in the recent years and little is known about the cause of the decline. In many relationships, men may influence their female intimate partner’s contraceptive choices. Thus, men’s involvement in reproductive health decisions and family programming may improve their support for contraceptive use, including the LARC use by their female intimate partners. This study investigated factors affecting men’s support for the use of contraceptive implant by their female intimate partners. Methods A quantitative, cross-sectional survey was conducted among adult men attending a public, primary health clinic in Cape Town, South Africa. Using a structured questionnaire, we measured men’s knowledge, awareness and support of, and attitudes towards use of the contraceptive implant by their female intimate partners. Data were analyzed using SPSS version 25. Results The sample included 65 men with a mean age of 31.2 years. Most (76.6%) believed that both men and women should be responsible for family planning. Support for general contraception use by their female intimate partners was prevalent at 80.0%, but only 33.9% reported that they would like their partners to use the implant in the future, while 35.6% were unsure and 30.5% did not support their partner’s use of the implant. Factors significantly associated with men’s support of their partner’s future use of the contraceptive implant included men’s reports that their partner wished to have another child in future, knowledge that the implant is safe for use by women who have not had children, knowledge that the implant can effectively prevent pregnancy for 3 years, and a positive attitude towards the implant’s long-lasting effectiveness. Conclusion Improving men’s knowledge of, and attitudes toward the contraceptive implant might increase their support for their partner’s use of the implant, which in turn might promote uptake of the implant among women. The findings of our study suggest the importance of actively engaging men in reproductive health and family planning programs.
- ItemOpen AccessFactors influencing adolescent girls and young women’s participation in a combination HIV prevention intervention in South Africa(2021-02-27) McClinton Appollis, Tracy; Duby, Zoe; Jonas, Kim; Dietrich, Janan; Maruping, Kealeboga; Abdullah, Fareed; Slingers, Nevilene; Mathews, CatherineBackground For interventions to reach those they are intended for, an understanding of the factors that influence their participation, as well as the facilitators and barriers of participation are needed. This study explores factors associated with participation in a combination HIV prevention intervention targeting adolescent girls and young women (AGYW) aged 15–24-years-old, as well as the perspectives of AGYW, intervention implementers, and facilitators who participated in this intervention. Methods This study used mixed-methods approach with quantitative household survey data from 4399 AGYW aged 15–24-years-old in six of the ten districts in which the intervention was implemented. In addition, qualitative methods included a total of 100 semi-structured in-depth interviews and 21 focus group discussions in five of the ten intervention districts with 185 AGYW who participated in one or more of the key components of the intervention, and 13 intervention implementers and 13 facilitators. Thematic analysis was used to explore the perspectives of participating and implementing the intervention. Results Findings reveal that almost half of AGYW (48.4%) living in the districts where the intervention took place, participated in at least one of the components of the intervention. For both 15–19-year-olds and 20–24-year-olds, factors associated with increased participation in the intervention included being HIV negative, in school, never been pregnant, and having had a boyfriend. Experiencing intimate partner violence (IPV) and/or sexual violence in the past 12 months was associated with increased levels of participation in the intervention for 20–24-year-olds only. In our analysis of the qualitative data, facilitators to participation included motivating participants to join the interventions through explaining the benefits of the programme. Barriers included misguided expectations about financial rewards or job opportunities; competing responsibilities, interests or activities; family responsibilities including childcare; inappropriate incentives; inability to disrupt the school curriculum and difficulties with conducting interventions after school hours due to safety concerns; miscommunication about meetings; as well as struggles to reach out-of-school AGYW. Conclusion Designers of combination HIV prevention interventions need to address the barriers to participation so that AGYW can attend without risking their safety and compromising their family, childcare and schooling responsibilities. Strategies to create demand need to include clear communication about the nature and potential benefits of such interventions, and the inclusion of valued incentives.
- ItemOpen AccessFactors that influence adolescents condom use decision-making in the Western Cape, South Africa(2019) Davids, Eugene Lee; Swartz, Alison; Mathews, CatherineThis study explores factors that influence condom use decision-making of adolescents from two schools in the Western Cape, South Africa. Thematic analysis was used to analyse the data generated from 16 individual semi-structured interviews. When exploring the factors that influence adolescent’s condom use decision-making, sexual debut and the role that emotion plays in the decision-making process were frequently discussed. The themes which emerged for sexual debut included relationships were about displaying true love which was equated with having sex and respecting parents’ expectations and rules informing decisions not to have sex at this age. When exploring the themes which emerged for condom use decision-making, the adolescents spoke about their concerns for the future and organising their lives. In addition, anticipated fear about falling pregnant, becoming parents and being infected with a disease emerged when exploring adolescent condom use decision-making. Understanding adolescent condom use can assist in aligning sexual and reproductive health (SRH) interventions and supporting healthy SRH decision-making and healthy relationships for adolescents.
