1 / 20

Acceptability of early initiation of antiretrovirals for treatment as prevention among HIV-infected persons in Mochud

Acceptability of early initiation of antiretrovirals for treatment as prevention among HIV-infected persons in Mochudi , Botswana.

jerome
Download Presentation

Acceptability of early initiation of antiretrovirals for treatment as prevention among HIV-infected persons in Mochud

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Acceptability of early initiation of antiretrovirals for treatment as prevention among HIV-infected persons in Mochudi, Botswana Andrew Logan, PhD; Rebeca Plank, MD, MPH; Laura M. Bogart, PhD; KeamogetsweMoloi; KhumoyameMaotonyane; Hermann Bussmann, MD, PhD; Lillian Okui, MD, MPH; Felton Earls, MD; Max Essex, DVM, PhD; ShahinLockman, MD, MSc

  2. Botswana –Adult HIV seroprevalence23.4% • 9,000 new infections annually • Early antiretroviral therapy (ART) may: • Improve outcomes in HIV-infected • Decrease risk of HIV transmission • However, 20% of ART-eligible patients (CD4<200 cells/mm3 or WHO Stage 4) in South Africa declined ART (Katz, AIDS, 2011) • Key unanswered question: • “Will HIV-infected persons with relatively high CD4 cell count (≥ 350 cells/mm3) want to initiate therapy?” Background

  3. Background: The ‘Mochudi Prevention Pilot Project’: Community-Wide HIV Testing with Viral-Load-Driven TasP

  4. Background: The ‘Mochudi Prevention Pilot Project’: Community-Wide HIV Testing with Viral-Load-Driven TasP • Community-based study providing package of HIV prevention interventions to 16–64-year-olds in a rural village, Mochudi, in southern Botswana (adult HIV prevalence 25%) • Core components: • Annual door-to-door HIV testing • Identification of individualswith CD4≥350 cells/mm3 and viral load ≥50,000 cp/mL (TasP) • Eligible for ART under study protocol

  5. Objectives and Design of Qualitative Substudy • To use qualitative methods to identify barriers and facilitators to uptake of TasP in the Mochudi Prevention Pilot Project • All participants eligible for TasP (ART-naïve adult residents with CD4≥350 cells/mm3 and viral load ≥50,000 copies/mL, excluding PMTCT) were asked to take part: • Individual in-depth interview • Focus group discussion (FGD) • Study period: July 2012 - January 2013 – 12 were eligible

  6. Methods • 12 Individual Interviews: To explore intention to initiate ART • 9 women (24-57 years, mean 37), 3 men (35-64 years, mean 46) • 2 Focus Group Discussions (FGDs): To explore intention to initiate ART, separated by gender • 6 women and 2 men • Conducted in Setswana by a trained counselor • Based on semi-structured interview guides • Audio recorded, transcribed and translated into English.

  7. Definition of Behavior Action – ‘Taking ART’ Target – ‘Before CD4<350 cells/mm3 or AIDS’ • Specifically with TasP as aim Context – ‘within the expanded program’ Time period – ‘within 30 days’

  8. An Integrated Model of Behavioral Prediction Background Influences Distal variables Demographics Culture Attitudes towards them (stigma, stereotypes) Personality and Emotions Other Individual variables (perceived risk, sensation-seeking) Exposure to media and other interventions Behavioral beliefs and Outcome evaluation Attitude Skills Injunctive and Descriptive Normative beliefs Perceived Norms Intention Behavior Environmental Constraints Self-Efficacy Efficacy Beliefs Fishbein and Yzer, Communication Theory (2003)

  9. Data Analysis • Manual coding to identify data features • Coded iteratively/independently by 2investigators • Discrepancies resolved through discussion and consensus • Thematic analysis to identify and arrange emerging categories according to the Integrated Model of Behavioral Prediction

  10. Results: Attitudes • “There was one at our work, and it was known that she had this disease. Then I saw people scorned her... the others no longer used the toilet that she used. They changed toiletsand told her to go to that one... It is still like that” Female, 51yrs • “Oh, the virus these days, I see it as a disease like everything else. It is the same as just being sick with diabetes. It is no longer feared today” Female, 31yrs Barriers to ART/TasP: • Fear of stigma* • Fear of disclosure/shame • Side effects • Cannot be stopped • Cannot takewith alcoholor traditional medicine Facilitators of ART/TasP: • Perception of HIV as a disease like any other* • Improvement in health • Knowing someone non-adherent who died

