Using a quality improvement approach in the prevention of mother-to-child HIV transmission program in Uganda improves key outcomes and is sustainable in demonstration facilities: Partnership for HIV-Free Survival

Mon, 13 Jan 2020 00:00:00 GMT-06:00 - Flax, Valerie L.; Kasasa, Simon; Ssendagire, Steven; Lane, Charlotte; Atuyambe, Lynn; Lance, Peter M.; Ssengooba, Freddie; Draru, Joyce; Bobrow, Emily A.
Εισαγωγή: The Partnership for HIV-Free Survival (PHFS) in Uganda used a quality improvement (QI) approach to integrate the prevention of mother-to-child transmission (MTCT) of HIV, maternal and child health, and nutrition services, with the goal of increasing the retention of mother-baby pairs in care and decreasing vertical transmission of HIV.
Μέθοδοι: This evaluation of PHFS used a retrospective longitudinal design to assess the program’s association with four outcomes. Data were extracted from patient records from 2011 (before the program) to 2018 (after the program) at 18 demonstration, 18 scale-up, and 24 comparison facilities. Difference-in-differences analyses were conducted with significance set at p<0.15 during and p>0.15 or a continued improvement after PHFS.
Αποτελέσματα: PHFS was associated with an increase in exclusive breastfeeding (EBF) (p=0.08), 12-month retention in care (p<0.001), and completeness of child 18-month HIV test results (p=0.13) at demonstration facilities during program implementation. MTCT at 18 months decreased but did not differ between groups. Increases in EBF (p=0.67) and retention in care (p=0.16) were sustained, and data completeness (p=0.10) continued to increase at demonstration facilities after the program. PHFS was associated with an increase in EBF (p<0.001) at scale-up facilities, but there was no difference between groups for retention in care, MTCT, or data completeness. Gains in EBF were lost (p=0.08) and retention in care declined (p<0.001) at scale-up facilities after the program.
Συμπέρασμα: PHFS’ QI approach increased EBF, retention in care, and data completeness during the program. These benefits were sustained at demonstration but not at scale-up facilities. Correspondence to: Valerie Flax, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709, +1-919-990-8481, vflax@rti.org The authors report no conflicts of interest related to this work. Funding: This publication was produced with the support of the United States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AID-OAA-L-14-00004. MEASURE Evaluation is implemented by the Carolina Population Center, University of North Carolina at Chapel Hill in partnership with ICF International; John Snow, Inc.; Management Sciences for Health; Palladium; and Tulane University. Views expressed are not necessarily those of USAID or the United States government. Presentation of findings: Parts of these findings were presented at a dissemination meeting held by MEASURE Evaluation and Makerere University in Kampala, Uganda on May 30, 2019 and at USAID in Washington, DC, USA on July 2, 2019. - Β© 2020

Estimated Number of Men who have Sex with Men with Indications for HIV Pre-Exposure Prophylaxis in a National Sexual Network Study

Mon, 13 Jan 2020 00:00:00 GMT-06:00 - Weiss, Kevin M.; Prasad, Pragati; Ramaraju, Ramya; Zlotorzynska, Maria; Jenness, Samuel M.
Εισαγωγή: A 2015 CDC analysis estimated that 24.7% of sexually active men who have sex with men (MSM) had indications for HIV preexposure prophylaxis (PrEP) based on 2014 US Public Health Service (USPHS) clinical practice guidelines. Given that the USPHS revised these guidelines in 2017, updated estimates of the fraction of MSM indicated for PrEP overall and stratified by demographic factors and geography are needed to scale-up PrEP for MSM in the US.
Μέθοδοι: We conducted a national web-based study of 4904 MSM aged 15–65 who had ever had sex with another man between July 2017 and January 2019. We estimated the percentage of HIV-negative, sexually active MSM meeting USPHS indications for PrEP by demographic category.
Αποτελέσματα: Of 3511 sexually active, HIV-negative MSM, 34.0% (95% CI: 32.4, 35.6) met USPHS indications for PrEP, with percentages consistent across US census region and varying slightly by race/ethnicity (Black: 32.2%, White: 33.7%, Hispanic: 36.4%, Other: 33.6%). Among individuals meeting USPHS PrEP indications, 93.5% reported condomless anal intercourse in the prior 6 months. Among all survey respondents, PrEP eligibility was lowest among non-Hispanic black (18.4%) and younger respondents (15-17: 4.1%; 18-24: 18.1%).
Συμπεράσματα: Estimated percentages of MSM meeting indications for PrEP exceeded the previous CDC estimate across race/ethnicity, age, and census regions, with one-third of adult, sexually active, HIV-negative MSM exhibiting indications for PrEP. This study suggests, given current guidelines for PrEP indications, that a different fraction of eligible MSM could be receiving PrEP than previously estimated. Corresponding Author: Emory University, 1520 Clifton Road, Atlanta, GA 30322. samuel.m.jenness@emory.edu. Conflicts of Interest: The authors declare no conflicts of interest. Funding: This work was supported by National Institutes of Health grants R21 MH112449 and R01 AI138783, and a grant from the MAC AIDS Fund. - Β© 2020