- ItemOpen AccessThe failure of routine rapid HIV testing: a case study of improving low sensitivity in the field(BioMed Central Ltd, 2010) Wolpaw, Benjamin; Mathews, Catherine; Chopra, Mickey; Hardie, Diana; de Azevedo, Virginia; Jennings, Karen; Lurie, MarkBACKGROUND:The rapid HIV antibody test is the diagnostic tool of choice in low and middle-income countries. Previous evidence suggests that rapid HIV diagnostic tests may underperform in the field, failing to detect a substantial number of infections. A research study inadvertently discovered that a clinic rapid HIV testing process was failing to detect cases of established (high antibody titer) infection, exhibiting an estimated 68.7% sensitivity (95% CI [41.3%-89.0%]) over the course of the first three weeks of observation. The setting is a public service clinic that provides STI diagnosis and treatment in an impoverished, peri-urban community outside of Cape Town, South Africa. METHODS: The researchers and local health administrators collaborated to investigate the cause of the poor test performance and make necessary corrections. The clinic changed the brand of rapid test being used and later introduced quality improvement measures. Observations were made of the clinic staff as they administered rapid HIV tests to real patients. Estimated testing sensitivity was calculated as the number of rapid HIV test positive individuals detected by the clinic divided by this number plus the number of PCR positive, highly reactive 3rd generation ELISA patients identified among those who were rapid test negative at the clinic. RESULTS: In the period of five months after the clinic made the switch of rapid HIV tests, estimated sensitivity improved to 93.5% (95% CI [86.5%-97.6%]), during which time observations of counselors administering tests at the clinic found poor adherence to the recommended testing protocol. Quality improvement measures were implemented and estimated sensitivity rose to 95.1% (95% CI [83.5%-99.4%]) during the final two months of full observation. CONCLUSIONS: Poor testing procedure in the field can lead to exceedingly low levels of rapid HIV test sensitivity, making it imperative that stringent quality control measures are implemented where they do not already exist. Certain brands of rapid-testing kits may perform better than others when faced with sub-optimal use.
- ItemOpen AccessFeasibility of an HIV self-testing intervention: a formative qualitative study among individuals, community leaders, and HIV testing experts in northern Tanzania(2020-04-15) Njau, Bernard; Lisasi, Esther; Damian, Damian J; Mushi, Declare L; Boulle, Andrew; Mathews, CatherineBackground Achieving the 95–95-95 global targets by 2030, innovative HIV testing models, such as HIV self-testing are needed for people, who are unaware of their HIV status. We aimed to explore key informants, mountain climbing porters, and female bar workers’ attitudes, perceived norms, and personal agency related to HIV self-testing. Methods This was a formative qualitative study to inform the design of an HIV self-testing intervention in Northern Tanzania. Informed by the Integrated Behaviour Model, we conducted four focus group discussions, and 18 in-depth interviews with purposively selected participants. Data were analyzed using the framework method. Results We recruited 55 participants. Most participants had positive attitudes towards HIVST, in that they anticipated positive consequences related to the introduction and uptake of HIVST. These included privacy and convenience, avoidance of long queues at health facilities, reduced counselor workload, and reduced indirect costs (given that transport to health facilities might not be required). Participants expressed the belief that significant people in their social environment, such as parents and peers, would approve their uptake of HIVST, and that they would accept HIVST. Additionally, features of HIVST that might facilitate its uptake were that it could be performed in private and would obviate visits to health facilities. Most participants were confident in their capacity to use HIVST kits, while a few were less confident about self-testing while alone. Strategies to maximize beliefs about personal agency and facilitate uptake included supplying the self-test kits in a way that was easy to access, and advocacy. Perceived potential constraints to the uptake of HIVST were the cost of buying the self-test kits, poverty, illiteracy, poor eyesight, fear of knowing one’s HIV status, lack of policy/ guidelines for HIVST, and the absence of strategies for linkage to HIV care, treatment, and support. Conclusions The findings suggest that HIVST may be feasible to implement in this study setting, with the majority of participants reporting positive attitudes, supportive perceived norms, and self-efficacy. Hence, future HIVST interventions should address the negative beliefs, and perceived barriers towards HIVST to increase HIV testing among the target population in Northern Tanzania.
- ItemOpen AccessThe impact of provider-initiated (opt-out) HIV testing and counseling of patients with sexually transmitted infection in Cape Town, South Africa: a controlled trial(BioMed Central Ltd, 2010) Leon, Natalie; Naidoo, Pren; Mathews, Catherine; Lewin, Simon; Lombard, CarlBACKGROUND:The effectiveness of provider-initiated HIV testing and counseling (PITC) for patients with sexually transmitted infection (STI) in resource-constrained settings are of particular concern for high HIV prevalence countries like South Africa. This study evaluated whether the PITC approach increased HIV testing amongst patients with a new episode of sexually transmitted infection, as compared to standard voluntary counseling and testing (VCT) at the primary care level in South Africa, a high prevalence and low resource setting. METHODS: The design was a pragmatic cluster-controlled trial with seven intervention and 14 control clinics in Cape Town. Nurses in intervention clinics integrated PITC into standard HIV care with few additional resources, whilst lay counselors continued with the VCT approach in control clinics. Routine data were collected for a six-month period following the intervention in 2007, on new STI patients who were offered and who accepted HIV testing. The main outcome measure was the proportion of new STI patients tested for HIV, with secondary outcomes being the proportions who were offered and who declined the HIV test. RESULTS: A significantly higher proportion of new STI patients in the intervention group tested for HIV as compared to the control group with (56.4% intervention versus 42.6% control, p = 0.037). This increase was achieved despite a significantly higher proportion intervention group declining testing when offered (26.7% intervention versus 13.5% control, p = 0.0086). Patients were more likely to be offered HIV testing in intervention clinics, where providers offered the HIV test to 76.8% of new STI patients versus 50.9% in the control group (p = 0.0029). There was significantly less variation in the main outcomes across the intervention clinics, suggesting that the intervention also facilitated more consistent performance. CONCLUSIONS: PITC was successful in three ways: it increased the proportion of new STI patients tested for HIV; it increased the proportion of new STI patients offered HIV testing; and it delivered more consistent performance across clinics. Recommendations are made for increasing the impact and feasibility of PITC in high HIV prevalence and resource-constrained settings. These include more flexible use of clinical and lay staff, and combining PITC with VCT and other community-based approaches to HIV testing.TRIAL REGISTRATION:Controlled trial ISRCTN93692532