  11. Injunctive Norms • “In my own family, I see it with my sister, it entered, then we were separated in the home. ‘Hey this person has a disease’... then you find you are given insults… It means that we made a mistake and it was better that some did not know what had happened” Female, 51yrs • “They would be happy. Isn’t it they don’t want to see me sick, because they know that this disease belittles people right?” Female, 57yrs Barriers to ART/TasP: • Knowing someone on ART - discriminated against * • Fear of disapproval - church, traditional healers Facilitators of ART/TasP: • Approval of ART - churches • Support to start ART* • Knowing someone on ART - adherent

  12. Descriptive Norms Barriers to ART/TasP: • Avoidance of local ART collection sites • Alcohol use affecting ART adherence* • Non-adherence of those on ART as health improves Facilitators of ART/TasP: • Knowing someone on ART • Side effects are short-term • Improvement to health* • “He (partner) drinks (takes) them (ART). He didn’t drink (takes) them well... he is a drunkard... he will be gone and the time will come and he doesn’t drink them (ART)” • Female, 30yrs • “You see that a person will not now be sick day after day, and they walk… they work… they were a patient who was sleeping in blankets” • Male, 61yrs

  13. Self Efficacy • “It is very difficult, I don’t know if I will manage… I am not used to it... And to forget them… I am not used to drinking tablets” • Female, 30yrs • “There is nothing that would prevent me… I am talking about my health” • Female, 57yrs Barriers to ART/TasP: • Fear of non-adherence* • Distance to travel for ART Facilitators of ART/TasP: • Personal health* • Ability to work • Prolonging life

  14. Skills • “I was able to forget them, you know that you are not used to it when you are doing it, you find that forgetting happens often” • Female, 36yrs • “They gave me the tablets of IPT to stop the big cough (TB) for six months and I drank them” • Female, 51yrs Barriers to ART/TasP: • Side effects on ART • Fear of non-adherence* Facilitators of ART/TasP: • Previously taking tablets for TB or PMTCT* • Coping strategies for traveland forgetfulness

  15. Environment • “Now if there is a hospital, being a hospital for everything, we know that all go to that hospital. But when you go to the hospital you know that you are given tablets that are for you (HIV+)” • Male, 38yrs • “I was able to enter the programs at clinic where we were taught about suppressants” • Female, 31yrs Barriers to ART/TasP: • Distance to travel for ART • Stigma at clinic, hospital* Facilitators of ART/TasP: • Media • HIV/ART lessons at clinics* • ART availability

  16. Intentions specific to TasP • Baseline knowledge of TasP was limited • Once information was provided, all participants stated prevention of transmission to partner would be a motivator for ART initiation

  17. Limitations • Constraints of the larger study protocol • Small sample size • Due to changes in CD4 ART initiation threshold in National Program • Disease progression to treatment eligibility • Findings may not be generalizable toprogrammatic settings which are influenced by provider and delivery systems

  18. Conclusions • Importance of community sensitization of ART as TasP • Stigma and shame were key barriers to uptake “I would say to people that they should stop being ashamed, but stand on their feet, and fight this disease. Everybody must stand up and fight this disease so that it finishes. We should take suppressants… the virus will reduce, and its spread. We should all be of the same mind” Female, 57yrs

  19. Future Directions Need to capitalize on identified determinants of behavior to successfully implement TasP Next steps: • Develop and test quantitative survey in persons offered TasP in Botswana • Measure predictors associated with TasP initiation and retention in treatment • Design and test interventions to improve TasP uptake

  20. Acknowledgements Funding Fogarty AITRP, NIAID R01AI083036 Sub-Study Principal Investigators • DrRebeca Plank • DrShahinLockman Harvard School of Public Health • Dr Max Essex • Dr Felton Earls Harvard School of Medicine • DrLaura Bogart Botswana-Harvard Partnership • Dr Hermann Bussmann • Dr Lillian Okui • KhumoyameMaotonyane • KeamogetsweMoloi • Mochudi Prevention Project Team

More Related