Knowledge of HIV status is associated with a decrease in the severity of depressive symptoms among female sex workers in Uganda and Zambia

Wed, 16 Oct 2019 00:00:00 GMT-05:00 - Ortblad, Katrina F.; Musoke, Daniel Kibuuka; Chanda, Michael M.; Ngabirano, Thomson; Velloza, Jennifer; Haberer, Jessica E.; McConnell, Margaret; Oldenburg, Catherine E.; Bärnighausen, Till
ÅéóáãùãÞ: Knowledge of HIV-positive status may result in depressive symptoms, which may be a concern to scaling novel HIV testing interventions that move testing outside the health system and away from counselor support. Setting: Uganda and Zambia.
ÌÝèïäïé: We used longitudinal data from two female sex worker (FSW) cohorts in Uganda (n=960) and Zambia (n=965). Over four-months participants had ample opportunity to HIV test using standard-of-care services or self-tests. At baseline and four months, we measured participants’ perceived knowledge of HIV status, severity of depressive symptoms (continuous PHQ-9 scale, 0-27 points), and prevalence of likely depression (PHQ-9 scores ≥10). We estimated associations using individual fixed effects estimation.
ÁðïôåëÝóìáôá: Compared to unknown HIV status, knowledge of HIV-negative status was significantly associated with a decrease in depressive symptoms of 1.06 point in Uganda (95%CI -1.79, -0.34) and 1.68 points in Zambia (95%CI -2.70, -0.62). Knowledge of HIV-positive status was significantly associated with a decrease in depressive symptoms of 1.01 points in Uganda (95%CI -1.82, -0.20) and 1.98 points in Zambia (95%CI -3.09, -0.88). The prevalence of likely depression was not associated with knowledge of HIV status in Uganda, but was associated with a 14.1% decrease with knowledge of HIV-negative status (95%CI -22.1%, -6.0%) and 14.3% decrease with knowledge of HIV-positive status (95%CI -23.9%, -4.5%) in Zambia.
ÓõìðåñÜóìáôá: Knowledge of HIV status, be it positive or negative, was significantly associated with a decrease in depressive symptoms in two FSW populations. The expansion of HIV testing programs may have mental health benefits for FSWs. Contact details of the corresponding author: Katrina F. Ortblad, ScD, MPH International Clinical Research Center, University of Washington, Department of Global Health 908 Jefferson St, Seattle, WA 98104 katort@uw.edu; +1-206-265-1856 Conflicts of interest: The authors declare no conflicts of interest. Conferences: Ortblad K, Kibuuka Musoke D, Chanda M, Ngabirano T, Velloza J, McConnell M, Oldenburg C, Bärnighausen T. Knowledge of HIV status decreases depressive symptoms among female sex workers. Conference on Retroviruses and Opportunistic Infections 2019. Seattle, WA. Sources of Support: International initiative for impact evaluation (3ie). This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - © 2019

Reducing provider workload while preserving patient safety: a randomized control trial using 2-way texting for post-operative follow-up in Zimbabwe’s voluntary medical male circumcision program

Wed, 16 Oct 2019 00:00:00 GMT-05:00 - Feldacker, Caryl; Murenje, Vernon; Holeman, Isaac; Xaba, Sinokuthemba; Makunike-Chikwinya, Batsirai; Korir, Michael; Gundidza, Patricia Tapiwa; Holec, Marrianne; Barnhart, Scott; Tshimanga, Mufuta
ÅéóáãùãÞ: Voluntary medical male circumcisions (MC) is safe: the vast majority of men heal without complication. However, guidelines require multiple follow-up visits. In Zimbabwe, where high mobile phone ownership, severe healthcare worker shortages, and rapid MC scale up intersect, we tested a two-way texting (2wT) intervention to reduce provider workload while safeguarding patient safety. Setting: Two high-volume facilities providing MC near Harare, Zimbabwe.
ÌÝèïäïé: A prospective, un-blinded, non-inferiority, randomized control trial of 722 adult MC clients with cell phones randomized 1:1. 2wT clients (n=362) responded to a daily text with in-person follow-up only if desired or an AE suspected. The control group (n=359) received routine in-person visits. All men were asked to return on post-operative day 14 for review. Adverse events ≤ day 14 visit and number of in-person visits were compared between groups.
ÁðïôåëÝóìáôá: Cumulative AEs were identified in 0.84% (%% CI: 0.28,2.43) among routine care men as compared to 1.88% (95% CI: 0.86, 4.03) of 2wT participants. Non-inferiority cannot be ruled out (95% CI: -∞, +2.72); however, AE rates did not differ between groups (p=0.32). 2wT men attended an average of 0.30 visits as compared to 1.69 visits among routine care men, a significant reduction (p<0.001).
ÓõìðÝñáóìá: Although non-inferiority cannot be demonstrated, increased AEs in the 2wT arm likely reflect improved AE ascertainment. 2wT serves as a proxy for active surveillance, improving the quality of MC patient care. 2wT also reduced provider workload. 2wT provides an option for men to heal safely at home, returning to care when desired or if complications arise. 2wT should be further tested to enable widespread scale-up. Corresponding author: Caryl Feldacker, Box 359932, University of Washington, Seattle, WA 98104-3508 USA, cfeld@uw.edu Competing interests: The authors declare no competing interests Email addresses of all authors: Caryl Feldacker: cfeld@uw.edu Vernon Murenje: vmurenje@itech-zimbabwe.org Isaac Holeman: iholeman@uw.edu Sinokuthemba Xaba: xabasino@gmail.com Batsirai Makunike: bmakunike@itech-zimbabwe.org Michael Korir: korir@medicmobile.org Patricia Tapiwa Gundidza: ptgundidza@gmail.com Marrianne M Holec: mmholec@uw.edu Scott Barnhart: sbht@uw.edu Mufuta Tshimanga: tshimangamufuta@gmail.com Funding: Research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health under Award Number R21TW010583. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. - © 2019